Research Proposal: Frequent Psychiatric Readmissions Among Teenagers Between the Ages of 13-17 Years

Currently, one in five children has mental disorders (Garcia-Ortega et al., 2013). The health departments suggest that early identification of the problem is the best approach in treating this condition. Also, the specialists should focus on the cause of the disorder before applying any treatment procedure. Most specialists provide that mentally disordered children express high risks of suicide attempts, low ability in social functionality and family participation. The cost of treating this disorder is high for the parents, caregivers and the insurance companies. It is therefore advisable for the health organizations to enact integrated health services to ease this burden. A study by Garcia-Ortega et al. (2013) shows that the medical facilities that have adopted community-based treatment present an aspect of ineffectiveness which results to high re-admissions. Therefore, the various interested parties suggest the inclusion of stakeholders as a change strategy in the health sector. As a result, the specialists will have broader approaches to identify biological and psychological factors that subject children to frequent readmission on mental disorders. (Tharayil et al., 2012).

Problem Statement

The primary factors that contribute to frequent readmission of the mentally disordered children include depression, anxiety disorder and substance misuse (Ambikile, & Outwater 2012). Due to the increasing incidence of readmission among teenagers and children on this disorder, it is necessary to intervene on the activities in inpatient hospitalization. The intervention would be more efficient if the organizing bodies consider the cost incurred by the caregivers, the effectiveness of the services and the frequency of readmission. Also, the research should emphasize on revealing the pretreatment, post-treatment of experiences of the patients.

Report from the current studies indicates that the severity of the disorder determines the extent of admission and readmissions (Mares, & Graeff-Martins, 2012). The severe the condition is the more likely the patient will be readmitted and stay longer in the hospital. With the increasing cost of hospitalization, Mares and Graeff-Martin (2012) contributes that between 1988 and 1994 the length of stay indicated a decrease by 90%. It, therefore, means that more patients are attending low-cost medical centers which are prone to poor quality services.

Parents and caregivers incur the cost on mentally disordered children in social, economic and emotional perspectives. In psychological effect, the parents suffer sadness and stigmatization effect due to the inability of their children to perform personal and social obligations. Also, the parents are subjected to additional financial commitments which constraints their consumption behaviors (Ambikile & Outwater, 2012). To some extent, the parents have to budget for family specialists to help the children in recovery programs. At the societal level, the patients express reduced public awareness.

A patient is described as a revolving door policy if the rate of hospitalization recurs three times within a 2-year period for psychiatric attendance (Szekendi et al., 2015). In addressing this issue, the mental health sector has the mandate of improving public health by the implementation of effective support services. The sector should influence the federal government to institutionalize relevant policies to cater for public inpatient at the community level. Above all, financial aid could facilitate depot medication which reduces the frequency of readmission for most patients. However, the health sector encounters uncertainties from political influence and governance imperfections. For the government to improve performance in the health sector, the policymakers should focus on stabilizing this sector by protecting it against the influence of public policy (Szekendi et al., 2015).

Despite the efforts enacted by the government to improve the health organizations, a significant number of patients still encounter poor treatment experiences. This problem has prevailed due to the limited resources to finance these organizations. The effect has, therefore, lead to poor community-based services where the parents struggle to make adequate consultation services with the psychiatrists.

Mental departments require including a wider database concept to identify the variances contributing to the frequency of readmission. It is important for intervention in the identification of socio-economic contribution of mental illness to the frequency of readmission (Chow, & Priebe, 2013).

Institutional and financial constraints are resulting in the extension of inpatients in the hospital. The strategies implemented by the government are ineffective to meet the increasing demand in the mental health organizations (Chow, & Priebe, 2013). Also, the organizations are facing inappropriate timing in the admission of patients; a factor that is resulting in unnecessary retention of the patients in the hospitals. The outreach services are also insufficient which leads to low specialists to patient ratio. With the shortcomings in the health sector, it is necessary to conduct an organizational assessment and draw attention to the factors that determine readmission of mentally ill patients (Chow, & Priebe, 2013). Currently, the organizations are using a narrowly scoped database in determining factors for readmission. The importance of the intervention is that it will induce factors of social, economic contributions and cover the existing gap through the provision of relevant diagnostic and demographic variables (Chow, & Priebe, 2013).

