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9 - Cognitive behaviour therapy in inpatient environments

Published online by Cambridge University Press:  21 August 2009

By
Jonathan Green
Edited by
Philip J. Graham
Jonathan Green
Affiliation:
Booth Hall Children's Hospital, Manchester, UK
Philip J. Graham
Affiliation:
Institute of Child Health, University College London
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Summary

Introduction

Children and adolescents treated within inpatient child and adolescent psychiatry units form a heterogeneous population in terms of age, functional difficulties and diagnosis. Adaptation of cognitive behaviour therapy (CBT) for use within these units therefore needs to take into account their varied characteristics. It also needs to consider the particular features of an inpatient unit as a treatment environment. Consequently, this chapter will begin by reviewing each of these two areas – the patient group and the treatment environment – before going on to consider the role of CBT as a treatment within the inpatient setting.

Characteristics of child and adolescent inpatients

Diagnostic pattern

Recent national UK survey data (O'Herlihy et al., 2001) have provided a comprehensive cross-sectional picture of the current diagnostic composition of inpatient practice in the UK (Table 9.1). Surveys from other countries have shown similar patterns of morbidity (Sourander and Turunen, 1999).

The census reflects some key diagnostic patterns in inpatient populations:

  • Eating disorders represent a high percentage of female admissions in both child and adolescent groups.

  • Acute psychosis is an important cause of admission in adolescence but is not at all negligible in children.

  • Despite often being thought of as contraindications for admission, conduct disorder and other externalizing problems are highly prevalent in child admissions, especially in younger boys.

  • Pervasive developmental disorders and other neuropsychiatric conditions are most common in child units.

  • Mood disorders are an important component of both adolescent and child populations.

Functional impairment

Diagnosis alone, however, is not the main predictor of outcome or need in this population (Green et al., 2001; Green, 2002).

Type
Chapter
Information
Cognitive Behaviour Therapy for Children and Families , pp. 136 - 154
Publisher: Cambridge University Press
Print publication year: 2004

