The unheard voice of the clinician: Perspectives on the key features of an adolescent inpatient model of care

Abstract

Problem Little has been reported from clinicians about the operations, interventions, and outcomes of inpatient units and how these comprise models of care in such units. The aim of this study was to explore an inpatient model of care in operation at the study site by defining key features of the model from the perspectives of clinicians. Methods Semi‐structured face to face interviews were conducted with ten clinicians working in a private inpatient unit in Melbourne, Australia. Interview data were analyzed using thematic analysis. Findings Analysis resulted in the identification of three thematic features relating to containment, engagement, and therapy. These included (a) an environment conducive to containment, (b) adolescent engagement through shared experiences, and (c) dialectical behavior therapy embedded culture. Conclusions The findings provide insights into often unheard clinician perspectives on what the key features of an adolescent inpatient model of care are. These features relate to the interventions that are currently offered on the unit and ways of working as informed by philosophies and practices. These findings should be used to improve clinical services and inform research aiming to articulate exemplary adolescent inpatient models of care. Furthermore, the findings provide guidance and practical information to commissioners, clinicians, and policy makers implementing models of care.

Constrained nursing: Nurses’ and assistant nurses’ experiences working in a child and adolescent psychiatric ward

“…Hayes et al . (2019a) interviewed 10 clinicians in a private adolescent inpatient unit in Australia to explore their perceptions of a dialectical behaviour therapy model of care. Matthews and Williamson (2016) collected diary entries from 10 health care assistants working in two female adolescent wards in England, and interviewed five of them, to explore the effect of the CAP inpatient environment on their health and well‐being.…”

Key features of adolescent inpatient units and development of a checklist to improve consistency in reporting of settings

“…Capacity of the adolescent inpatient unit is another important descriptor. Several adolescent studies have emphasized the value of peer support (Hayes et al, 2020a ; Hayes, Simmons, Palmer, et al, 2019 ; Hottinen et al, 2020 ; Salamone‐Violi et al, 2015 ). Information related to the inpatient unit capacity and group therapy size could be useful for interpretation and what could be considered the ‘ideal’ unit or group size.…”

“…Admissions typically occur for the purpose of (a) detailed observation to facilitate diagnosis, (b) to initiate supervised treatment, and/or (c) acute containment of risk (Hazell, 2021 ; Perkes et al, 2019 ). While there has been a proliferation of recent articles focusing on specific therapies such as Dialectical Behaviour Therapy (DBT) or Cognitive Behaviour Therapy (CBT) that may be used in these settings, research that describes operations and models of care within child and adolescent inpatient units remains limited (Delaney, 2019 ; Hayes et al, 2020a , 2020b ; Hayes, Palmer, Hamilton, et al, 2019 ; Hayes, Palmer, Simmons, et al, 2019 ; Hayes, Simmons, Palmer, et al, 2019 ; Saito et al, 2020 ).…”

“The little ants that make everything else work”: Experiences of healthcare support workers in inpatient Child and Adolescent Mental Health Services (CAMHS).

“…In comparison with similar services in other industrialised countries and compared to adult inpatient services in the UK, T4 service-users experience longer length of stay (Watkins, 2021). Also, as they may enter T4 with delays (following a long wait), they often experience more severe difficulties (Hayes et al, 2019). This could contribute to an increase in the use of restraint (Watkins, 2021) to support incidents of physical harm to themselves and/or others.…”

“…Retention rates between April 2020 and March 2021 varied between trusts, with the lowest reported at 16% (Health Education England, 2021). This necessary dependence on temporary and/or inexperienced staff raises concerns, as it can lead to disruptions in therapeutic relationships and recovery (Hayes et al, 2019;Matthews & Williamson, 2016;McCarthy & Gastmans, 2015;Stewart et al, 2015).…”