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Reinbergs EJ, Smith LH, Au JS, Marraccini ME, Griffin SA, Rogers ML. Potential Harms of Responding to Youth Suicide Risk in Schools. Res Child Adolesc Psychopathol 2025; 53:785-799. [PMID: 39448436 PMCID: PMC12022146 DOI: 10.1007/s10802-024-01261-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2024] [Indexed: 10/26/2024]
Abstract
The potential harms related to interventions for adults with suicide-related risk, particularly hospitalization, have been well documented. Much less work has focused on the potential harms related to interventions with youth struggling with suicidal thoughts and behaviors. Young people are most likely to receive mental health services in schools, which are recognized as meaningful sites for effective suicide prevention work. However, no overviews have conceptualized the potential harms to youth when schools engage in ineffective suicide prevention efforts. In this article, we discuss three prominent overlapping areas of potential harms: (1) privacy-related, (2) relationship-related, and (3) mental health-related. We then discuss key factors thought to influence the development and maintenance of these potential harms. We conclude by noting ways in which school-based mental health providers may attempt to reduce unintentional harms in this area, with an overarching goal of helping support school mental health providers and the youth they serve.
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Affiliation(s)
- Erik J Reinbergs
- Department of Psychology, Utah State University, 6405 Old Main Hill, Logan, UT, USA.
| | - Lora Henderson Smith
- School of Education and Human Development, University of Virginia, Charlottesville, VA, USA
| | - Josephine S Au
- Department of Applied Psychology, Northeastern University, Boston, MA, USA
| | - Marisa E Marraccini
- School of Education, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Sarah A Griffin
- Clinical Health and Applied Sciences, University of Houston Clear Lake, Clear Lake, TX, USA
| | - Megan L Rogers
- Department of Psychology, Texas State University, San Marcos, TX, USA
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2
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Smith LH, Hendrickson N, Warren E, Tran A, Savina E. Training School Staff to Support Students Returning to School After A Psychiatric Hospitalization. SCHOOL MENTAL HEALTH 2025; 17:19-31. [PMID: 40342867 PMCID: PMC12058121 DOI: 10.1007/s12310-024-09717-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2024] [Indexed: 05/11/2025]
Abstract
Supporting students returning to school after a mental health crisis often involves more training than many school staff members receive. With the increase in youth mental health diagnoses, there has also been an increase in the number of youth requiring psychiatric emergency department visits and hospitalizations. As such, this study employed a basic qualitative design to gather the perspectives of school staff who support students' mental health about their experiences and training needs related to supporting youth returning to school after psychiatric hospitalization. Semi-structured interviews were conducted with 10 school mental health professionals or administrators. Thematic analysis was used to analyze the data. Three themes were identified: 1) most participants received minimal formal training in graduate school on hospital to school transition, 2) most participants learned about hospital to school transition on the job, and 3) participants made recommendations and identified specific training needs. Implications for training are discussed including a need for variety (e.g., some practitioners need basic training while others need more advanced training) and different format preferences (in-person may be preferred but online asynchronous is more convenient).
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Affiliation(s)
| | | | - Emily Warren
- University of Virginia, School of Education and Human Services
| | - Amy Tran
- University of Virginia, School of Education and Human Services
| | - Elena Savina
- James Madison University, Department of Graduate Psychology
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3
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Marraccini ME, McGraw CB, Henderson Smith L, Pittleman C, Griffard M, Vanderburg JL, Tow AC, Middleton TJ, Cruz CM. Information sharing between psychiatric hospitals and schools to better support adolescents returning to school following a suicide-related crisis. J Sch Psychol 2024; 106:101343. [PMID: 39251318 PMCID: PMC11384308 DOI: 10.1016/j.jsp.2024.101343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 06/07/2024] [Accepted: 06/07/2024] [Indexed: 09/11/2024]
Abstract
As rates of adolescent hospitalization for suicide-related crises increase, so does the urgency for improving adolescent school reintegration. Communication and collaboration are considered key mechanisms for continuity of care during times of transition; however, to date, few studies have identified critical information to share or have explored strategies for navigating challenges to information sharing during and following school reintegration. The present study explored previously hospitalized adolescent (n = 19), parent (n = 19), school professional (n = 19), and hospital professional (n = 19) views of information sharing and their perceptions of facilitators and barriers to this communication. Applied thematic analysis revealed three key themes related to the best information to share across entities, including the (a) need to consider environmental relevance to information (i.e., informing school supports and hospital treatment), (b) importance of considering information unique to each patient's circumstance (i.e., sharing information on a "case-by-case basis"), and (c) duality between families preferring to share minimal information but school professionals desiring the maximum (i.e., less is more vs. more is better). Regarding facilitators and barriers to information sharing, six key themes emerged, including (a) understanding risks and benefits of information sharing; (b) trust in hospitals and schools; (c) mental health stigma; (d) communication processes; (e) navigating individual, family, school, and community contexts; and (f) "push and pull" between privacy and need. Findings inform key considerations for collaborating with families in determining if and what information to share during school reintegration.
