Started in June 1998, the Hasbro Children’s Hospital Partial Hospital Program provides an unusual combination of services for kids with both medical and psychiatric/behavioral needs. Last month, the program celebrated its 10th anniversary with an open house; Providence Business News followed up with some questions for Dr. Michelle Rickerby, the program’s clinical director.
PBN: What does “partial hospitalization” mean in practical terms?
RICKERBY: It means children and teens spend the day here in the program (7:30 a.m. to 3:30 p.m.), five days a week, but go home at the end of the day and for weekends. It is ideal in treating children with complex med-psych problems in that the key goal is reinforcing their ability to have healthy behavior in their “real life.” So every night and weekend is important practice ground. Because our program is so intensive (in terms of time) and because we’re specialized to handle medical issues, children may be able to be discharged from inpatient medical units sooner with providers feeling secure about ongoing monitoring.
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PBN: What kinds of children do you serve?
RICKERBY: The population we serve are kids and teens ages 6-18 with combined medical and emotional/behavioral issues. These patients often have been ill enough to have already required inpatient care or are at high risk of needing it, or have failed typical outpatient treatment options. They may have chronic illnesses such as diabetes, Crohn’s disease, HIV, etc., and be adhering poorly to treatment; or a huge range of eating disorders; or medical symptoms that prevent school attendance and impair functioning without a clear medical diagnosis; we also have cases in which there is concern that children are getting excessive medical treatment that may put them at risk, a sort of Munchausen’s by proxy syndrome.
PBN: What might a typical patient’s day look like?
RICKERBY: Our team is multidisciplinary – pediatrics, child psychiatry, psychology, social work, pediatric nurses, nutrition, physical therapy, milieu therapists. The day is very structured with a goal of addressing all medical and psychiatric needs while having as normalized a setting as possible. Each day includes a family check-in and checkout with pediatric nurses to ensure close communication with families, supervised meals and snacks, medical monitoring and pediatric intervention as needed, school time, group therapy, activities and individual therapy, and at least twice a week, there are family meetings.
PBN: How long do patients typically stay in this kind of program?
RICKERBY: Average length of stay is 18 program days, though [it] is individualized.
PBN: I know Bradley Hospital has a partial hospitalization program as well. Is this a fairly common approach, nationwide, to providing care for vulnerable kids?
RICKERBY: Partial hospitalization is common in child/teen and adult mental health. Having a med-psych combined focus in a day hospital level of care is extremely unique. We’ve had teams from multiple hospitals do site visits in the last few years (from the Cleveland Clinic, Connecticut Children’s Hospital, Boston Children’s Hospital) in an effort to work towards establishing similar programs.
Hasbro Children’s Hospital, the pediatric division of Rhode Island Hospital, cares each year for more than 6,000 inpatients, 63,000 outpatients and an additional 42,000 patients in its pediatric emergency department. It is a member of the nonprofit Lifespan health care system. For more information, visit www.HasbroChildrensHospital.org.
