6.4 ADAPTATIONS OF EVIDENCE-BASED PSYCHOLOGICAL TREATMENTS IN INPATIENT, PARTIAL HOSPITALIZATION, AND RESIDENTIAL SETTINGS

Objectives: This study examines evidence based psychological treatments for multiple psychiatric illnesses in acute care settings. Studies have shown that the health gain of a psychiatric hospitalization is significant. Total inpatient days increased for children and for adolescents from 1996 to 2007. Because the length of stay is short, the hospitalization involves stabilizing acute symptoms, rapid and in depth review of diagnosis and the psychosocial circumstances, implementation of effective psychopharmacologic and psychological treatments and planning for discharge. There are several factors limiting implementation of evidence based psychological treatments for psychiatric disorders in inpatient, partial and residential settings including group-based programming, training of staff, acuity and complexity of the patient population and short length of stay. To address these challenges, it is necessary to explore different evidence based modalities of treatment. The hypothesis is that evidence based psychological treatments can be successfully adapted to short term acute therapeutic settings. Methods: 1) DBT-C for children in residential care - 47 children randomly assigned to DBT-C or TAU. Children were provided with 34 individual sessions, 48 group skills training sessions and 12 parent training sessions. 2) Components based CBT for adolescents in a Partial Hospital Program - adolescents aged 13-17 admitted the NYP PHP between 2014-2015 receiving components based CBT group sessions. 3) One-session CBT group for patients with psychotic disorders on the inpatient unit -- 113 inpatients attended a manualized, brief, structured, one-session CBT group for patients with psychotic disorders dealing with delusions and hallucinations Results: Children in DBT-C, as compared to TAU, had a significantly greater reduction in internalizing and externalizing symptoms on the staff reported Child Behavior Checklist. For CBT in the Partial Hospital Program, emphasis was placed on identifying specific problem areas and implementing components of CBT to target these symptoms. Investigators identified positive themes generated from the one-session CBT groups for psychosis. Conclusions: Evidence based psychological treatments, such as DBT and CBT, can be successfully adapted to short term acute child and adolescent therapeutic settings.