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Affiliation(s)
- Marisa E Marraccini
- School of Education, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Chelsea B McGraw
- School of Education, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Lora Henderson Smith
- School of Education and Human Development, University of Virginia, Charlottesville, VA, USA.
| | - Cari Pittleman
- School of Education, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Megan Griffard
- College of Education, University of Nevada, Las Vegas, Las Vegas, NV, USA.
| | - Juliana L Vanderburg
- School of Education, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Amanda C Tow
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Telieha J Middleton
- School of Education, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Christina M Cruz
- School of Education, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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4
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Wang Y, Chen X, Song C, Wu Y, Liu L, Yang L, Hao X. A qualitative internet-based study of parental experiences of adolescents suffering from affective disorders with non-suicidal self-injury during the COVID-19 pandemic. Front Psychiatry 2024; 15:1361144. [PMID: 38596632 PMCID: PMC11002897 DOI: 10.3389/fpsyt.2024.1361144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 03/12/2024] [Indexed: 04/11/2024] Open
Abstract
Objective Non-suicidal self-injury (NSSI) behaviors of adolescents with affective disorders can directly deteriorate parents' internal experiences, and negative parental experiences can exacerbate or even worsen NSSI behaviors. This study investigates the impact of NSSI behaviors exhibited by adolescents with affective disorders on the internal experiences of parents. Specifically, our research focuses on the inner experiences of parents when their children engage in NSSI behaviors during social isolation of the COVID-19, offering insights for addressing parental mental health issues related to NSSI and developing positive parental behavioral models to optimize adolescent behavior during major public health events. Methods Semi-structured interviews were conducted with 21 parents of adolescents with affective disorders displaying NSSI behaviors during the COVID-19 pandemic. The Colaizzi 7-step analysis was employed to refine and categorize emerging themes. Results Our study revealed that parents of adolescents facing NSSI during the COVID-19 pandemic underwent different internal experiences, which could be classified into four themes: negative experience, high caregiving burden, lack of caregiving capacity, and resilience. Conclusion This Internet-based research is the first to explore the internal experiences of parents of adolescents with affective disorders experiencing NSSI during the COVID-19 pandemic. It sheds light on how parents, in response to their children's NSSI behaviors, undergo resilience following negative experiences, explore more open and supportive family model. Despite these positive outcomes, parents express a need for increased knowledge about NSSI illness care and a desire for professional assistance.
