Hospitalizing a Child or Adolescent

        Eight million of our nation’s children – about 12 percent of America’s nearly 67 million citizens under the age of 18 – suffer from emotional or other mental health problems that warrant treatment. Fortunately, most of these children can be treated by a qualified professional on an outpatient basis. However, for a significant number of children, inpatient treatment may be necessary.
        This Sheppard Pratt Health System site will help you identify the kind of information you need to gather and evaluate when you are considering hospital treatment. Naturally, the answers to the questions here will vary widely, depending on the nature and seriousness of your child’s illness. And, you can expect that different hospitals will offer treatment in different ways. What is important is to find a hospital qualified to treat your child and one with which you are comfortable. One of the key elements in inpatient treatment is effective communication with the treatment team. If you don’t feel you can communicate effectively with your child’s hospital treatment team, look for another hospital. If your child’s admission is not an emergency, we suggest that you ask for a tour of the hospitals you are considering before you decide on one.

Why is inpatient psychiatric care being recommended for your child?
        Decisions about hospitalization are most often based on the severity of a patient’s illness and on the nature of his or her social support system (e.g., stability at home, academic and social adjustment, etc.) rather than on the diagnosis. Thus, for example, one seriously depressed patient may need inpatient treatment while another may not.
        Each child’s illness must be individually assessed before admission to inpatient treatment is considered. In addition to the assessment of the need for hospitalization, psychiatric hospitals have stringent criteria for the admission of children and adolescents, including:
       The child poses an actual or imminent danger to him or herself or to others.
       The child’s behavior is destructive or inappropriate in the community.
       The child needs medication which must be adjusted or closely monitored.
       The child requires a period of stabilization calling for 24-hour comprehensive and intensive observation by skilled professionals.
       The child cannot sustain social relationships and is disruptive in school, the family, or the community.
       The child has failed to improve in other, less restrictive settings.

Which hospitals would be suitable for your child?
        Your child’s clinician will probably suggest a hospital or hospitals equipped to treat your child’s specific illness. If you’re uncertain where to turn for help, try asking school counselors, clergy, your family physician, or other parents who have faced a similar situation for advice.
        Most U.S. hospitals are accredited by the Joint Commission of the Accreditation of Healthcare Organizations (JCAHO), which means that they meet an extensive set of standards and requirements. 
        Determine whether or not the hospital regularly treats children and adolescents and if your child will be on a specialized unit for children. If you are able to tour the hospital, assure yourself that it provides a safe environment with adequate space for living, an ability to meet your child’s educational needs, and provision for therapeutic activities that will facilitate re-entry into the family and community. Sheppard Pratt at Ellicott City, Maryland is one of the country’s most experienced hospitals providing specialized treatment for children and adolescents for over 40 years; our programs can be found on the web at Admissions can be arranged by calling 410-938-3800.

How is inpatient care expected to help your child?
        At the hospital, your child’s doctor should develop a treatment plan with specific, measurable goals to be met during hospitalization. Both the plan and the goals should be carefully reviewed with the family and other members of the treatment team on a regular basis by the primary therapist. Progress toward meeting these goals should be reported and discussed with the family, as should any need to make major changes to the treatment plan or goals.

Who will be treating your child?
        Nearly all psychiatric hospitals use a team approach to treating children and adolescents. Members of your child’s team will include a variety of mental health professionals who offer different, specialized skills to help your child get better. Find out what role each team member will play in your child’s treatment and each member’s responsibilities. Mental health professionals likely to be involved include:
       Psychiatrist: A fully trained and licensed physician (MD or DO) who has completed three to four years of training in general psychiatry after medical school. Your child may also be treated by a child/adolescent psychiatrist who has completed two years of specialized training in child and adolescent psychiatry. Psychiatrists may be certified by the American Board of Psychiatry and Neurology. The psychiatrists at Sheppard Pratt at Ellicott City are Board Certified or Board eligible. 
       Clinical Psychologist: A licensed mental health professional with a doctoral (Ph.D.) degree in clinical psychology from an accredited institution and an additional one to two years of supervised training in an inpatient setting.
       Clinical Nurse Specialist: A registered nurse (RN) who is licensed by the state and may be certified by the American Nurses Association for child and adolescent psychiatric nursing or adult psychiatric nursing after two years of supervised psychiatric practice and a certification examination.
       Clinical Social Worker: A mental health professional with a master’s degree in social work (MSW) and a minimum of two years of supervised clinical experience in an inpatient setting. Some states require licensure for clinical social workers and others do not. A clinical social worker may be a member of the American Academy of Certified Social Workers (ACSW) or be listed in the National Association of Social Workers’ Register of Clinical Social Workers.

At Sheppard Pratt at Ellicott City, the Case Manager is typically a Licensed Clinical Social Worker (LCSW-C) or a Ph.D. psychologist who will work with you and your child throughout hospitalization.

Other mental health professionals who may play an important part in your child’s treatment include an internist or pediatrician, drug/alcohol counselors, occupational and activity therapists, teachers, and dieticians.

