Discharge interventions from inpatient child and adolescent mental health care: a scoping review
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REVIEW
Discharge interventions from inpatient child and adolescent mental health care: a scoping review A. Chen1 · C. Dinyarian2 · F. Inglis3 · C. Chiasson3 · Kristin Cleverley2,3,4 Received: 25 March 2020 / Accepted: 26 August 2020 © The Author(s) 2020
Abstract The post-discharge period is an extremely vulnerable period for patients, particularly for those discharged from inpatient children and adolescent mental health services (CAMHS). Poor discharge practices and discontinuity of care can put children and youth at heightened risk for readmission, among other adverse outcomes. However, there is limited understanding of the structure and effectiveness of interventions to facilitate discharges from CAMHS. As such, a scoping review was conducted to identify the literature on discharge interventions. This scoping review aimed to describe key components, designs, and outcomes of existing discharge interventions from CAMHS. Nineteen documents were included in the final review. Discharge interventions were extracted and summarized for pre-discharge, post-discharge, and bridging elements. Results of this scoping review found that intervention elements included aspects of risk assessment, individualized care, discharge preparation, community linkage, psychoeducation, and follow-up support. Reported outcomes of discharge interventions were also extracted and included positive patient and caregiver satisfaction, improved patient health outcomes, and increased cost effectiveness. Literature on discharge interventions from inpatient CAMHS, while variable in structure, consistently underscore the role of such interventions in minimizing patient and family vulnerability post-discharge. However, findings are limited by inadequate reporting and heterogeneity across studies. There is a need for further research into the design, implementation, and evaluation of interventions to support successful discharges from inpatient child and adolescent mental health care. Keywords Mental health · Discharge · Scoping review · Child · Adolescent
Introduction Discharge from psychiatric inpatient care can be a time of vulnerability for patients due to the complexity of instructions, transitions between care providers, and shifts in responsibility of those involved [1–3]. These risks may be even more pressing for the pediatric age group, a demographic more likely to experience the onset of mental illness than any other age group [4]. In the United States, pediatric mental health admissions have increased approximately 50% * Kristin Cleverley [email protected] 1
Faculty of Medicine, University of Toronto, Toronto, Canada
2
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
3
Centre for Addiction and Mental Health, Toronto, Canada
4
Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
in the past fifteen years [5] and a doubling of emergency department visits related to suicidal attempts and suicidal ideation among youth during 2007–2015 [6]. Existing rese
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