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Affiliation(s)
- Yongna Wang
- Beijing Hui-Long-Guan Hospital, Peking University, Beijing, China
| | - Xueqiu Chen
- Beijing Hui-Long-Guan Hospital, Peking University, Beijing, China
| | - Chun Song
- Xinjiang Key Laboratory of Neurological Disorder Research, The Second Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yan Wu
- Beijing Hui-Long-Guan Hospital, Peking University, Beijing, China
| | - Lihua Liu
- Beijing Hui-Long-Guan Hospital, Peking University, Beijing, China
| | - Lili Yang
- Beijing Hui-Long-Guan Hospital, Peking University, Beijing, China
| | - Xuege Hao
- Beijing Hui-Long-Guan Hospital, Peking University, Beijing, China
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Ormiston HE, Husmann PR, Wikel KC, Ruark C, Reisinger DL, Curtin MJ. An Exploratory Study of Educators' Perspectives Towards Hospital School Program Support for Children with Special Health Care Needs After Hospitalization. CONTINUITY IN EDUCATION 2024; 5:31-49. [PMID: 38774599 PMCID: PMC11104305 DOI: 10.5334/cie.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/17/2024] [Indexed: 05/24/2024]
Abstract
More than 14 million children in the United States are identified as children with special healthcare needs (CSHCN). Rates of hospitalization for CSHCN with chronic conditions as well as re-admissions have been increasing in recent years. For hospitalized children transitioning back to their school of record, a host of issues may arise such as socioemotional concerns, peer rejection, and being behind in academics. Hospital-based school programs (HBSPs) play an important role in the transition back to a child's school of record. Utilizing a database of inpatient CSHCN at a midwestern children's hospital's HBSP, private and public-school educators associated with the previously hospitalized CSHCN were asked to complete an online survey to gather their perspectives related to the child's transition back to the school of record upon hospital discharge. Overall, educators' perspectives of the HBSP were positive while perceptions related to communication provided by the HBSP were mixed. Educators surveyed reported a lack of training related to working with CSHCN. Finally, accommodations and services offered to students upon return to school focused mostly on academic performance and attendance. Study limitations and implications for practice in schools are discussed.
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Affiliation(s)
| | | | | | | | - Debra L. Reisinger
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, US
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Smith LH, Warren E, Hendrickson N, Joshua K. An Empty Scoping Review of Emergency Department to School Transition for Youth with Mental Health Concerns. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.23.24301673. [PMID: 38343854 PMCID: PMC10854341 DOI: 10.1101/2024.01.23.24301673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
The number of youth Emergency Department (ED) visits due to mental health concerns has been steadily increasing with a large number of youth being referred from school. Despite the increase in ED visits, there has not been an increase in the number of students who are actually admitted to the hospital. Further, youth referred from school are more likely to be discharged from the ED. Given the unique relationship between school and ED referrals and the large number of youth who do not require hospitalization, this study sought to understand how schools are supporting students who return to school after an ED visit. We conducted a scoping review to identify programs and practices to support ED to school transition. Two reviewers screened 907 manuscripts, but none of the manuscripts met the inclusion criteria. We discuss the importance of supporting students returning to school from the ED and draw from the literature on hospital to school transition to make recommendations for educators.
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Affiliation(s)
| | - Emily Warren
- University of Virginia, School of Education & Human Development
| | | | - Kate Joshua
- University of Virginia, Claude Moore Health Sciences Library
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7
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Marraccini ME, Griffard MKR, Whitcomb CE, Wood C, Griffin DC, Pittleman C, Sartain L. School-based Mental Health Supports During COVID-19: School Professional Perspectives. PSYCHOLOGY IN THE SCHOOLS 2023; 60:2460-2482. [PMID: 37692888 PMCID: PMC10488322 DOI: 10.1002/pits.22869] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 01/15/2023] [Indexed: 01/28/2023]
Abstract
Objective The present study explored the ways school professionals adapted school-based mental health supports and services for remote delivery during the COVID-19 pandemic. Method We surveyed 81 school professionals (e.g., counselors, psychologists, social workers) and conducted in-depth interviews with a subsample of professionals (n=14) to explore their perceptions and experiences of supporting youth with mental health concerns and suicide-related risk during the fall and winter of the 2020-2021 school year. Results Commonly endorsed school-based mental health interventions (e.g., counseling services, checking in), ways of communicating (phone, email), and individuals delivering supports and services to students with suicide-related risk (e.g., counselors, teachers) were identified based on school professional survey responses. Qualitative findings point to facilitators (e.g., specific platforms for connecting with students and families) and barriers (e.g., limited communication) to successful service delivery during COVID-19. Conclusion Findings highlight the creative ways school support professionals adapted to provide school-based mental health supports. Implications for remote school-based mental health services during and following the pandemic are discussed.
