Inpatient Psychiatry Service

Your Child's Hospitalization

No caregiver wants to see their child in the hospital. Our staff on the Inpatient Psychiatry Service (IPS) at Boston Children's Hospital are devoted to getting your child home as quickly as possible.

Treatment

Assessment: Our staff works with you and your child to understand the focal treatment problem(s) that have led to your child’s hospitalization. Called Focal Treatment Planning, the staff identifies a plan to return your child to a less intensive care setting as soon as possible while outlining a discharge program that will set your child on a path to health and wellness.
Treatment: The Focal Treatment Plan will include individual, group, and/or family therapies as well as therapeutic interactions with our nursing team taking care of your child. Every child receives a medication evaluation from our psychiatrists as well as consultation with pediatric specialists as indicated. Every child and family develops a safety and coping plan with expectation for use during hospitalization.
Goals: Before leaving the IPS, it is expected that the focal treatment problem(s) are resolved or are resolving, that your family and child have an improved ability to cope with their illness, and that modifiable measures related to safety in the home/school/community have been addressed. You and your child will have developed the shared safety and coping plan on the unit and it will be moved into a plan on how to manage your child’s illness, how to address safety issues, and what to do if symptoms return outside the IPS.
Medications: While not all children on the IPS receive medication, medication can be a valuable tool for treating psychiatric symptoms. The psychiatrist on your child’s treatment team will discuss this possibility if indicated with you and review medication target symptoms, actions and potential side effects. The only time a child would receive medication without your informed consent would be in an emergency situation, on a one-time basis, and you would be notified as soon as possible.
Length of stay: We aim to discharge all children as soon as possible. Our average length of stay is between seven and 10 days, but varies depending on resolution or near resolution of the focal treatment problem(s). Some children are discharged sooner and others later, depending on safety, degree of symptom severity, and after care planning.

There may be other components of your child's treatment, depending on the reason for admission, including consultation with a dietitian or with other medical specialists. In addition, the team will assess your child's need for follow-up in outpatient care after they are discharged and work to connect you and your child with these services before discharge.

Long-term outlook

Please remember that your child's stay on the IPS unit is meant to help stabilize them while in crisis, and to give you and your child some skills to cope if their symptoms get worse in the future. While a stay on the IPS unit may be a critical part of your child's treatment, it is just one piece of an ongoing process.

Meals

Children and staff typically eat meals together, family style. There is usually one meal selection, but some children on special diets, such as vegetarian, have meals sent up on trays. If your child has any special dietary requirements, please let the staff know when you meet with them at admission. We also offer snacks three times a day and encourage healthy food and beverage choices. Caffeinated drinks are not allowed, and we discourage consumption of soda and juices with high sugar content.

Medication

Medication can be a valuable tool for the treatment of symptoms such as depression, anxiety, psychosis, insomnia, and agitation. However, not every child treated on the IPS unit at Boston Children's Hospital receives medication. Your child's treatment team may recommend medication if they feel it could decrease your child's symptoms or provide some relief for their distress. The doctor will talk with you about the possibility of using medication as a part of your child's treatment and review medication actions and potential side effects with you.

Medications are not ordered without informed consent from caregivers. The only time a child could receive medication without advance consent would be in an emergency situation, and you would be notified as soon as possible.

Learn about commonly prescribed psychiatric medications.

Schedule

Weekdays

Weekdays on the IPS are structured to provide time for school, groups, individual therapy, and family meetings. Your child will also have "self-care time," which is similar to free time, when kids can take space in their rooms to read or do an activity they enjoy, or join peers and staff in one of our TWO lounges to relax. There are select times, such as "evening recreation group," when staff and patients watch movies, play video games, and play other games together. Many groups focus on teaching and practicing age-appropriate coping skills such as relaxation, gentle exercise, and healthy, distracting activities.

6:30 to 8 a.m.: Wake up. Check vital signs. Get ready for the day.
8 to 9 a.m.: Breakfast and goals group to review goals and plan for the day
9 a.m. to noon: School
Noon to 12:30 p.m.: Lunch
12:30 to 1:15 p.m.: Self-care time
1:15 to 5 p.m.: Groups, individual, or family therapy sessions
5 to 5:30 p.m.: Dinner
5:30 to 6:15 p.m.: Self-care time
6:15 to 7 p.m.: Evening recreation group
6 to 7:30 p.m.: Visiting hours (on Wednesdays there is a family night activity)
8:30 p.m.: Bedtime for school-aged children (ages 8-12)
9:30 p.m.: Bedtime for adolescents (ages 13-17)

Weekends

Weekends are less structured; however, children and adolescents will still have the opportunity to participate in group programming and will be encouraged to work on their safety and coping plans.

Nursing staff remain fully available, but your clinical team members will not be seeing your child on the weekend. Your child will see the on-call psychiatrist briefly on weekend mornings to review the past 24 hours. A child psychiatry fellow and pediatrician are also on call to address any psychiatric or medical issues that may arise.

Therapy

A clinician from Boston Children's Hospital will meet with your child several times each week to build a relationship with them, gain some insight and understanding of your child's issues, and develop a plan for treatment.

The clinician will also assess your child and make recommendations for medications if necessary.

Family involvement

Family involvement is critical to your child's treatment. You have the greatest understanding of how your child responds to stress and what has been helpful in the past. As such, you are an important member of the treatment team.

Please bring any medical records and psychiatric or school testing results, if available, to the first family meeting. It is also a good idea to write down any questions or suggestions you might have.

Family meetings

You will be asked to attend at least two family meetings per week. These meetings provide an important opportunity for you to identify stumbling blocks and plan ways to help your child cope and keep them safe once at home. Usually, you will first meet your child's social worker alone, and then have your child join for the second part of the meeting.

As you might expect, some children become upset during family meetings. Some will need to leave meetings for a time to calm down. Our staff are there to enable your child to return to the family meeting as soon as possible. Staff cannot supervise young siblings during meetings.

Visiting

Because children on the IPS unit at Boston Children's Hospital spend much of their day in classes, groups or appointments, visiting hours are limited during the week. Special exceptions may be made to accommodate specific scheduling needs or to coordinate visits with meals or family meetings.

Visiting hours

Weekdays: 6 to 7:30 p.m. (Wednesday hours are extended to 8 p.m.)
Weekends: 10 a.m. to 8 p.m.

Visitor lists

Caregivers are asked to complete a visitor list to indicate the friends and family allowed to visit and also to point out people who are restricted from visiting. You can also indicate if you have concerns about restrictions in telephone and mail contact. A caregiver of the patient must supervise visitation of siblings or family friends under age 21.

Telephone use

To reach your child, you should call between the hours of 7 a.m. and 9 p.m. Telephone calls should be scheduled around meals and unit activities.

To reach your child's treatment team or a staff person on the unit, please call 617-355-7721. You should feel comfortable calling the office at any time to share concerns or if you cannot reach your child.

Pastoral/religious visits

Pastoral services can be arranged through the hospital for persons of all denominations but many families arrange for someone from their own place of worship to visit.