Handbook of Evidence-Based Day Treatment Programs for Children and Adolescents

Description

This book examines the intermediate level of mental health services with a focus on partial hospitalization program (PHP) and intensive outpatient program (IOP) models of care for youth. It reviews the history of PHPs and IOPs and highlights their current care models, demonstrating the increase in the development and implementation of evidence-based treatment (EBT) practices. The book explores issues relating to program development, implementation, and considerations for sustainability. It provides interventions designed to enhance the well-being of youth who are experiencing a range of mental health concerns as well as strategies to engage and involve their families. In addition, the book offers feasible strategies for measuring outcomes and applying these results to meaningful clinical evaluations in PHP and IOP settings. It describes the process of accessing and using these intermediate services as well as additional treatment resources that may be necessary in the continuum of mental health care for youth. Key areas of coverage include: The history and purpose of mental health care and the role of day treatment programs for youth.Working with program administration and other stakeholders, identifying a patient population, and engaging community and referral sources.The importance of family involvement, coordination of care, and simultaneously addressing the transactional relationship between physical and mental health.Transitioning youth from pediatric mental health services into the adult mental health system.Working with a diverse patient population in intermediate treatment programs.Providing practical information for families and practitioners navigating the pediatric mental health continuum of care. The Handbook of Evidence-Based Day Treatment Programs for Children and Adolescents is a must-have resource for researchers, professors, and graduate students as well as clinicians, therapists, course instructors, and other professionals in child and adolescent psychiatry, clinical child and school psychology, social work, counseling, public health, family studies, developmental psychology, pediatrics, and all related disciplines. Preface Acknowledgments Contents About the Editors Contributors Part I: Building Blocks of Day Treatment Programs 1: Introduction and Overview of Day Treatment Programs What Are Day Treatment Programs? Handbook Overview Part I: Building Blocks of Day Treatment Programs Part II: Partial Hospitalization Programs (PHPs) Part III: Intensive Outpatient Programs (IOPs) Part IV: Programs of Special Interest Part V: Special Topics on Service Utilization and Follow-Up Care Conclusion References 2: The History and Purpose of Day Treatment Programs Introduction History and Evolution Program Models The History and Role of Academics in Day Treatment Programs Treatment Team Treatment Setting Treatment Components and Program Outcomes The Menninger Clinic History PHP Programming Schedule Milieu Therapy Outcomes Future of Day Treatment Programs Telehealth Adaptions Integrating Technology Family Involvement Future Research Conclusion References 3: Program Development and Administration in Day Treatment Settings Overview of Day Treatment Programs Titles of Day Programs Treatment Elements Population Mental, Medical, and Physical Health Needs Patient and Caregiver Availability Program Access Billing Practices and Covered Services Developing and Maintaining a Day Treatment Program Working with Stakeholders and Leaders Program Length and Duration Patient Considerations and Characteristics Staffing Models and Needs Team Communication Staff Training Financial Aspects of the Program Facility and Space Considerations Referrals and Working with the Community Cultural Considerations Transportation Working with Schools Program Licensure, Accreditation, and Regulatory Requirements Evidence-Based Assessment and Outcome Measurement Implementation of Evidence-Based Treatments Conclusion References 4: Implementation and Training Introduction Patient Factors Comorbidity and Acuity Family System and Developmental Considerations Diversity Treatment Planning and Potential Barriers to Care Therapist Factors Engagement and Support of Implementation Working with a Treatment Team Organizational Factors Clinical Burden and Burnout Training Factors and Methods Training Models in Day Treatment Programs Recommendations for Training Strategies in Day Treatment Settings Application of Training Lessons Learned Conclusions References 5: Assessment and Evaluation