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Affiliation(s)
| | | | - Cason E Whitcomb
- Gillings School of Public Health, University of North Carolina at Chapel Hill
| | - Caitlin Wood
- School of Education, University of North Carolina at Chapel Hill
| | - Dana C Griffin
- School of Education, University of North Carolina at Chapel Hill
| | - Cari Pittleman
- School of Education, University of North Carolina at Chapel Hill
| | - Lauren Sartain
- School of Education, University of North Carolina at Chapel Hill
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8
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Vanderburg JL, Tow AC, Marraccini ME, Pittleman C, Cruz CM. Caregiver Experiences of Adolescent School Reentry After Adolescent Hospitalization Due to Suicidal Thoughts and Behaviors: Recommendations to Improve Reentry Practices. THE JOURNAL OF SCHOOL HEALTH 2023; 93:206-218. [PMID: 36575594 PMCID: PMC9928915 DOI: 10.1111/josh.13291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 11/07/2022] [Accepted: 11/10/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Suicide rates among adolescents increased over the past few decades. Following psychiatric hospitalization, many adolescents return to school, a context that can influence recovery. Families can play an integral role in supporting adolescents through the hospitalization and school reentry process; however, little research has focused on family experiences during adolescent school reentry. Grounded in ecological systems theory, the aim of the present study was to explore the experiences of caregivers whose children were hospitalized for suicidal thoughts and behaviors (STBs) and provide recommendations for the school reentry process. METHODS In-depth interviews were conducted with caregivers (n = 19) whose adolescents returned to school following hospitalization for suicide-related crises. Researchers analyzed the transcribed interviews using applied thematic analysis. RESULTS Themes emerged regarding academic difficulties during hospitalization; breakdowns in communication between schools, families, and hospitals; logistical challenges during the school reentry planning process; and challenges navigating peer relationships and academics following school reentry. IMPLICATIONS AND CONCLUSIONS Few reentry recommendations account for the specific challenges faced by families. Recommendations informed by caregiver experiences are needed to ensure that families can effectively support the recoveries of their children. This study presents caregiver-informed recommendations to facilitate an improved reentry process for caregivers and adolescents.
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Affiliation(s)
- Juliana L Vanderburg
- School Psychology Program, University of North Carolina at Chapel Hill School of Education, Chapel Hill, NC, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Amanda C Tow
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Marisa E Marraccini
- School Psychology Program, University of North Carolina at Chapel Hill School of Education, Chapel Hill, NC
| | - Cari Pittleman
- School Psychology Program, University of North Carolina at Chapel Hill School of Education, Chapel Hill, NC
| | - Christina M Cruz
- School Psychology Program, University of North Carolina at Chapel Hill School of Education, Chapel Hill, NC, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
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9
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Midura S, Fodstad JC, White B, Turner AJ, Menner S. Supportive Transition Planning for Adolescents Transitioning From Psychiatric Hospitalization to School: A Systematic Literature Review and Framework of Practices. CONTINUITY IN EDUCATION 2023; 4:23-40. [PMID: 38774904 PMCID: PMC11104309 DOI: 10.5334/cie.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 11/24/2022] [Indexed: 05/24/2024]
Abstract
School-aged youth with behavioral health needs often struggle in the academic environment. When admitted to acute psychiatric hospital settings, the student's difficulties and needs increase upon discharge and return to the school setting. While the literature describes systemic issues in transitioning from an acute psychiatric hospital to the school setting, limited resources exist for practitioners to plan for and support the successful reintegration of affected students. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the purpose of the current systematic review was to collect and synthesize evidence from the literature (N = 20) in the areas of barriers, challenges, and significance of the need for a formal transition planning framework. Four major key factors emerged as important to assist in creating a transition planning framework for acute psychiatric hospitals to school-based settings: (a) Stakeholder Voice (Student, Caregiver, Hospital/Treatment Team, or School Team Voice); (b) Establishing a Point Person for Transition (Medical or School Point Person); (c) Recommendations/Accommodations (Formal or Informal Supports); and (d) Having a Transition Meeting. Other common factors are discussed, and recommendations are provided to aid practitioners in increasing the likelihood that school-age youth succeed in the school environment post-discharge from acute psychiatric settings. Finally, gaps in the literature are identified as areas for further research.