Need Assessment

The current performance in the mental facilities creates a need for assessment that will necessitate the engagement of all stakeholders. As a result, this will introduce significant organizational changes that affect various departments. From the studies, a meeting of families, parents, and specialists is the most appropriate step in determining the shortcomings in the mental health program according to Antwi and Kale (2014). Therefore, the organizations should formulate various organizational changes by considering the challenges faced by parents and the caretakers. Among the effective strategies would be conduction of proper training and communication programs, and strategizing transition of inpatients through the employment of appropriate data collection techniques (Antwi, & Kale, 2014).

Project Identification

Purpose

The purpose of the study is to build an outpatient clinical service that will help to reduce the readmission rates for children between the ages of 13-17 years.

Objectives

To establish an outpatient mental health clinic for administering long acting injectable psycho-pharmacological medications through outpatient clinic observation.

To reduce the frequency of inpatient re-hospitalization among mentally disordered adolescents.

Policies and procedure

Procedure

The experts will start by collecting data on the population of the ill-minded children in the relevant areas. The specialists will then formulate a work plan schedule that will facilitate timely participation in helping the patients.The attendance program will base on the following;

Assessing the patients.

The parent will feel relevant forms which will include an indication of the contact number.

Upon admission, the nurses complement in identifying the needs of the child.

Specialists such as nutritionists, psychiatrists, psychologists, and nurses will help in the treatment of the child.

The specialists arrange for the regular review of behavioral change, nutritional and medical program.

On completion, the discharge arrangement begins where the parent is called for training on medical requirements.

The parent is entitled to revisit the specialists on the performance of the patient.

Policies

The clinic will operate under the following policies;

The Non-discrimination of human rights. The experts will ensure that the patients have equal rights to food and shelter.

Equity will be observed at all levels despite economic, social and political status.

All patients will be attended to despite the citizenship.

The limited resources available will be rationally utilized to meet the needs of the patients.

Children should be protected against vulnerability by the provision of appropriate prevention interventions.

The specialist should respect the cultural divergences in interpreting culture.

The service should aim at satisfying the role of mental health society to help the patients build capacity and recover to meet respective roles in the society.

Proposed Structure of the Organization

Position Duties

Case Children a psychologist or a social worker

meets children several times a week

Nursing Team 2 nurses

Are direct supervisors to the children

Work close to the doctor for developing treatment plans

Pediatrician Carries out physical test to the child

Manages medical issues in the hospital

Communicates directly to the child to gather information

Clinical Dietician Assesses the eating issues

Monitors critical signs and make a nutrition plan

Plans on nutrition discharge arrangements

Recreation Therapist Promotes interaction

Program Director Supervises nurses

Provides recommendations and give feedback to the unanswered questions

Director Acts as a consultant and Monitor programs

Summary and Strength of Evidence

An effective strategy for addressing limitations in mentally disordered children should focus on the identification of the cause using extensive variables. It is therefore important to include caregivers, parents, and specialists before enacting hospitalization services. The experience from the stakeholders on the mental disorders in adolescents would contribute to improving overall organizational strategies. However, the participation of various stakeholders requires government support in inducing relevant policies to enhance proper utilization of the available resources (Murphy, & Fonagy, 2012). This action would have a great impact on people living with mentally disordered children; especially in financial and economic and social relations. The improved quality of services would eventually reduce the time for re-hospitalization and the cost in the delivery of mental health services.

References

Ambikile, J. S., & Outwater, A. (2012). Challenges of caring for children with mentaldisorders: Experiences and views of caregivers attending the outpatient clinic atMuhimbili National Hospital, Dar es Salaam-Tanzania. Child and adolescentpsychiatry and mental health, 6(1), 16.

Antwi, M., & Kale, M. (2014). Change Management in Healthcare. Kingston, ON: The Monieson Centre for Business Research in Healthcare, Queen's University School of Business.

Garcia-Ortega, I., Kadlec, H., Kutcher, S., Hollander, M., Kallstrom, L., & Mazowita, G.(2013). Program evaluation of a child and youth mental health training program forfamily physicians in British Columbia. Journal of the Canadian Academy of Childand Adolescent Psychiatry, 22(4), 296.

Mares, S., & Graeff-Martins, A. S. (2012). The clinical assessment of infants, preschoolers and their families. IACAPAP e-Textbook of child and adolescente mental health. Geneva: International association for child and adolescents psychiatry and allied professions.

Murphy, M., & Fonagy, P. (2012). Mental health problems in children and young people.Annual report of the chief medical officer.

Szekendi, M. K., Williams, M. V., Carrier, D., Hensley, L., Thomas, S., & Cerese, J. (2015).The characteristics of patients frequently admitted to academic medical centers in theUnited States. Journal of hospit...