Systematic Review: Patient Outcomes in Transdiagnostic Adolescent Partial Hospitalization Programs.

OBJECTIVE: Partial hospitalization programs (PHPs) are designed to help stabilize patients with acute mental health problems and are considered more cost-effective than inpatient care for patients who do not require 24-hour monitoring. Many PHPs treat transdiagnostic adolescents to reduce suicidality, self-harm, and other high-risk behaviors; however, the effectiveness of such programs is unknown. We aimed to review the existing evidence for the effects of PHPs on adolescent mental health symptoms and functioning. METHOD: We retrieved peer-reviewed evaluations of PHPs treating adolescents with a range of disorders that reported quantitative clinical outcomes. We followed PRISMA guidelines for systematic reviews and included studies published since 2000. RESULTS: Fifteen studies of 10 PHPs in North America, Europe, Asia, and Australia met inclusion criteria, 5 of which used comparison groups. Most participants were White and female with depressive disorders. All studies found improvements in adolescents' functioning and mental health from admission to discharge; however, only 1 study tested PHP relative to other levels of care, and only 1 study included follow-up data. Dialectical behavior therapy (DBT) may be an effective theoretical orientation for PHP settings, but evidence is limited. CONCLUSION: Evidence for effectiveness of PHPs relative to other models is limited. Currently available research suggests that many high-risk transdiagnostic adolescents tend to improve during PHP treatment; however, controlled studies with follow-up data are needed to determine whether partial hospitalization is effective and, if so, how effective, and whether treatment gains persist after discharge.

Ethical Considerations in Balancing Use of Seclusion and Restraint With Risk of COVID-19 Exposure: Recommendations for Youth Inpatient Psychiatry Units.

The onset of the COVID-19 pandemic has presented unique challenges for inpatient psychiatry units (IPUs). IPUs, especially those caring for children and adolescents, rely heavily on milieu group programming to provide care and supervision for patients, and have had to adapt unit policies and procedures to maintain a therapeutic milieu while minimizing COVID-19 transmission.1 Simultaneously providing care while preventing transmission of COVID-19 within IPUs is a formidable task, and many IPUs face the additional challenge of treating youth who have been exposed to, or are actively infected with, COVID-19. In addition, given the need to prevent transmission of COVID-19, recommendations include "mandatory quarantine and isolation when patients refuse to adhere to guidelines,"2 potentially leading to the use of restraint when patients attempt to leave isolation; thus a conflict between the potential risks of enforcing infection prevention policies in order to reduce virus transmission and best practices of eliminating seclusion and restraint (S/R) creates an ethical dilemma for IPUs.

Experiences with the Child and Adolescent Psychiatry Milestones: Results of Two Nationwide Surveys.

OBJECTIVES: Child and Adolescent Psychiatry began using milestones in 2015 as a way to document observable progress through training. The study is the first assessment of Child and Adolescent Psychiatry (CAP) faculty and fellows' experience with the milestones. METHODS: This study presents findings from two surveys conducted one year apart. The first electronic survey polled CAP fellows and faculty nationwide using five opinion questions; demographic data and comments were also gathered. The second, four-question survey polled CAP faculty at the American Association of Directors of Psychiatry Residency Training annual meeting. RESULTS: Seventy-nine fellows and 101 faculty members responded to the first survey. Averaged over the five questions, 53% of faculty and 49% of fellows responded positively, with 29 and 33% respectively giving neutral responses. Participants were a diverse group in terms of geographic distribution, program size, and experience level. Comments were predominantly negative or mixed. Fifty CAP faculty and fellows responded to the second survey. Of the three opinion questions, positive responses ranged from 62 to 90%. Forty percent of respondents reported having had no faculty development on the milestones. CONCLUSIONS: Implementing the milestones has been a mixed experience for faculty and fellows. Direct comparison between these two surveys is not possible given their different content and format. Future directions include standardization of faculty development sessions, and improved structures to create and share best practices for assessment of trainees.