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Affiliation(s)
- Sara Midura
- Northwest Education Services (current), US
- Riley Hospital for Children (former), US
| | - Jill C. Fodstad
- Indiana University Health
- Indiana University School of Medicine, US
| | - Benjamin White
- Multnomah ESD at The Unity Center for Behavioral Health, US
| | | | - Scott Menner
- Archdiocese of Cincinnati (Current), US
- Cincinnati Children’s Hospital (Former), US
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10
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Framework for successful school reintegration after psychiatric hospitalization: A systematic synthesis of expert recommendations. PSYCHOLOGY IN THE SCHOOLS 2022. [DOI: 10.1002/pits.22791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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11
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Marraccini ME, Pittleman C, Griffard M, Tow AC, Vanderburg JL, Cruz CM. Adolescent, parent, and provider perspectives on school-related influences of mental health in adolescents with suicide-related thoughts and behaviors. J Sch Psychol 2022; 93:98-118. [PMID: 35934453 PMCID: PMC9516717 DOI: 10.1016/j.jsp.2022.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/04/2022] [Accepted: 07/06/2022] [Indexed: 10/17/2022]
Abstract
Previous research supports a link between school-related factors, such as bullying and school connectedness, and suicidal thoughts and behaviors. To deepen understanding of how school experiences may function as both protective and risk factors for youth struggling with suicidal thoughts and behaviors, this qualitative study explored multiple perspectives. Specifically, in-depth interviews were conducted with adolescents previously hospitalized for a suicidal crisis (n = 19), their parents (n = 19), and the professionals they may interact with in schools and hospitals (i.e., school professionals [n = 19] and hospital providers [n = 7]). Data were analyzed using applied thematic analysis revealing three main themes related to perceptions of how school experiences can positively or negatively impact mental health, including (a) school activities, (b) school social experiences, and (c) school interventions. An emergent theme related to the complexity of suicide-related risk identified the ways in which school experiences may intersect with other environmental, biological, and psychological factors. Findings underscore the need for school-based approaches to address the unique academic, social, and emotional needs of students with suicide-related risk that complement the supports and services provided in their home and community.
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Affiliation(s)
- Marisa E Marraccini
- School of Education, University of North Carolina at Chapel Hill, Campus Box 3500, Peabody Hall, Chapel Hill, NC 27599, United States.
| | - Cari Pittleman
- School of Education, University of North Carolina at Chapel Hill, Campus Box 3500, Peabody Hall, Chapel Hill, NC 27599, United States
| | - Megan Griffard
- School of Education, University of North Carolina at Chapel Hill, Campus Box 3500, Peabody Hall, Chapel Hill, NC 27599, United States
| | - Amanda C Tow
- School of Medicine, University of North Carolina at Chapel Hill, 101 Manning Drive Campus Box 7160, Chapel Hill, NC 27599, United States
| | - Juliana L Vanderburg
- School of Education, University of North Carolina at Chapel Hill, Campus Box 3500, Peabody Hall, Chapel Hill, NC 27599, United States; School of Medicine, University of North Carolina at Chapel Hill, 101 Manning Drive Campus Box 7160, Chapel Hill, NC 27599, United States
| | - Christina M Cruz
- School of Education, University of North Carolina at Chapel Hill, Campus Box 3500, Peabody Hall, Chapel Hill, NC 27599, United States; School of Medicine, University of North Carolina at Chapel Hill, 101 Manning Drive Campus Box 7160, Chapel Hill, NC 27599, United States
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12
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Dickson KS, Sklar M, Chen SZ, Kim B. Characterization of multilevel influences of mental health care transitions: a comparative case study analysis. BMC Health Serv Res 2022; 22:437. [PMID: 35366865 PMCID: PMC8976965 DOI: 10.1186/s12913-022-07748-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/08/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Mental health care transitions are increasingly prioritized given their potential to optimize care delivery and patient outcomes, especially those focused on the transition from inpatient to outpatient mental health care. However, limited efforts to date characterize such mental health transition practices, especially those spanning multiple service setting contexts. Examination of key influences of inpatient to outpatient mental health care transitions across