of Outcomes in Youth Day Treatment Programs Overview Definition Components Rationale Evidence Base Adult Populations Youth Populations Mechanisms, Benefits, and Stakeholders Proposed Mechanisms Benefits to Stakeholders Barriers and Recommendations Conclusion References Part II: Partial Hospitalization Programs (PHPs) 6: Perspectives on General Partial Hospital Programs for Children Program Development and Implementation Financial Planning Training Opportunities Stakeholder Involvement Day-to-Day Programming Daily Schedule In-Person Treatment Day Schedule Theoretical Framework Clinical Approaches Treatment Modalities Crisis and Safety Response and Management Use of Evidence-Based and Empirically Informed Assessment Assessing Suicidality The PHP Standard Assessment Battery Use of Evidence-Based and Empirically Informed Interventions Evidence-Based Interventions Cultural Considerations The Role of Psychiatry in the Partial Hospital Program Treatment Team Collaborations and Generalizing Treatment Gains Inclusion of Family and Caregivers Working with Schools Coordinating with Outside Treatment Providers Discharge Planning Integrating Research and Practice Lessons Learned, Resources, and Next Steps References 7: Child and Adolescent Integrated Mood Program (CAIMP) Child and Adolescent Integrated Mood Program (CAIMP) Attendance Requirements Demographics Theoretical Overview Structure Programming Managing Mental Health Crises During Program Discharge and Follow-Up Care Program Development Staffing CAIMP Daily Schedule Trainees Supervision Day-to-Day Programming Groups Light Stretch, Goal Setting, and Daily Goal Review Groups Stress Management Mindfulness Group Health and Wellness Group Multifamily Group Youth CBT Group Interpersonal Therapy Group Occupational Therapy Group Recreational Therapy Group Caregiver Group Caregiver Skills Group Crisis and Safety Response Management Individual and Family Therapy Use of Daily Projects and SMART Goals Miscellaneous Activities Implementation of Evidence-Based Assessment Depression Bipolar Disorder Assessment Strategies for Youth Assessment in CAIMP Admission Discharge and Follow-Up Implementation of Evidence-Based Interventions Collaborations and Generalizing Treatment Gains Integrating Research and Practice Lessons Learned and Program Longevity Program Development and Goals Finances Physical Space and Milieu Internal and External Resources Considerations for Development and Implementation of Similar Programs Resources for Program Development and Maintenance Ongoing Initiatives and Next Steps Conclusion References 8: The UCLA Achievement, Behavior, Cognition (ABC) Program Which Children/Families Are Admitted to ABC? Program History Program Format Patient Population The Multidisciplinary Treatment Team Goals and Treatment Planning Typical Treatment Course Overview Admission Screening Initial Assessment and Clinical Interview Case Conceptualization Measurement-Based Care Evidence-Based and Empirically Informed Interventions Individual Interventions Group Interventions Family/Parent Interventions Communication About Cases Internal Communication External Communication Program Development and Implementation Cost and Coverage Staffing Family Strategies Including Stakeholders and Navigating Institutional Expectations and Limitations What Does Clinical Change Look Like at ABC? Lessons Learned and Next Steps References 9: Center for Autism and Developmental Disabilities Partial Hospitalization Program Program Overview Program Structure Patient Presentation Program Goals and Expectations Program Development and Implementation Referral Sources Billing, Reimbursement, and Insurance Training Day-to-Day Programming Theoretical Framework Use of Evidence-Based and Empirically Informed Assessment Use of Evidence-Based and Empirically Informed Interventions Case Example Refining and Generalizing Interventions Culturally Competent Treatment Collaborations and Generalizing Treatment Gains Integrating Research and Practice Lessons Learned, Resources, and Next Steps Conclusion References 10: Dialectical Behavior Therapy Overview of 3East Partial Hospitalization Program DBT and Adolescents History of the DBT PHP The DBT PHP Structure Patient Overview Treatment Goals Program Components Group Therapy Individual Therapy Family Involvement Psychiatric Consultation Homework Skills Coaching Consultation Team Program Extensions Discharge Planning/Recommendations Crisis and Safety Response/Management Diversity Considerations Related to Staff, Adolescents, and Access to Care Training Building Stakeholders and Navigating Institutional