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References

American Academy of Child and Adolescent Psychiatry (1990). Model for Minimum Staffing Patterns for Hospitals Providing Acute Inpatient Treatment for Children and Adolescents with Psychiatric Illnesses. Washington DC: American Academy of Child and Adolescent Psychiatry
Asarnow, J. R., Thompson, M. C., Hamilton, E. B., Goldstein, M. J. and Guthrie, D. (1994). Family expressed emotion childhood onset depression and childhood onset schizophrenic spectrum disorders: is expressed emotion a non-specific correlate of psychopathology or a specific risk factor for depression?Journal of Abnormal Psychology, 22, 129–46Google Scholar
Brent, D. A., Gaynor, S. T. and Weersing, V. R. (2002). Cognitive behavioural approaches to the treatment of depression and anxiety. In M. Rutter and E. Taylor (eds.), Child and Adolescent Psychiatry, 4th edn. Oxford: Blackwells, pp. 921–37
Cotton, N. S. (1993). Lessons from the Lion's Den: Therapeutic Management of Children in Psychiatric Hospitals and Treatment Centres. San Francisco, CA: Jossey-Bass
Crick, N. R. and Dodge, K. A. (1994). A review and reformulation of social information process mechanisms in children's social adjustment. Psychological Bulletin, 115, 74–101CrossRefGoogle Scholar
Gowers, S. G., Harrington, R. C., Whitton, A.et al. (1999). A brief scale for measuring the outcomes of emotional and behavioural disorders in children: the Health of the Nation Outcome Scales for children and adolescents (HoNOSCA). British Journal of Psychiatry, 174, 413–16CrossRefGoogle Scholar
Green, J. M. (1994). Child in-patient treatment and family relationships. Psychiatric Bulletin, 18, 744–7CrossRefGoogle Scholar
Green, J. M. (2002). Provision of intensive treatment: inpatient units, day units and intensive outreach. In M. Rutter and E. Taylor (eds.), Child and Adolescent Psychiatry: Modern Approaches, 4th edn. Oxford: Blackwells, pp. 1038–50
Green, J. M. and Burke, M. (1998). The ward as a therapeutic agent. In J. M. Green and B. W. Jacobs (eds.), Inpatient Child Psychiatry. Modern Practice Research and the Future. London: Routledge, pp. 93–110CrossRef
Green, J. M. and Jacobs, B. W. (1998a). Current practice: a questionnaire survey of inpatient child psychiatry in the United Kingdom. In J. M. Green and B. W. Jacobs (eds.), Inpatient Child Psychiatry. Modern Practice Research and the Future. London: Routledge, pp. 9–22
Green, J. M. and Jacobs, B. W. (1998b). Team dynamics in different phases of admission. In Inpatient Child Psychiatry. Modern Practice Research and the Future (eds J. M. Green and B. W. Jacobs). pp. 170–82. Routledge. London
Green, J. M., Kroll, L., Imre, D.et al. (2001). Health gain and predictors of outcome in inpatient and daypatient child psychiatry treatment. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 325–32CrossRefGoogle Scholar
Harrington, R. C.Whittaker, J.Shoebridge, P. and Campbell, F. (1998). Systematic review of cognitive behaviourtherapies in child and adolescent depressive disorder. British Medical Journal, 316, 1559–63CrossRefGoogle ScholarPubMed
Hill, J. (2002). Disorders of personality. In M. Rutter and E. Taylor (eds.), Child and Adolescent Psychiatry, 4th edn. Oxford: Blackwells, pp. 723–36
Hollis, C. (2002). Schizophrenia and allied disorders. In M. Rutter and E. Taylor (eds.), Child and Adolescent Psychiatry, 4th edn. Oxford: Blackwells, pp. 612–35
Jacobs, B. W. (1998a). Behavioural and cognitive therapies. In J. M. Green and B. W. Jacobs (eds.), Inpatient Child Psychiatry: Modern Practice Research and the Future. London: Routledge, pp. 110–24
Jacobs, B. W. (1998b). Externalising disorders: conduct disorder and hyperkinetic disorder. In J. M. Green and B. W. Jacobs (eds.), Inpatient Child Psychiatry: Modern Practice Research and the Future. London: Routledge, pp. 220–32
Kroll, L.Woodham, A.Rothwell, J.et al. (1999). Reliability of the Salford Needs Assessment Schedule for Adolescents. Psychological Medicine, 29, 891–902.CrossRefGoogle ScholarPubMed
Kurtz, Z. (1994). Treating Children Well. London: Mental Health Foundation.
Leibenluft, E., Tasman, A. and Green, S. A. (1993) (eds.). Less Time to Do More: Psychotherapy on the Short-Term Inpatient Unit. Washington DC: American Psychiatric Press
Luthar, S. S.Woolston, J. L.Sparrow, S. S. and Zimmerman, L. D. (1995). Adaptive behaviours among psychiatrically hospitalised children: the role of intelligence and related attributes. Journal of Clinical Child Psychology, 24, 98–108CrossRefGoogle Scholar
Magagna, J. (1998). Psychodynamic psychotherapy. In J. M. Green and B. W. Jacobs (eds.), Inpatient Child Psychiatry: Modern Practice Research and the Future. London: Routledge, pp. 124–43
National Health Service Health Advisory Service (1995). Thematic Review – Together We Stand. The Commissioning Role and Management of Child and Adolescent Mental Health Services. London: HMSO
O'Herlihy, A., Worrall, A., Banerjee, S. et al. (2001). National In-Patient Child and Adolescent Psychiatry Study. (Report submitted to the Department of Health, May 2001.) London: Royal College of Psychiatrists' Research Unit.
Paterson, R.Bauer, P.McDonald, C. A. and McDermott, B. (1997). A profile of children and adolescents in a psychiatric unit: multidomain impairment and research implications. Australian and New Zealand Journal of Psychiatry, 31, 682–90CrossRefGoogle Scholar
Royal College of Psychiatrists (1999). Guidance for the Staffing of Child and Adolescent Inpatient Units. Council Report 62. London: Royal College of Psychiatrists
Shaffer, D.Gould, M. S.Brasic, J.et al. (1983). A children's global assessment scale (CGAS). Archives of General Psychiatry, 40: 1228–31CrossRefGoogle Scholar
Shaw, M. (1998). Goal setting. In J. M. Green and B. W. Jacobs (eds.), Inpatient Child Psychiatry. Modern Practice Research and the Future. London: Routledge, pp. 51–6
Sourander, A. and Turunen, M. M. (1999). Psychiatric hospital care among children and adolescents in Finland: a nationwide register study. Social Psychiatry and Psychiatric Epidemiology, 34, 105–10CrossRefGoogle ScholarPubMed
Steinhausen (2002). Anorexia and Bulimia Nervosa. In M. Rutter and E. Taylor (eds.), Child and Adolescent Psychiatry, 4th edn. Oxford: Blackwells, pp. 555–70
Tarrier, N.Beckett, R.Harwood, S.Baker, A.Yusupoff, L. and Ugartebur, I. (1993). A trial of two cognitive behaviour matters of treating drug resistant residual symptoms of schizophrenic patients. British Journal of Psychiatry, 162, 524–32CrossRefGoogle Scholar
Towbin, K. E., Dykens, E. M., Pearson, G. S. and Cohen, D. J. (1993). Conceptualising ‘borderline syndrome of childhood’ and ‘childhood schizophrenia’ as a developmental disorder. Journal of the Academy of Child and Adolescent Psychiatry, 32, 775–82CrossRefGoogle Scholar
Webster-Stratton, C. and Hammond, M. (1997). Treating children with early onset conduct problems: a comparison of child and parent training interventions. Journal of Counselling and Clinical Psychology, 65, 93–109CrossRefGoogle ScholarPubMed
Wever, C. (1998) Obsessive compulsive disorder. In J. M. Green and B. W. Jacobs (eds.), Inpatient Child Psychiatry. Modern Practice Research and the Future. London: Routledge, pp. 247–58

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