This client came to the KidsPeace Children’s Hospital with an extensive history of mental and behavioral health treatment. She has had previous hospitalizations and residential placements related to anger outbursts, aggression towards herself and others and at time erratic behaviors. These behaviors were exhibited in all settings of home, school and community.
Her previous treatment history included KidsPeace’s Diagnostic program when she was younger along with a long history of community and home-based services. Her medication management treatment was also complex in several trials of medications to assist in mental stability and behavioral stability.
In addition to the presenting problems, she was adopted at a young age from another country and it is suspected she endured abuse at the orphanage in her country of origin. She had also recently reported that just prior to this admission another client in a facility she was placed in had attempted or engaged with her in an inappropriate manner and identified this was something she was struggling with as well at the time of admission to KidsPeace Children’s Hospital.
While at the inpatient level of care, she presented with a significant amount of aggression She was easily triggered or upset by directions or tasks placed upon her that were non-preferred or auditory stimulation (as in loud noises). However, she herself was charismatic, personable and energetic. It was quickly discovered she enjoyed very much to laugh with peers and staff and sharing jokes with others.
Given her extensive mental health and behavioral health treatment from different providers, the treatment team took a collaborative approach involving in-depth conversations with the family and previous providers to individualize her care at the inpatient level of treatment. The family remained an ongoing support for her and would provide observational feedback while they had visits throughout the weekends and during family therapy sessions and phone calls. Her family was well versed in the different community-based services and previous treatment plans that have been successful for her. Her parents were an additional resource at times when she was struggling in a different manner than the staff was accustomed to, and they were also helpful in discussions related to previous trials of medications. They would offer educated suggestions of how to manage her outbursts, supply information about previous behavioral plans or contracts and incentive systems she had in other settings such as home, school and community.
Amongst adjustments to her individualized programming, this client also received medication management services from the psychiatrist to address the severity and intensity of her aggression along with mood stability. The psychiatry department worked closely with her parents to provide clear rational, communication and feedback related to medication adjustments being suggested, implemented and assessed.
In addition to the information from previous providers, the hospital treatment team utilized behavioral modification plans to put in place where she was able to demonstrate positive, safe behavior for a duration of time along with utilizing the Komfort Room to manage her anxieties and feelings of being overwhelmed, and provide her with sensory feedback that can produce calming sensations. The Komfort Room is an additional resource in the KidsPeace Children’s Hospital that provides sensory stimulation for individuals that require additional interventions. Within the Komfort Room a client can chose from a variety of tactile, visual sensations to induce relaxation, calmness and peace. This room is often utilized for clients that struggle with anxiety and overall feelings of being overwhelmed or stressed.
To manage some of her energy that at times could lead to her becoming off task or possibly crisis, the treatment team used an outdoor ball in the hallways as a stress reliever and/or coping skill. Here she would have individualized attention from staff, engaging in a physical activity and would have reminder or prompts to start transitioning her back to the unit to continue in programming. Gradually over time this increased her ability to maintain stabilize, participate and grow in her ability to maintain safety to herself and others more frequently. With these factors in place, she was able to gain a longer time period of stabilization.
Her family would often come in for visits and have daily phone calls with her; they were proud of her improvements in managing herself in a positive way.
The ultimate goal of our Hospital treatment teams is to provide the benefits of collaborative efforts of a multi-disciplinary team in managing complex cases related to mental and behavioral health needs. The collaboration of these disciplines for her treatment at the inpatient level of care contributed to her having a successful discharge in accordance with the KidsPeace Continuum of Care.
- By Katie Lennon
KidsPeace now offers TRICARE adolescent hospital and residential treatment programs on our Orchard Hills Campus in Pennsylvania. TRICARE certification allows us to provide a complete continuum of care for our clients whose families are in the military.