Expectations/Limitations Staffing Patient Age Range Level of Acuity Navigating Insurance Coverage and Billing Generalizing Treatment Gains and Collaborations Use of Empirically Informed Assessment Use of Empirically Informed Interventions Integrating Research and Practice Lessons Learned, Resources, and Initiatives Conclusion References 11: Obsessive Compulsive and Related Disorders Program Overview Patient Population Program Focus Length of Stay and Follow-Up Care Models Program Development and Implementation Resources, Finances and Stakeholders Patient Caregivers as Stakeholders Day-to-Day Programming Theoretical Framework Structure of Intervention Use of Empirically Informed Assessment Use of Empirically Informed Interventions Evidence Base for Outpatient Level of Care Evidence Base for Higher Levels of Care Application of Empirically Informed Treatment Collaborations and Generalizing Treatment Gains Families Schools Treatment Providers and Others Integrating Research and Practice Research Team Lessons Learned, Resources and Next Steps Training and Communication Managing Growth: Differentiation Adapting to New Realities: Opportunities and Challenges Next Steps References 12: Family-Based Interdisciplinary Care for Children and Families with Comorbid Medical and Psychiatric Conditions: The Hasbro Children’s Partial Hospital Program Program Overview and History Empathy and Expectations: HCPHP Community Rules Behavioral Principles: The HCPHP “Point Store” After-Hours Support Unified Messaging Across Teams at HCPHP Essential Ingredients: Components for Treatment Nursing Milieu Family Therapy Individual Therapy Pediatrics Nutrition Psychiatric Medication Management Case Examples Claire: 16-Year-Old with Functional Neurological Disorder (FND) Tommy: 13-Year-Old Boy with Poorly Controlled Diabetes Summary References Part III: Intensive Outpatient Programs (IOPs) 13: Development and Implementation of an Intensive Outpatient Program for Suicidal Youth Introduction Overview of Effective Treatments for Suicidal Youth Integration of Technology Need for Intensive Outpatient Program (IOP) Level of Care Developing an IOP for Suicidal Youth Intake Procedures Safety Planning Chain Analysis Components of a Chain Analysis Treatment Planning Treatment Components Teen Group Therapy Parent Education Individual Therapy Family Therapy Medication Management Program Outcomes Program Evaluation Outcomes Quality Improvement Outcomes Measures Program Outcomes Discussion Conclusions Appendix A: Home Safety Checklist Appendix B: Diary Card References 14: Seattle Children’s Hospital’s Obsessive Compulsive Disorder-Intensive Outpatient Program Overview and Program Goals Origins and Program Development Stakeholders Use of Evidence-based and Empirically Informed Interventions SCH OCD-IOP Program Model Use of Evidence-based and Empirically Informed Assessment Programming Clinical Approaches Parent and Family Involvement School Involvement Coordinating Care Integrating Research and Practice Predictors (Moderators/Mediators) Depression and Comorbidity Family Accommodation and Family Factors Symptom Presentation Ongoing Research Projects, Publications, and Presentations Lessons Learned, Resources, and Next Steps References 15: Evidenced-Based Programming for LGBTQ Young Adults: An Intensive Outpatient Model Program Development and Implementation The Initial Groundwork Process of Building an IOP Team Setup and Involvement of Trainees Navigating Insurance Coverage and Billing Rationale for LGBTQ Specific Program Risk Factors for LGBTQ Youth Theoretical and Clinical Considerations Family Involvement and Support Moving Families Along the Continuum: Negative Versus Tolerant Versus Accepting Case Example Elements Specific to an LGBTQ+ Program Referrals Intake Admission (Criteria and Procedures) Therapeutic Effect of a Milieu Self-Selection and Self-Disclosure Conceptualization of the Right Track IOP Program Intervention and Treatment Day-to-Day Programming and Daily Schedule Team Members and Roles Evidence-Based Treatment for LGBTQ Youth Skill Implementation and Process Therapy Expressive and Vocational Therapy Dialectical Behavior Therapy (DBT) Skills Stigma Management: Understanding Shame Self-Compassion Building and Understanding Healthy Relationships Creating Family of Choice Experiences (“The Family Meal”) Crisis and Safety Response/Management Summary, Lessons Learned, and Next Steps Case Example: A Reflection on Treatment References 16: Adolescent Dialectical Behavior Therapy Intensive Outpatient Programs Introduction Terminology Suicide in Adolescents Non-suicidal