Standardizing Care and Measuring Outcomes in the Partial Hospitalization Program

How can creating a unified approach to partial hospitalization improve patient outcomes?

While studying at the University of Miami, Sarah Kennedy, PhD, worked alongside a mentor to take an evidence-based mental health treatment approach for adults and adapt it for children and adolescents. When she joined Children’s Hospital Colorado in 2019, she had the opportunity to put that approach, called the Unified Protocols for Children and Adolescents, into practice through the Partial Hospitalization Program (PHP). 

When Dr. Kennedy first became a part of the PHP team, it looked like many other similar programs across the country. Kids with anxiety, suicidality, depression and other diagnoses would spend six to seven hours a day with the program, gaining skills through various modalities, including group therapy, individualized therapy, creative arts therapies and more. But Dr. Kennedy noticed some challenges. 

“There wasn't really a standardized approach or a common philosophy to treatment that all members of the treatment team shared,” she explains. “There was no real clear message or core set of skills that everybody's on the same page about and everybody's working toward.” 

Working with Chief of Psychology Jessica Hawks, PhD, she began thinking through ways to improve PHP outcomes and give treatment team members clearer guidance for care.  

A ‘unified’ approach to mental health care 

The pair landed on the Unified Protocols for Children and Adolescents, which were originally developed to provide a flexible, transdiagnostic approach to treating kids with a variety of conditions in outpatient therapy. Its core principle is to help kids tolerate uncomfortable or negative emotional experiences and to identify less avoidant, more helpful coping strategies in those moments of difficulty. Through this, the program aims to improve self-confidence and self-efficacy and to make kids more aware of their emotions. 

To make these principles function in the PHP setting, the Unified Protocols would need further adaptation.  

“It was really developed for a totally different setting and format,” Dr. Kennedy says. “We had to think about how we take this intervention that's designed to be delivered once a week in an outpatient setting over the course of four months and adapt it and restructure it for multiple groups that can be delivered each day based on these core components, and so that patients can get the full treatment package in about a two-week stay.” 

After working through initial changes, the PHP took two full days to train every team member in the new approach. Then the work began. To aid in its success and monitor progress, Dr. Kennedy implemented new measures and designed research to evaluate outcomes of the new programming. A Children’s Colorado Research and Innovation Scholar Award and an early career award from the American Psychological Foundation allowed Dr. Kennedy to bring these plans to life.  

Findings from the research were published in a 2024 study. “We looked at changes in anxiety and depression, and we also looked at changes in functional impairment — how kids are functioning in different areas of their life from the time they started in the PHP to up to one month after they were discharged,” she says. “And then we also looked at changes in their ability to tolerate distress, to regulate emotions and changes in their negative reactions to their emotional experiences.” 

In each case, outcomes indicated that the new approach to care was working. Significant improvements occurred on almost all outcomes, and patient satisfaction scores were over 90% positive. Overall, patients maintained their gains when the research team followed up with them one month after discharge. 

Exploring team member experience 

After seeing an improvement in outcomes, Dr. Kennedy and her team turned their attention inward in hopes of understanding how the team members implementing these changes felt and how their experience might improve. Their findings were published in January 2025. This was especially important considering the need to train new team members in the protocols and to ensure everyone felt confident in delivering this type of care.  

“We knew we needed to get some qualitative feedback from team members on PHP to better understand their experience. Who are the patients for whom this intervention approach feels really successful? Who are the patients for whom it doesn't feel as successful? What do we still need to adapt and change?” she says. “We created this adapted version, but we never thought it would be the final version.” 

Though the iterative process will continue as new needs are identified, Dr. Kennedy is proud of what the team has accomplished in such a short time and hopes the larger mental health field with take a similar approach to improving outcomes for kids with acute needs.  

“There has been very little research examining and adapting interventions that were really designed for an outpatient, low intensity setting for these higher levels of care,” Dr. Kennedy explains. “These settings are serving our kids who are experiencing significant safety concerns, and yet we know so much less about how to treat them. It's an area where we really need to do better.”

Citations

1. Kennedy, Sarah M et al. “Pilot Effectiveness and Acceptability of Partial Hospitalization Treatment Incorporating Transdiagnostic, Cognitive-Behavioral Intervention.” Behavior therapy vol. 55,4 (2024): 751-767. doi:10.1016/j.beth.2023.11.002. 
2. Casline, Elizabeth et al. “Provider perception of the acceptability, appropriateness, and feasibility of a transdiagnostic intervention in a youth partial hospitalization setting: A mixed methods implementation process evaluation.” Psychological services, 10.1037/ser0000933. 27 Jan. 2025, doi:10.1037/ser0000933.