Inpatient Milieu Therapy: Considerations for Adolescent and Transitional Age Youth

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.

Milieu Management and Therapeutic Groups in Inpatient Child and Adolescent Psychiatry Units

The therapeutic milieu has long been considered an essential mechanism of recovery for youth requiring inpatient psychiatric admissions. However, with increasing demand for crisis services, shrinking length of stay, rising patient acuity, and critical workforce shortages, innovation is necessary to maintain the goals of the therapeutic milieu (and equip the workforce to meet this challenge). This review surveys the evolution of the goals of milieu therapy over time, evidence for increasing challenges, and initial evidence for possible solutions. The study concludes with a case example detailing efforts to improve milieu therapy and empower frontline staff at a Midwestern pediatric hospital.