Outpatient psychotherapy practice with adolescents following psychiatric hospitalization for suicide ideation or a suicide attempt

Abstract

Outpatient treatment is standard care for adolescents discharged following a psychiatric hospitalization. There is little research, however, on the amount and types of psychotherapy these clients receive in the community. We examined therapy attendance and therapist report of outpatient therapy practice with adolescents discharged from psychiatric hospitalization following either a suicide attempt or severe suicidal ideation in the Northeastern USA. Therapists (n = 84) completed a packet of self-report questionnaires regarding treatment of these adolescents in the first six months after discharge from the hospital. Information on number of sessions attended, primary presenting problem, therapist orientation, therapy techniques, and therapeutic relationship was collected. The findings indicated that therapists met their clients in both private and community outpatient settings. The most common modality of treatment was individual therapy, but almost all types of therapeutic techniques were endorsed. Adolescents attended an average of 8.1 therapy sessions (SD = 4.7), with 18% terminating treatment against therapist advice within the first three months. Psychologists, psychiatrists, and social workers used cognitive-behavioral, psychodynamic, and family system techniques about equally. Social workers used humanistic techniques more than their counterparts. The variability in number of therapy sessions attended suggests that many adolescents discharged after a psychiatric hospitalization will not receive adequate care. Short-term therapy protocols designed for community practice emphasizing cognitive techniques may be useful to test in future community-based research trials based on the high percentage of adolescents attending relatively few sessions.

Temporal relationship between substance use and delinquent behavior among young psychiatrically hospitalized adolescents

“…These high lifetime and past month rates of alcohol and marijuana use (see Table 1) are consistent with the rates of substance use reported in other psychiatric samples of adolescents (Deas-Nesmith, Campbell, & Brady, 1998; Martin, Milich, Martin, Hartung, & Haigler, 1997). It is also noteworthy that there were substantial increases in substance use rates over the 18 month follow-up period, despite the fact that the majority of this sample received mental health treatment ( M = 8.1 sessions, SD = 4.7 sessions) following discharge from the hospital (Spirito et al, 2011). …”

Follow-up Treatment Utilization by Hospitalized Suicidal Adolescents

“…Recruitment for our study occurred between 2006 and 2010. Comparison studies with low rates of involvement in treatment, such as the study by Spirito et al 1992, 21 were published much earlier than that, and a more recent study from that same hospital published in 2011 9 found higher levels of treatment attendance than in the 1992 study. Changes in patterns of treatment utilization for these different cohorts could be due to factors such as changes in insurer willingness to fund an array of services and a greater awareness of the importance of receiving ongoing mental health treatment following a period of intensive care such as hospitalization.…”

“…8 The high rates of service use in these samples may be due to the fact that, unlike in the studies reviewed above, the participants were psychiatrically hospitalized, which suggests that they represented higher risk samples. Nonetheless, Spirito et al reported that, during a 3-month period after discharge, 18% terminated outpatient therapy against therapist advice, 9 and James et al found that, over a 30-month follow-up period, 28% of their sample of children and adolescents failed to receive any treatment following their first psychiatric hospitalization, 10 thus offering a less optimistic view of patterns of service use. In a review of data concerning children and adolescents who received inpatient psychiatric care, Daniel et al reported that, in general, two thirds or more of psychiatrically hospitalized youth received treatment of some kind following discharge from the hospital.…”

Initial RCT of a distress tolerance treatment for individuals with substance use disorders

“…To more fully test the specificity of SIDI, future research should assess and control for other dimensions of negative affect. Finally, we included two comparison conditions, including a SC condition that captures non-specific treatment effects and mirrors a common form of treatment often provided in the community (Koekkoek et al, 2010; Andrews, 1993; Spirito et al, 2011). However, neither comparison condition was active or included empirically-supported elements.…”