Higher-level, acute or intensive psychiatric care focuses on crisis stabilization, assessment, safety monitoring and long-term treatment planning. Determining the appropriate programming for pediatric patients is a collaborative process, engaging a multidisciplinary team that reviews a number of factors including severity and duration of symptoms, functional impairment and assessment of patient safety. This article outlines programs for patients and families who need higher-level care.

Levels of intensive care

Inpatient psychiatric units

Inpatient units are designed to mitigate immediate risk, initiate treatment and prepare individuals for continuing care after hospitalization. Psychiatric hospitalization involves 24/7 medical supervision that typically lasts from 48 hours to 10 days based on individual patient needs. It’s intended for patients who present an ongoing risk toward self or others.

Children’s Hospital Colorado’s intensive services admission is accessed through the Emergency Department or the psychiatry consult/liaison team. Children and adolescents receive a thorough psychiatric evaluation and ongoing multidisciplinary treatment from a team of child psychiatrists, social workers, psychologists and mental health counselors.

Partial hospitalization programs

These programs, also called “day programs,” provide time-limited intensive intervention to stabilize psychiatric symptoms that affect daily functioning at school, work or other activities. Patients may present ongoing risk towards self and others, but are able to maintain safety in the community without 24-hour supervision.

Partial programs can be used as either a step-down from inpatient care or as a stand-alone level of care to stabilize a deteriorating condition and prevent hospitalization. Patients attend for six or more hours a day, every day or most days of the week. These programs may specialize in a specific problem area or cover a broader scope of psychiatric concerns. Services provided in partial hospitalization programs often include individual and group counseling, nursing, psychiatric evaluation, medication management, education services and family education and support.

Children’s Colorado’s Partial Hospitalization Program provides comprehensive, multidisciplinary treatment for children and adolescents with a range of psychiatric challenges, such as suicidal thoughts or behaviors, significant emotional distress, defiant and aggressive behaviors, depression and anxiety, which prevent participation in school. Patients receive group transdiagnostic treatment in addition to individual therapy, psychiatric consultation, medication management, education services, parent psychoeducation groups and other mental health supports. The program runs from 8:30 to 2:30 Monday through Friday at both Anschutz Medical Campus and North Campus locations.

Intensive outpatient programs

Intensive outpatient programs are more intensive than routine outpatient, providing a minimum of three hours per day of treatment, two to five days per week. Intensive outpatient programs primarily use a group format and are intended for individuals who require multi-modal treatment that cannot be provided in a traditional outpatient setting. Services may include group, individual and family psychotherapy, as well as psychoeducational activities. This level of mental health treatment is appropriate for youth with mental health concerns significant enough to disrupt day-to-day living, but who can still safely live at home and go to school.

Children’s Colorado’s six-week evidenced-based, intensive outpatient program is suited for teens experiencing high levels of impairment due to anxiety or obsessive-compulsive disorder. This teen- and parent-focused group meets three times a week with teens in one group per week and an option for consultation with a psychiatrist. All meetings take place on the Anschutz Medical Campus.

Continuity of care

Supporting patient transitions across levels of care is critical. Specifically, post-discharge period of intensive psychiatric programs is a time of marked risk. Patients admitted because of suicidal ideation or behaviors and those in the first months after discharge should be a particular focus of concern. Establishing appropriate follow-up care within seven days can help reduce this risk, significantly lowering odds of patient suicide. Despite this widely recognized expectation, only about half of patients nationally receive services within the one-week parameter. Each member of the treatment team shares responsibility for continuity of care.

COVID-19 impact

Across levels of care, mental health services for children and adolescents have been heavily disrupted by the COVID 19 crisis. Worldwide reports continue to highlight increased rates of mental health problems for youth and families. Data analyzed from over 300 hospitals (8.6 million pediatric patients) concluded that, as of February 28, 2021, visits with a mental health diagnosis have made up a significantly larger proportion of pediatric outpatient (up 44%) and ED (36%) visits than they did before the pandemic.

The increase in the proportion of ED visits for children’s mental health concerns likely reflects unintended consequences of mitigation measures, including reduced or modified access to children’s primary and preventative mental health care. Subsequently, there has been an increase in the reliance on ED and other acute psychiatric programs for both routine and crisis treatment. The pandemic’s provisional yet consequential pause in school- and community-based mental health supports generated an overwhelming need for higher acuity clinical care.

Resources

For more information or to refer for Children’s Colorado ambulatory programs serving patients with high acuity concerns, please connect with an intake coordinator at 720-777-2735.

• Children’s Hospital Colorado Pediatric Mental Health Institute provides evidence-based, family-focused comprehensive mental health services. For more information, providers can call 720-777-6200.
• Additional Colorado mental health services can be found through the Colorado Department of Health and Human Services.