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Discussion

Child/adolescent psych programming

I've worked on an inpatient child/adolescent unit since getting my bachelors in psych 5 years ago. I've recently graduated from nursing school and have transitioned to a nurse on the unit. I'm really trying to be a leader on the unit as our management is pretty poor. Approximately 3 years ago we moved away from a point sheet/level system in hopes of transitioning to CPS (collaborative problem solving). The hospital put a lot of money and time into this effort but without adequate leadership, the change failed and we're now left with no programming. The kids pretty much do as they please and we (the staff) feel powerless and like the unit is out of control when the acuity increases. Management gave me the go ahead to meet with staff and discuss changes that need to be made on the unit, including programming. Does anyone have any experience/suggestions for models that work? Or know of places to get information? I've done some pretty extensive journal searches but only come up with articles on seclusion/restraint, why level systems don't work, and implementing CPS.

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    Are you doing the usual, traditional stuff like morning goals group, group therapy, wrap-up group in the evening? How much time is spent in school? What about arts/crafts activities and physical exercise?

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    Yes, we have two goals groups and a wrap up group at the end of the day, RT activities and therapy groups until 4 pm, and 2 hours of school with IU teachers M-F. Unfortunately we don't have a gym or a lot of options for the kids to get their energy out safely, which is one of the things we'd like to look into. Our staffing grid has been cut significantly in the past 5 years. It used to be doable to have nursing staff lead groups throughout the day but most of our time is now spent doing paperwork and more or less babysitting and redirecting the kids. We're looking for some sort of structure for the unit and motivation for the kids to want to participate in treatment/follow directions without being punitive and causing more acting out behaviors.

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