Self-Injury in Adolescents Relationship Between NSSI and SAs in Adolescents Evidence-Based Treatment for Suicidal Youth Comprehensive Dialectical Behavior Therapy in Practice DBT in Intensive Outpatient Levels of Care Research on DBT IOPs Description of DBT Intensive Outpatient Programs Overview of Programs Reaching Interpersonal and Self Effectiveness (RISE) Overview Children’s Hospital of Orange County IOP (CHOC) Overview Program Development and Implementation RISE Program Development CHOC Program Development Day-to-Day Programming RISE Programing CHOC Programing Collaborations and Generalizing Treatment Gains Working with Parents RISE Skills Generalization CHOC Skills Generalization Critical Considerations and Lessons Learned Adopt or Adapt Insurance DBT Cost Effectiveness Admissions Criteria Adolescent Milieu and Contagion Working with Minoritized Groups Creating a Safe Environment Use of DBT Principles Helpful Resources Ongoing Initiatives and Areas to Improve Program Intake Process Pretreatment Commitment in the IOP Setting Treating Comorbid Disorders and Special Considerations for Care Balancing School and IOP Aftercare and Staying Connected Virtual and Hybrid Program Models Conclusion References 17: Co-occurring Disorders Scope of the Problem Bradley Vista Program Development and Implementation Day-to-Day Programming Adapting to a Telehealth Platform Evidence-Based and Empirically Informed Assessments Evidence-Based and Empirically Informed Interventions Setting Treatment Goals Enhancing and Sustaining Motivation and Treatment Engagement Group Therapy Individual Therapy Family Therapy Pharmacotherapy Collaborations and Generalized Treatment Gains Integrating Research and Practice Lessons Learned, Next Steps, and Resources Next Steps Resources References Part IV: Programs of Special Interest 18: Pediatric Pain Programs: A Day Treatment Model at Boston Children’s Hospital Program Overview Patients Admission Program Goals and Expectations Referral Process Program Development and Implementation Physical Space Treatment Team Insurance Coverage Day-to-Day Programming Theoretical Framework Treatment Modalities Behavioral and Crisis Management Assessment Interventions Evidence Base Key Components of Intervention Keys for Success Collaborations and Generalizing Treatment Working with Schools Outpatient Follow-Up Care Case Example Integrating Research and Practice Lessons Learned and Next Steps Conclusion References 19: Transitioning to Adult Services: Young Adult Partial Hospitalization and Intensive Outpatient Programs Introduction Why PHP and IOP, and Why Young Adult Specific? Keys to Success Features of Young Adult Programming Access Assessing Fit Program Curriculum: Incorporating Empirically Informed Interventions Program Philosophy Prioritizing Psychosocial Recovery Program Treatment Providers Staffing Physician/Medical Provider Role Therapist Role Occupational Therapist (OT) Role Special Considerations Basic Human Needs Parent Involvement Program and Patient-Specific Focus: The Pathfinders Track Expanded Assessments Aftercare Planning Conclusion References 20: Integrating Day Treatment in the School Setting Overview of Program History Population Served Admission and Exclusion Criteria Program Goals and Expectations Length of Stay Diversity Considerations Related to Staff, Patients, and Access to Care Program Development and Implementation Process of Building Our Program Setting Up Your Team and Working with an Interdisciplinary Team Involvement of Trainees Building Stakeholders and Navigating Institutional Expectations/Limitations Navigating Insurance Coverage and Billing Day-to-Day Programming Daily Schedule Theoretical Framework and Clinical Approaches Treatment Modalities Crisis and Safety Response/Management Use of Evidence-Based Assessment Cultural Considerations and Adaptations Use of Evidence-Based Interventions Key Treatment Components Detailed Adaptations of Evidence-Based Interventions for Setting and Patient Population Tips for Maximizing Treatment Gains in Population/Level of Care Providing Culturally Competent Intervention in an Empirically Supported Context Collaborations and Generalizing Treatment Gains Inclusion of Family and Caregivers Working with Schools Coordinating with Outside Treatment Providers Working with Other Community Members Integrating Research and Practice Lessons Learned, Resources, and Next Steps Tips for Developing and Implementing Similar Programs Helpful Resources Ongoing Initiatives Conclusions References 21: Wilderness Therapy Introduction to Outdoor Behavioral Healthcare Origins of Outdoor