Adolescents in crisis: When to admit for self-harm or aggressive behavior
Assess suicide risk, family support, other factors when considering hospitalization
Know your system
Child and adolescent psychiatric services are in great demand but often fall far short in meeting these needs across ethnic and socioeconomic groups. Availability of resources differs by geographic location and payer source.18,19 Community-funded mental health varies considerably. The best organizations offer a complete system of care, including outpatient therapy, medication management, case management, wraparound services, respite care, group homes, residential programs, and crisis programs.
Be familiar with local and regional programs and methods of accessing them. For patients who have access to a system of care, timely mobilization of appropriate resources often can avoid a hospital admission and place a patient in a less restrictive setting. Such options, however, frequently are not available to patients covered by commercial payers. For them, the decision typically is reduced to whether the family can manage the patient at home; if the family is unable to ensure safety, the adolescent is hospitalized.
Knowing the capability of available inpatient programs is essential to making an appropriate referral. Consider the level of medical care the psychiatric unit can provide and the accessibility of medical consultation services—both primary and medical subspecialty. Specialized programs for young people with comorbid severe cognitive delays, eating disorders, or forensic difficulties also assist with effective management. The inpatient unit’s collaboration and communication with outpatient providers frequently determines the success of the patient’s transition to less restrictive care.
- Child and Adolescent Service Intensity Instrument (CASII). www.aacap.org/cs/root/member_information/practice_information/casii.
Drug brand names
- Aripiprazole • Abilify
- Fluoxetine • Prozac
Disclosure
Dr. Sorter reports no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.
