The Hospitalized Adolescent

Implementation of Contraception Care for Psychiatrically Hospitalized Adolescents: A Hybrid Type 2 Effectiveness-Implementation Study

PURPOSE

To examine the implementation and effectiveness of a contraception care intervention for adolescents hospitalized with psychiatric disorders.

METHODS

This prospective, observational, hybrid type 2 effectiveness-implementation study examined the effectiveness of the Contraception Care at the Behavioral Health Pavilion (CC@BHP) intervention in 4 inpatient psychiatric units at a quaternary children's hospital. A multifaceted implementation blueprint guided implementation. CC@BHP is a clinical pathway intervention designed to increase access to contraceptive counseling and initiation during hospitalization. Eligible patients were assigned female at birth, at least 14 years old, and admitted to one of four units between December 2021 and February 2023. Implementation outcomes were provider adoption (documentation of assessing interest in contraception care) and intervention reach (order placed for contraception consultation). Intervention effectiveness outcomes assessed downstream health service access, including patient receipt of contraception consultation and contraceptive prescription/initiation.

RESULTS

Across 1,461 visits, the mean patient age was 15.9 years and 63.4% were White. Forty percent (n = 586) of visits included at least one intervention component. Overall, healthcare providers adopted CC@BHP in 29.0% (n = 424) of visits and ordered contraception consultations in 19.1% (n = 279) of visits (reach). Adolescents received contraception consultations in 16.7% (n = 244) of visits and 116 patients (7.9%) initiated a contraceptive (effectiveness). Later study waves demonstrated greater adoption and reach.

DISCUSSION

Implementation improved over time and CC@BHP delivered contraceptive counseling and initiation, including implants and intrauterine devices, in a large quaternary hospital to interested adolescents. Inpatient psychiatry admissions offer a timely opportunity to address reproductive health needs of adolescents.

Training on Inpatient Child and Adolescent Psychiatry Units

Child and adolescent psychiatry (CAP) inpatient units are a common site in academic settings for trainee education. The authors review the foundational aspects of education that should be covered during these rotations. Trainees should begin with a solid foundation of child and adolescent development and learn how this impacts risk assessment, formulation, and treatment planning. In addition, the authors review milieu considerations, agitation management, legal considerations, family involvement, systems of care, trainee supervision, transference, countertransference, and the Accreditation Council for Graduate Medical Education requirements as they relate to resident and fellow education on a CAP inpatient unit.

Current Inpatient Screening Practices for Sexual History and STIs: An Opportunity to Seize

The American Academy of Pediatrics recommends utilizing hospitalizations as an opportunity to provide sexual health screenings for adolescents. This study aimed to describe the current practice of sexual history documentation (SHxD) and sexually transmitted infection (STI) testing among adolescents admitted to a pediatric hospital medicine service. Retrospective cross-sectional study of adolescents (14-19 years old) admitted to the PHM service from 2017-2019 was performed at an academic children's health system. Patient (demographics, history of complex chronic condition, and insurance), hospitalization (length of stay, diagnosis, STI tests ordered/results), and physician (level of training and gender) characteristics were extracted for each encounter. A natural language processing algorithm identified the presence of SHxD. Univariate analysis and multivariable analysis were performed to detect factors associated with SHxD and STI screening. The prevalence of STIs was calculated for those who were tested. Out of 2242 encounters, SHxD and STI testing rates were 40.9% and 17.2%, respectively. Patient gender, race, lack of complex chronic condition, and resident involvement were predictive of SHxD and STI testing. SHxD increased the odds of STI testing significantly (OR 5.06, CI 3.90-6.58). Among those who were tested, the prevalence of STIs was highest for chlamydia (37/329, 11.2%). Overall, sexual health screening rates remain low in the hospital setting and future improvement initiatives are needed.

The Hospitalized Adolescent

This clinical report provides pediatricians evidence-based information on the developmentally appropriate, comprehensive clinical care for hospitalized adolescents. Included in this report are opportunities and challenges facing pediatricians when caring for specific hospitalized adolescent populations. The companion policy statement, “The Hospitalized Adolescent,” includes detailed descriptions of adolescent hospital admission demographics, personnel recommendations, and hospital setting and design advice, as well as sections on educational services, legal and ethical matters, and transitions to adult facilities.