Behavioral Healthcare Program Characteristics Multimodal, Multisystemic, Multidisciplinary Treatment Team Day to Day Programming Individual Therapy Group Work Family Therapy Role of Nature Risk Management and Safety Who Attends OBH? Treatment and Program Considerations Admission and Exclusion Criteria Assessment Program and Clinical Goals Ongoing Focus on Risk Management and Safety Collaborations and Stakeholders Research on OBH Treatment Outcomes Cost Effectiveness Progress Monitoring and Research Informed Practice Research Limitations Additional Considerations Medical Insurance and OBH Diverse Populations in OBH Programs Aftercare Moving Forward References Part V: Special Topics on Service Utilization and Follow-Up Care 22: Family Engagement and Coaching in a Five-Day Intensive Treatment Program for Youth with Anxiety Disorders and OCD Chapter Overview Brief Background on Childhood Anxiety Disorders Evidence-Based Treatment for CADs Barriers to Efficacious Treatment for CADs Parent Coached Exposure Therapy (PCET) Parental Involvement in PCET Parent-Focused Skills in PCET Five-Day Intensive Outpatient Group Treatment Program Overview of Goals for the Five-Day Intensive Overview of Structure for the Five-Day Intensive The Initial Assessment Outline of Treatment Activities Case Example Conclusion References 23: Telehealth Adaptations in Day Treatment Programs Existing Research/Literature on Telehealth Day Treatment Programs Development and Implementation of a vPHP in a Private Practice Setting Technological Considerations Telecommunication Platform Internet Access Hardware and Lighting Multiple Devices and Software Tools Privacy Considerations Legal Considerations Training and Orientation Working Remotely Clinical Adaptations of a Partial Hospital Program to Telehealth Treatment Rational Initial Consultation vPHP Intervention Theory Group Structure Data Collection to Support Treatment Clinical Adaptation of Selected Interventions to Telehealth Individual Therapy Family Therapy Group Therapy Clinical Adaptations of Specific Evidence-Based Treatment Interventions Used in Virtual PHP Exposure Response Prevention (ERP) Dialectical Behavioral Therapy (DBT) DBT- Prolonged Exposure/DBT-Post-traumatic Stress Disorder Conclusion References 24: Inpatient Psychiatric Hospitalization Inpatient Psychiatric Hospitalization: What Does Care Look Like? Inpatient Psychiatric Hospitalization and Evidence-Based Psychotherapies Inpatient Psychiatric Hospitalization’s Role in the Mental Health Continuum of Care PHP and IOP’s Role in the Mental Health Continuum of Care PHP and IOP as Step-Down Services from Inpatient Psychiatric Care Stepping Up to Inpatient Psychiatric Hospitalization from PHP or IOP PHP and IOP as Prevention of IPH Access to PHPs and IOPs from IPH How Inpatient Teams Decide About PHP and IOP Coordination of Care Between PHP and IOP and IPUs Challenges with Discharging to PHP or IOP from the IPU Limitations to Access Conclusion References 25: The Youth Crisis Stabilization Unit: An Alternative Psychiatric Treatment Model Program Overview Population Served Admission/Exclusion Criteria Average Length of Stay Criteria to Move to Higher/Lower Levels of Care Diversity Considerations Program Development and Implementation Building Stakeholders and Navigating Institutional Expectations/Limitations Navigating Insurance Coverage and Billing Setting Up the Team Day-to-Day Programming Daily Schedule Theoretical Framework Clinical Approaches Treatment Modalities Crisis and Safety Response/Management Use of Evidence-Based Assessments Chronological Assessment of Suicide Events (CASE) Columbia-Suicide Severity Rating Scale (C-SSRS) Use of Evidence-Based Interventions Review of Existing Evidence-Based Interventions Collaborations and Generalizing Treatment Gains Inclusion of Family and Caregivers Working with Schools Coordinating with Outside Treatment Providers Integrating Research and Practice Lessons Learned and Future Directions References 26: Strategies to Navigate Day-Treatment Services and Follow-up Plans: A Guide for Families and Providers Introduction Levels of Mental Health Care Outpatient Mental Health Day-Treatment Programs Inpatient Psychiatric Hospitalization and Residential Treatment Facilities Day-Treatment Programs Access Costs Identifying and Addressing Barriers Intervention Working with the Treatment Team Team Composition and Communication Safety and Crises Working with Schools Caregiver Involvement Discharge and Follow-Up Planning Discharge Planning Mental Health Follow-Up Returning to School and the Community Conclusion References Index