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By the Book: Guiding Teens Through Inpatient Psychiatric Stays

By the Book: Guiding Teens Through Inpatient Psychiatric Stays 1024 555 Katie Brind'Amour, PhD, MS, CHES

A new patient guidebook provides evidence-based resources to engage adolescents in their recovery throughout and after their hospital stay.

Inpatient admissions for child and adolescent psychiatry patients typically occur due to a psychiatric crisis. At Nationwide Children’s Hospital, children stay an average of eight days before transitioning to outpatient care. While in the hospital, they have access to group therapy, individual counseling and therapeutic services, psychological testing, family therapy and school services. Now, thanks to years of interdisciplinary collaboration, they also have a customizable workbook to help reinforce what they learn from psychotherapy and make progress during and after their stay.

“It’s become a vital part of how we support patients,” says Ian McKay, PhD, clinical psychologist and clinical assistant professor in the Department of Psychiatry and Behavioral Health at Nationwide Children’s.

The book is now routinely distributed and introduced to families on the first day of inpatient admission.

“These patients are struggling, they’re in crisis and they really want to get better,” says Dr. McKay, who is also senior author on a publication about the guidebook development process. “This gives them immediate access to a book — something they can literally hold onto — that can help stabilize them and guide them throughout their stay.”

Key goals of the guidebook include improving retention of the concepts delivered during daily care activities as well as increasing patient engagement in their recovery. The workbook includes a section that invites patients to explore why they were admitted. It contains evidence-based information about coping strategies for the most common challenges faced by this population: anxiety, depression, anger, hallucinations and more. There is also a section focused on helping prepare patients to transition to back to life outside of the hospital.

Patient participation is rewarded with points the patients can use in the unit’s “store,” which supplies items like stuffed animals, stress balls, journals and other gear. The guidebook also includes blank spaces for self-expression and provides an outlet to fill some of the downtime between scheduled activities. Its psychotherapeutic content is evidence-based and written in age-appropriate language by the clinical team and the hospital’s Patient Education department.

“Walking through each step encourages reflection and helps patients better understand their hospitalization and what they need for recovery,” explains Dr. McKay.

The Nationwide Children’s team aimed to ensure consistency and quality in the information delivered to patients during what can otherwise be a fast-paced, high-stress time. Guidebook development involved input from all clinical stakeholders to boost its adoption and enable its streamlined incorporation into inpatient care practices across multiple disciplines. Even the binding was carefully designed to be free of metal and coils that could be used by patients for self-harm.

The guidebook has become an indispensable tool for both patients and staff. It serves as a shared resource for clinicians, patients and families to refer to during care and after discharge — including outpatient providers, to help them understand the child’s crisis and recovery process. The tool began roll-out in the adolescent inpatient unit at Nationwide Children’s in late 2022. Since then, more than 1,000 patients have received the guidebook.

The team plans to implement adapted versions for parents, younger patients, the Partial Hospitalization Program, Intensive Outpatient Program and other groups moving forward.

“This was a labor of love by Dr. McKay,” says Anna Kerlek, MD, associate clinical professor in the Department of Psychiatry and Behavioral Health at Nationwide Children’s. She attributes the success of the project to Dr. McKay’s determination and commitment after its initiation by the publication’s first author, Oula Khoury, PhD, now at Stanford School of Medicine.

Dr. Kerlek also serves as co-chair of the Inpatient, Residential and Partial Hospitalization Committee of the American Academy of Child and Adolescent Psychiatry — a position that has taught her to appreciate the guidebook even more.

“I hear a lot about what’s happening around the country through my work in AACAP, and I feel fortunate to work at Nationwide Children’s, where we truly provide evidence-based acute care for patients and families,” she says. “Many hospitals lack the resources to launch and sustain a project like this in practice, even just thinking about the help from the hospital’s marketing and print shop teams — there was a lot of background support for making this a reality and a service we can grow moving forward.”

The team feels similar guidebooks could assist patients in hospitals with fewer resources to manage inpatient adolescents, as a general guide to supplement more patient-specific therapy. However, they stress that more work must be done to understand the true impact of the intervention — a complicated matter when many patients take part in additional research initiatives or interventions during their stay.

“Pediatric and adolescent psychiatry is a nascent area in medical research in general, so it’s an exciting field to be in — there is room for creativity and growth,” says Dr. Kerlek. “We believe this guidebook is a valuable tool and a step in the right direction for evidence-based care for this population.”

 

Reference:

Khoury O, Kerlek A, McKay I. Development of a Patient Guidebook for Inpatient Child and Adolescent Psychiatry Units. Child Adolescent Psychiatric Clinics of North America. 2025 Jan;34(1):25-37.

Image credit: Adobe Stock

About the author

Katherine (Katie) Brind’Amour is a freelance medical and health science writer based in Pennsylvania. She has written about nearly every therapeutic area for patients, doctors and the general public. Dr. Brind’Amour specializes in health literacy and patient education. She completed her BS and MS degrees in Biology at Arizona State University and her PhD in Health Services Management and Policy at The Ohio State University. She is a Certified Health Education Specialist and is interested in health promotion via health programs and the communication of medical information.

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