Daily Psychiatric Support Without Inpatient Admission
The Partial Hospitalization Program (PHP) in Cincinnati Children’s Division of Child and Adolescent Psychiatry provides children and adolescents with professional mental health support within a comprehensive, evidence-based framework—one that’s care-intensive rather than time-intensive, and that’s backed by a multidisciplinary network of specialists.
“We’re uniquely positioned to serve as an effective and agile step-down program for children and adolescents who need mental health support but not the full scope of inpatient psychiatric hospitalization,” says Carie Norris, program clinical director. “Our goal is to be proactive in a child’s overall health and well-being.”
Through the Partial Hospitalization Program, referred children and adolescents—who range in age from 9 to 17—attend therapies, such as cognitive behavioral therapy and dialectical behavioral therapy, during the day, while spending nights and weekends at home.
“We take a team approach to mental health care that helps support the child or adolescent to their best functional status, so they can get back to their respective school and home environments as quickly as possible, and function better in those environments,” says Ashley-Marie Berry, MD, program medical director and psychiatrist in the Division of Child and Adolescent Psychiatry.
A Singular Approach
The Partial Hospitalization Program at Cincinnati Children’s is distinctive from other programs for a variety of reasons.
First, “our program is very intense,” Berry says. “Providers see patients almost daily, making it very similar to an inpatient program.”
However, she adds, the program is shorter than most. It runs between seven and 10 business days, while others typically last four to six weeks.
“There’s an advantage to our shorter duration because the goal is always to get the child or teen back to their least-restrictive environment,” Berry says. “It can be disruptive for kids to be out of school that long, especially because more kids have been struggling with school and school avoidance issues since COVID-19.”
For that reason, the program offers school transition days. That means patients can spend half the day in school and half the day in the program.
“A lot of parents worry that their kids will fall behind,” Berry says, “but we directly collaborate with the school to ensure the child is either going to be excused from any work they miss or that it can be turned in later.”
After they leave the program each day, children and adolescents go home and spend the evening with their families so they can practice what they’ve learned. Each morning, the family submits a letter updating the providers on how the child did. The parent letter covers areas like interactions with family members, mood, appetite and sleep quality.
“Because a provider is seeing the child nearly every day, we can make timely and expedited medication adjustments to help restore them to their optimal level of functioning while they are in the program,” she says. “That agility is another key differentiator for us and another reason our program isn’t as long—because we’re making those changes and plans and implementing them pretty quickly. We don’t want to keep them out of school any longer than we have to.”
Norris notes that another goal of the program is to get children and adolescents into the program quickly once they’re referred—usually within three business days. Plus, the day a patient arrives for intake is the day they start the program.
That’s unlike other programs where you come for intake and then it’s another few days or even weeks before you can start, she adds.
In addition, a referral to the program doesn’t need to wait for a crisis. Instead, it can come when a provider—such as a pediatrician, therapist or school counselor—notices a child or adolescent experiencing worsening mental health symptoms. The child doesn’t have to go to the emergency department first, Norris says.
The program also approaches care through a multidisciplinary lens, with a team of day-to-day providers including psychiatrists, psychiatric advanced practice nurses, direct care nurses and behavioral health specialists. It also offers specialty services, including psychological testing and speech therapy. Plus, each family works with a designated social worker.
Although its providers don’t directly treat children and adolescents with substance use or eating disorders, the program does include chemical dependency and nutrition evaluation and counseling pathways. There’s also collaboration with community providers.
