School Re-Entry of Adolescent Patients Discharged from Psychiatric Hospital: One Step in Continuous Quality Improvement

Objective: School re-entry following hospitalization for psychiatric care has been reported as difficult for many adolescent patients. Continuous quality improvement initiatives may improve programming to enhance school re-entry experiences. The purpose of this study was to explore the school re-entry perspectives of the youth discharged from a psychiatric inpatient unit after implementing programs that patients previously identified as needed. Methods: A survey was administered to the youth about one month after discharge to gather their perspective of their school re-entry, along with self-rated resilience and stress. Results: Twenty-six youth (23%) participated in the post-discharge survey who reported a mean age of 15.6 years (SD 1.0), 77% identified as female, 13 (50%) provided very positive re-entry comments, eight (31%) reported moderately positive experiences, and five (19%) reported a very poor school re-entry. Mean perceived resilience (4.01, SD 0.6) and stress (3.42, SD 0.8) scores suggest youth thought they had good resilience and moderate stress. Conclusions: Most youth reported a good school re-entry. Considerable concerns remain for the 19% who reported a poor school re-entry who may benefit from specialized outpatient or day programming post-discharge before attempting a return to school. Future directions for research are provided.

Evaluating Potential Iatrogenic Effects of a Suicide-Focused Research Protocol

Background: Concerns regarding the potential iatrogenic effects of suicide assessment have long impeded suicide research. Aims: We sought to examine the effects of an intensive, suicide-focused assessment protocol on mood, suicidality, and urges to harm oneself or others. Method: Participants were adults admitted to a psychiatric inpatient unit for recent suicidal ideation or behavior, or reasons unrelated to suicide. Our study protocol included clinical interviews evaluating suicide history and laboratory tasks with suicide-related stimuli. We modified an existing measure to create a brief, 6-item interview, the Assessment Session Check-In, which was administered before and after research procedures. Results: These indicated overall reductions in distress, suicidal intent, and urges to harm oneself or others from preassessment to postassessment. Postassessment reductions in stress predicted lower likelihood of a suicide attempt at follow-up. Limitations: Although beneficial to examine a high-risk sample, it is possible that an intensive suicide-focused protocol could prove more problematic for those with lower baseline levels of negative affect and suicidal thoughts. Conclusions: Results challenge the belief that assessing suicide elevates distress or suicidality, even among a high-risk sample of adults admitted to a psychiatric inpatient unit.

The experience of parents faced with the admission of their adolescent to a child and adolescent psychiatric inpatient unit. A qualitative study with focus groups

The admission of an adolescent to a child and adolescent psychiatric inpatient unit has a serious impact on the entire family unit. The emotional experience of those primary caregivers has been scarcely studied qualitatively despite being recommended by previous research. This study aims to examine the experience of parents of adolescents with mental health needs that required psychiatric hospitalization in a child and adolescent unit. Qualitative cross-sectional research was carried out under the recommendations of Grounded Theory with three Focus Groups of parents (N = 22) of adolescents who required psychiatric hospitalization in a child and adolescent ward. The COREQ quality criteria were applied. The parental experience implies a high level of emotional suffering modulated by feelings of guilt, stigma, parental awareness of their child’s illness and the passage of time. The use of Prochaska’s and Diclemente’s trans-theoretical model of health behavior change is useful in understanding the parental experience.