Category: Treatment - CBT
Few studies have examined the effectiveness of psychosocial interventions for youth in psychiatric inpatient settings despite significant morbidity and mortality in this population and high re-hospitalization rates. Providing inpatient empirically-based treatment (EBT) is challenging given short length of stay, high comorbidity, and severity of self-injury and suicidality. This study investigated the adaptation of a manualized outpatient CBT treatment for suicidal youthto acute adolescent inpatients. Feasibility and acceptability of this COPES program was examined by tracking intervention completion rates and identifying clinical predictors of adherence and response using demographics, diagnoses, re-hospitalizations, and psychiatric emergency-room visits. Effects of COPES on staff burden were assessed by comparing pre- and post-implementation number of staff sick days, leaves of absence/workers’ compensation, and a staff satisfaction survey. The sample included 463 inpatients (64.58% female) ages 12-16 (M=14.45; SD=1.20). Mean number of diagnoses was 2.38 (SD=1.48), and average length of stay was 9.34 days (SD=8.79).
98.70% of patients completed at least one COPES module. 42.98% completed all four components. No factors cited in the literature as reducing feasibility of EBTs in inpatient settings were associated with module completion (i.e. age, sex, length of stay, diagnoses). Conduct disorder was the only diagnosis associated with lower completion rate of any individual module (Enhancing Life; OR=.62, 95% CI=.42-.90). Survival analyses showed after controlling for age, sex, length of hospital stay, and number of diagnoses, greater number of modules completed predicted longer time to intensive psychiatric service utilization following discharge (OR=.796, 95% CI=.690-.918). Completion of Enhancing Life (OR=.689, 95% CI=.515-.923) and Safety Plan (OR=.649, 95% CI=.450-.936) modules significantly predicted longer time to subsequent intensive services utilization. There was no significant difference in number of staff sick days (p=.086) or leaves of absence/workers’ compensation (p=.425) from pre to post COPES implementation.
Results suggest COPES is feasible and acceptable to implement on inpatient despite potential barriers (i.e. severe comorbid psychopathology, short length of stay) and has no significant impact on staff absenteeism, suggesting COPES does not increase staff burden. Treatment module completion significantly reduces risk for emergency psychiatric service use following discharge, suggesting effectiveness at reducing psychiatric crises in the high-risk period following discharge from inpatient. This may improve cost-effectiveness of intensive psychiatric services. Implications and future directions will be discussed.