What will your child’s treatment include?
        Each patient’s treatment plan is designed under physician supervision to meet his or her particular needs. Find out to what degree you will be expected to participate with your child’s therapist in the formulation of a plan for your child.
        While no two treatment plans are exactly alike, some common components of treatment plans for children and adolescents are:
       Group therapy with peers led by a trained therapist
       Family therapy with parents and siblings, typically by the Case Manger 
       Individual therapy with your child’s primary therapist
       An academic program
       Occupational therapy- to develop skills for daily living
       Activity therapy – to learn how to get along with other people, to cooperate on a given task, and to develop the capacity for healthy and satisfying social relationships in the community
       Drug and alcohol education and (if appropriate) therapy
       Plans for discharge and follow-up care

What will your child be doing all day?
        As a parent, you will know what your child will be doing all day. What time do patients get up? What’s the food like? Is there unstructured free time? What kind of contact do the children have with one another? Are units coeducational? Who does laundry? It’s natural for parents to have these and a lot of other questions about their child’s daily life inside the hospital. Most hospitals have a patient handbook with the answers to many of these questions. Ask for a copy of it when you visit the hospital. At Sheppard Pratt at Ellicott City, your contact person who can answer these kinds of questions for you throughout your child’s hospitalization will be your child’s Case Manager.

What are your child’s legal rights within the hospital?
        Laws about children’s rights in regard to inpatient psychiatric care vary widely from state to state. Some states allow children to sign themselves out of the hospital without parental approval while other states require parental approval for many aspects of hospitalization. This is another matter you should discuss fully with your child’s treatment team to make sure that both you and your child fully understand your legal rights.
        In Maryland, at Sheppard Pratt at Ellicott City, you will be requested to sign a Voluntary Minor Form revised by the State to admit your child to the hospital. Children and adolescents can also be admitted by Physician’s Certificates or by a court order. If your adolescent is 16 or 17 years old he or she may become a voluntary patient by signing in on their own. Except under special circumstances in Maryland, your child cannot sign out of the hospital unless he or she signed themselves in. (See voluntary minor and patient’s rights)

How will your child’s educational needs be met during hospitalization?
        It is vital to your child’s long-term recovery that he or she continues to learn while hospitalized. In fact, most states require psychiatric hospitals to complete an educational assessment on every child and adolescent admission and to provide an accredited educational program for their long-stay child and adolescent patients. While some hospitals – particularly smaller ones – will have a special teacher come in to teach your child, others – particularly larger hospitals – will have a complete school set up. Most teachers in these programs have received special training, and the educational programs are an extension of therapy. They teach your child to focus his or her attention, to complete assignments and to identify and fulfill responsibilities as well as many other skills necessary to get along in daily life. Learn the details of your child’s educational program. 
At Sheppard Pratt at Ellicott City, patients who stay more than three weeks are enrolled in Home Hospital Teaching. If your child’s stay is shorter, as most are, it will be helpful if you can bring your child’s school assignments to the hospital. Staff at the hospital will encourage your child to try to remain up to date with his or her schoolwork.

What is your role in your child’s treatment?
        Find out whether or not you will be able to visit your child in the hospital and whether (and to what extent) you will participate in his or her therapy. Ask what arrangements can be made for visiting your child. It is not unusual for programs to recommend limiting visiting hours and telephone contact between children and parents for an initial period immediately following admission. This gives the child’s condition a chance to stabilize and the therapist a chance to evaluate your child away from the influences of family and friends, home and school.
        The therapist usually will recommend family therapy with parents and possibly siblings. Counseling for you, separate from your child, may also be suggested. Determine your degree of access to each member of your child’s treatment team, and be as actively involved as the professional team thinks appropriate at the various stages of your child’s recovery. Ask the therapist how often you will be updated on your child’s condition and what some of the indications of improvement and progress are. At Sheppard Pratt at Ellicott City expect to have family therapy once a week for longer stays. Short-term patients typically are seen in family therapy three or more times a week.

How will the decision be made to discharge your child?
        Just as, in most states, a physician is needed to admit your child, one is needed to discharge him or her from a psychiatric hospital. There are three criteria that should be met before your child can be discharged from inpatient treatment:
       The goals of treatment have been substantially met.
       Follow-up goals and a post-hospital treatment plan (aftercare) have been formulated by the treatment team with input and assistance from the patient and family.
       Releasing the patient poses no substantial threat to him or herself or to others.

What will happen once your child is discharged?
        There are a variety of treatment options available when your child no longer needs the intensive level of care offered by hospital treatment. The team may believe that your child still needs the structured program offered by a residential treatment center or the supportive group environment of a halfway house. Or, your child may be ready to live at home and receive treatment in a partial hospitalization, day treatment, or outpatient program. Thoroughly discuss whatever recommendations your child’s therapist makes and make sure you understand what his or her medication needs are.

How much will hospitalization cost?
        Hospitals differ in what they include in their daily rate. Some may include only room and board and nursing services; others, room and board, nursing, and social work services; and still others, room and board and all therapies (an all-inclusive charge). Find out what is included in the daily rate and the typical charges for any services and medications your child is likely to need. Professional or physician fees are generally billed separately.

Will your health insurance pay for hospitalization?
        Unless you are dealing with an emergency, confer with your employer or insurance company before your child is hospitalized. Insurance policies differ widely in the benefits they offer for mental illness, and dependent coverage for children and adolescents is often different from that provided for the employee. Today, about three-quarters of insurance plans and employers require pre-admission certification prior to hospitalization. This involves an evaluation by your insurance company (or an independent representative acting on behalf of the insurance company or employer) that your child’s psychiatric illness is severe enough to warrant hospitalization and that your benefits cover such care. This is usually accomplished conferring with your child’s primary therapist or primary care physician.
        Meet with a representative from the hospital’s financial office during your tour or at the time of admission to discuss insurance coverage and limitations. Explore what arrangements can be made should your child’s stay exceed your insurance coverage. Check if the hospital is in the network for your insurance plan. 
        At Sheppard Pratt at Ellicott City, the assessment staff in the admissions office will seek insurance authorization of your child’s admission after completion of your child’s admission evaluation.

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