care contexts is needed to inform ongoing and future efforts to improve mental health care transitions. The current work aims to characterize multilevel influences of mental health care transitions across three United States-based mental health system contexts. METHODS A comparative multiple case study design was used to characterize transition practices within the literature examining children's, non-VA adult, and VA adult service contexts. Andersen's (1995) Behavioral Health Service Use Model was applied to identify and characterize relevant distinct and common domains of focus in care transitions across systems. RESULTS Several key influences to mental health care transitions were identified spanning the environmental, individual, and health behavior domains, including: community capacity or availability, cross-system or agency collaboration, provider training and experience related to mental health care transitions, client care experience and expectations, and client clinical characteristics or complexity. CONCLUSIONS Synthesis illustrated several common factors across system contexts as well as unique factors for further consideration. Our findings inform key considerations and recommendations for ongoing and future efforts aiming to plan, expand, and better support mental health care transitions. These include timely information sharing, enhanced care coordination and cross setting and provider communication, continued provider/client education, and appropriate tailoring of services to improve mental health care transitions.
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Affiliation(s)
- Kelsey S. Dickson
- Department of Child and Family Development, San Diego State University, San Diego, CA USA
- Child and Adolescent Services Research Center, San Diego, CA USA
| | - Marisa Sklar
- Child and Adolescent Services Research Center, San Diego, CA USA
- Department of Psychiatry, University of California, San Diego, San Diego, CA USA
- UC San Diego ACTRI Dissemination and Implementation Science Center, San Diego, CA USA
| | - Serena Z. Chen
- Harvard South Shore Psychiatry Residency Training Program, Harvard Medical School / VA Boston Healthcare System, Boston, MA USA
- Department of Psychiatry, Harvard Medical School, Boston, MA USA
| | - Bo Kim
- Harvard South Shore Psychiatry Residency Training Program, Harvard Medical School / VA Boston Healthcare System, Boston, MA USA
- Department of Psychiatry, Harvard Medical School, Boston, MA USA
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA USA
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13
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Marraccini ME, Pittleman C, Toole EN, Griffard MR. School Supports for Reintegration Following a Suicide-Related Crisis: A Mixed Methods Study Informing Hospital Recommendations for Schools During Discharge. Psychiatr Q 2022; 93:347-383. [PMID: 34599735 PMCID: PMC8486966 DOI: 10.1007/s11126-021-09942-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/07/2021] [Indexed: 11/17/2022]
Abstract
The immediate period following psychiatric hospitalization is marked by increased risk for suicide behavior and rehospitalization. Because adolescents commonly return to school settings following hospital discharge, school-related stressors and supports are important considerations for psychiatric treatment and discharge planning. The current study aimed to inform recommendations provided by hospitals to schools to improve school reintegration practices by employing a concurrent, mixed-methods design. Specifically, we: (1) surveyed school professionals (n = 133) in schools varying in resource availability and populations in one southeastern state of the United States about supports and services provided to returning students; and (2) conducted in-depth interviews with a subset of these professionals (n = 19) regarding their perceptions of the hospital to school transition for youth recovering from suicide-related crises. Findings from survey responses indicated that, compared to schools located in urban and suburban areas, schools in rural areas were less likely to have school reintegration protocols for returning students. More generally, however, available interventions and modifications were relatively consistent across rural and urban/suburban schools, schools serving high and low poverty communities, and schools with predominantly white and predominantly ethnic and racial minoritized student bodies. Key themes across interviews signify the importance of communication between stakeholders, the type of information used to develop re-entry plans, available school-based services for returning youth, and the need to mitigate stigma associated with mental health crises. Findings inform recommendations that can be provided by hospitals to schools to support adolescent recovery as they return to school following psychiatric hospitalization.
