Psychiatric Day Treatment Offers Needed Mental Health Services to Children and Adolescents

from Practice Update, Summer 2004

May was Mental Health Awareness Month in Colorado . Ironically, Colorado has experienced a reduction and even cessation of many psychiatric services for children and adolescents along the Front Range .

In contrast to the loss of these services, Colorado children and adolescents require more mental health services than any other age group in our state. Kids in these age groups make up nearly one quarter of Colorado ’s population, but experience more than one third of the severe mental health needs in the state, according to last year’s report, The Status of Mental Healthcare in Colorado . The study results were published by the Mental Health Funders Collaborative, consisting of eight Colorado grant-making foundations.

The Children’s Hospital offers one of the most comprehensive psychiatric treatment programs for children and adolescents in the Rocky Mountain region. The staff works with patients requiring hospitalization, stabilization and outpatient therapies in a variety of units, including our Psychiatric Day Treatment Program.

“There are few day treatment settings for children and teens in the metro area. Our Day Treatment Program has greater psychiatric involvement and can manage and treat more severe patients because of our rich availability of psychiatric resources,” said Wendy Smith, PhD, Clinical Director of the 10-year-old Psychiatric Day Treatment program.

An Avenue for Success With Less Disruption

The Psychiatric Day Treatment Program provides diagnostic clarification, stabilization and treatment, including medication management and disposition planning. The program is an effective option for children ages six to 18 for whom a higher level of mental health intervention is needed and who may present with one or more of the following issues:

• Mental health issues or behaviors not effectively managed in outpatient care
• Complex presentations or diagnostic dilemmas
• Multiple, unsuccessful medication trials
• School refusal
• Psychosomatic symptoms, including chronic pain and nausea/vomiting

“We are optimistic that kids can thrive even when there may have been something stopping them from doing so in the past,” Smith said. “What we offer families is hope. We have created a place for kids when normal community interventions have not worked.”

Smith described the program’s treatment philosophy as integrative. It starts with discovering each patient’s roadblocks or missing skills—from anger management, medication complexities, undiagnosed depression or other mental health presentations, learning disabilities, to a mismatch between a youth and their environment. In the latter case, this could include a patient who is overwhelmed by a large classroom at school or has a conflict with a family member.

According to the program’s Medical Director and psychiatrist, Susan Lurie, MD, the staff can often stabilize acute and complex patients in one to six weeks, a relatively brief intervention, while keeping the youth at home with their family. This feature of the Day Treatment Program may ease some of the anxiety families might experience at the thought of hospitalizing their children for psychiatric issues.

Experienced Staff, School Work, Guitars and Paint

The Multidisciplinary Staff Includes

• Child and adolescent certified psychiatrist, Susan Lurie, MD
• Licensed psychologist, Wendy Smith, PhD
• One additional half-time licensed staff psychologist
• A full-time licensed social worker
• A master’s-level special education teacher
• Three mental health counselors
• One full-time and one half-time nurse practitioner with prescriptive authority who can do medication management and two nurses.
• An art therapist, music therapist, and the Prescription Pet Program round out and diversify the therapeutic program offerings. “This allows us to provide a broad range of ways for the kids to express themselves and for us to learn how they communicate and what their strengths are,” Smith said.

Day Treatment Follows a Daily Schedule Which Includes:

• School work
• A community meeting to review the previous evening and the current day’s goals
• Group activities which include art, music, group therapy or therapeutic education
• Relaxation skills learning and practice, therapeutic recreation teaching social and cooperative skills
• A psycho education group entailing anger management, communication, coping skills and goal setting
• Behavioral expectations are clearly presented and reviewed daily

While the daily schedule creates structure, the staff tailors highly individualized plans for each patient including individual and family therapy. The program also makes use of a back-and-forth book to collect details about home behaviors which can then lead to adjustments in treatment strategy.

A Team of Diagnosticians

As a member of The Children’s Hospital, Psychiatric Day Treatment has an evaluation team beyond its own area’s offerings and clinicians. While in the program, staff can refer patients for assessment throughout the hospital including but not limited to Speech and Audiology for learning issues, Neurology, Rehabilitation and Occupational Therapy.

The program staff view each member of the outpatient treatment team as integral including the Primary Care Provider, a community psychiatrist or outpatient therapist. The staff works hard to act as a consulting service and to collaborate with these care providers who have followed these children most of their lives. They can provide important information and insight to the case, as well as help manage continued care after patients leave the program.

Departure: Discharge Planning and Transition

“The goal is to have the patients return to their home and school routine as soon as possible,” said Maureen Davis, RN, BSN, Psychiatric Day Treatment. Discharge planning helps patients ready themselves for their everyday life, including how to explain to peers that they “tried out another school for a bit” so as to avoid stigmas.

“We interface with their school or if it’s summer, we have the kids touchbase and then work with the school in the fall. The school and parents can contact Day Treatment for help with the return to school.”

How to Refer

Give your patient families the Psychiatric Day Treatment intake phone number: 720-777-7794. An intake specialist will assist the family with determining if our Psychiatric Day Treatment Program is an appropriate level of care and what insurance benefits may exist for the treatment.

While the program operates year-round, summer is a good option, much like scheduling a needed procedure when school is out. There tends to be more openings and patients may altogether avoid missing any school.

The program serves more than 250 children and adolescents annually and can accommodate up to ten children and ten teenagers in its programs at any one time.