Implementing psychiatric day treatment for infants, toddlers, preschoolers and their families: a study from a clinical and organizational perspective (original) (raw)
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Tradition-a Journal of Orthodox Jewish Thought, 1997
The purpose of this study was to describe the methods of clinical assessment in an academic infant/preschool subspecialty clinic and to investigate the psychosocial demographic and diagnostic characteristics of this outpatient population. The clinic charts of 120 patients seen by the clinic director (first author) and second-year child psychiatry fellows were reviewed for data entry and analysis. Patients and their primary caretakers had undergone a comprehensive, multiple-session interactive play assessment to formulate clinical diagnoses using the DSM-III-R. Mean age of patients was 42 months Ϯ 13 with a range of 9 to 70 months. Similar to previous reports, a preponderance of externalizing disorders were seen (66%). A variety of Axis I DSM-III-R diagnoses were found and 37% of children had a developmental disorder on Axis II. Not-otherwise-specified categories were used in 8% of cases due to the lack of any other appropriately descriptive classification. Eightyeight percent of these occurred in children younger than 4 years of age. A high rate of prematurity (20%), maternal psychiatric history (44%), as well as the use of corporal punishment (28% frequent; 37% occasional) was found in the sample. The implications of these findings for the clinical assessment and classification of early onset psychiatric disorders are discussed. The utilization of mental health services by the youngest children for whom the DSM taxonomy was disproportionately inadequate is noted.
BJPsych Bulletin
Summary I present a rationale for two different types of in-patient child psychiatric unit: 24/7 intensive units and 24/5 child and family units. Intensive units address safety requirements. The developing personality of young people is at the centre of in-patient approaches on the child and family units. This requires attachment-informed practice. Families must always be involved and placement of units must facilitate their participation. The primary skill characterising these units is use of the milieu for therapy and combining this with family therapy. In other words, nurses and allied professionals need to be the dominant force in unit development, under the reflective guidance of consultants and clinical psychologists.
Evidence-based psychotherapies for preschool children with psychiatric disorders
Current psychiatry reports, 2012
The field of child and adolescent psychiatry is increasingly aware of the existence of psychiatric disorders in preschool-aged children. Concomitantly, there has been a greater understanding of both the effects of parenting on development as well as how a child's brain is shaped by the environment. There has also been a strong trend toward the use of time-limited, evidence-based therapies in adults and school-aged children, but evidence has been limited regarding the use of interventions to treat psychiatric disorders in preschoolers. In recent years, multiple research groups have worked to create effective psychotherapies for use with preschool populations, and there are also novel applications of existing psychotherapies. This review examines the latest evidence-based psychotherapies that treat preschool children with psychiatric disorders.
Tradition-a Journal of Orthodox Jewish Thought, 1997
This article describes the mental health assessment in preparation for treatment conducted in two University-based clinical programs that offer dyadic child -parent psychotherapy as the treatment modality. The Infant -Parent Program is a mental health program serving children between birth and 3 years of age and their families when the parent -child relationship is jeopardized by risk factors in the parent, child, or family circumstances. The Child Trauma Research Project is an intervention outcome research program serving preschoolaged children and their mothers when the child witnessed domestic violence. The programs share a similar assessment approach emphasizing the importance of a working alliance, spontaneous parental reports, and observation of child -parent interaction in a variety of settings. However, their different functions in terms of clinical service and research dictate appropriate modifications in their respective assessment procedures. The two assessment protocols and their rationale will be described in the context of the clinical and research goals of the programs.
Tradition-a Journal of Orthodox Jewish Thought, 2010
Infants ages 0 to 1 year consecutively referred for psychiatric treatment during the year 2005 were followed, and variables associated with diagnosis and short-term outcome were assessed. Infants were evaluated using the Psychiatric Infant Navigator Chart and Evaluation that includes nosological diagnoses [Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, (DC 0–3), Zero to Three, 1994] as well as risk and protective factors, treatment procedure, and outcomes. Seventy-six percent of the infants had an Axis I diagnosis, with anxiety disorders and a mixed disorder of emotional expressiveness being the most frequent. Twenty-five percent had an Axis II diagnosis. Multiple correspondence analyses showed that two dimensions corresponding grossly to DC 0–3 Axes I and II emerged. They emphasized three clinical profiles characterized by (a) good infant functioning, parent's awareness of their own difficulties, and a good outcome; (b) moderate child symptoms, overinvolved relating, and a good/intermediate outcome; (c) severe child symptoms, underinvolved relating, and a less favorable short-term outcome, signaling the risk for developmental disorders. Among the associated risk factors were cumulative parental stress, maternal psychopathology, and family dysfunction. Clinical implications of these findings indicated that infants under the age of 1 year who are referred for mental health evaluation and intervention are a heterogeneous group in terms of both severity and prognosis. Clinicians should differentiate subgroups of young children to detect those infants at risk for persistent psychopathology.
Child and Adolescent Mental Health, 2012
Background: This study focused on the behavioral functioning and treatment outcomes of preschool-aged children who attended a specialized, family focused psychiatric partial hospitalization program. Method: Study data were collected between 2002 and 2007. Maternal reports of child behavioral functioning were obtained at program admission and discharge. Maternal parenting stress and psychiatric impairment were assessed at admission. Results: Children's symptom severity decreased from admission to discharge, particularly with respect to externalizing symptoms. Both child age and maternal functioning emerged as predictors of treatment outcome. Conclusions: Specialized partial hospitalization may be an effective approach to treatment for preschool children with severe psychopathology.
Author eBooks, 2018
This study was not funded. All authors declare that they have no conflict of interest. Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent: Informed consent was obtained from all individual participants included in the study.
Psychiatric Bulletin, 2000
Aims and MethodsThis paper describes a 10-year alliance between an adult psychotherapy service and a child and adolescent mental health service to bring psychotherapeutically-informed help to families in difficulties early in the lives of their children.ResultsIt outlines staff training, the development of the unit into a significant training resource, the unit's underlying philosophy, its therapies and the key inter-relationships between teams and with health visitors to enable mutual teaming and the rapid access of families to assessment and treatment of the parent-child relationship.Clinical ImplicationsFunding, future plans and the preventive and economic implications of such work are mentioned.