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Affiliation(s)
- Marisa E Marraccini
- School of Education, University of North Carolina at Chapel Hill, Chapel Hill, USA.
| | - Cari Pittleman
- School of Education, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Emily N Toole
- School of Education, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Megan R Griffard
- School of Education, University of North Carolina at Chapel Hill, Chapel Hill, USA
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14
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Marraccini ME, Pittleman C. Returning to School Following Hospitalization for Suicide-Related Behaviors: Recognizing Student Voices for Improving Practice. SCHOOL PSYCHOLOGY REVIEW 2022; 51:370-385. [PMID: 36034937 PMCID: PMC9400799 DOI: 10.1080/2372966x.2020.1862628] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Adolescent hospitalizations for suicide-related behaviors have increased in recent years, with the highest rates occurring during the academic school year. Schools are a primary environment that adolescents return to following hospitalization, making them an important context for understanding recovery following a suicidal crisis. Although previous research highlights provider perceptions for improving this transition, limited research has focused on adolescent views. This qualitative study presents findings from interviews with 19 adolescents previously hospitalized for a suicide-related crisis. Results highlight the need to strengthen social supports for returning youth. Specifically, findings suggest the importance of emotional supports (e.g., positive school relationships and a safer psychosocial school climate), instrumental supports (e.g., collaborations and communication around re-entry), informational supports (clearer procedures for academics and re-entry processes), and appraisal supports that acknowledge the complexity of adolescent functioning upon return. Findings reinforce the importance of the school psychologist's role in partnering with returning youth and their families and providing consultation to other school professionals about supporting their recovery.
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15
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Preyde M, Parekh S, Markov A, Carpenter H, Heintzman J. School Re-Entry of Adolescent Patients Discharged from
Psychiatric Hospital: One Step in Continuous Quality
Improvement. ADOLESCENT PSYCHIATRY 2021. [DOI: 10.2174/2210676611666211105121616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective:
School re-entry following hospitalization for psychiatric care
has been reported as difficult for many adolescent patients. Continuous quality
improvement initiatives may improve programming to enhance school re-entry
experiences. The purpose for this study was to explore the school re-entry
perspectives of the youth discharged from a psychiatric inpatient unit after
implementing programs that patients previously identified as needed.
Methods:
A survey was administered to the youth about one month after discharge
to gather their perspective of their school re-entry, along with self-rated resilience
and stress.
Results:
Twenty-six youth (23%) participated in the post-discharge survey who
reported a mean age of 15.6 years (SD 1.0), 77% identified as female, 13 (50%)
provided very positive re-entry comments, eight (31%) reported moderately
positive experiences, and five (19%) reported a very poor school re-entry. Mean
perceived resilience (4.01, SD 0.6) and stress (3.42, SD 0.8) scores suggest youth
thought they had good resilience and moderate stress.
Conclusions:
Most youth reported a good school re-entry. Considerable concerns
remain for the 19% who reported a poor school re-entry who may benefit from
specialized outpatient or day programming post-discharge before attempting a
return to school. Future directions for research are provided.
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Affiliation(s)
- Michèle Preyde
- College of Social and Applied Human Sciences, University of Guelph, Guelph, Ontario,Canada
| | - Shrenik Parekh
- Child and Adolescent Psychiatry, Grand River Hospital, Kitchener, Ontario,Canada
| | - Anna Markov
- College of Social and Applied Human Sciences, University of Guelph, Guelph, Ontario,Canada
| | - Hayley Carpenter
- College of Social and Applied Human Sciences, University of Guelph, Guelph, Ontario,Canada
| | - John Heintzman
- Child and Adolescent Psychiatry, Grand River Hospital, Kitchener, Ontario,Canada
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16
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Nickerson AB, Breux P, Schaffer GE, Samet M. An Initial Evaluation of the Helping Students at Risk for Suicide Professional Development Workshop. SCHOOL PSYCHOLOGY REVIEW 2021. [DOI: 10.1080/2372966x.2021.1919494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | - Pat Breux
- Suicide Prevention Center of New York
| | | | - Mitch Samet
- New York Association of School Psychologists
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