Paradigm Shifts in Inpatient Psychiatric Care of Children: Approaching Child- and Family-Centered Care

Journal of Child and Adolescent Psychiatric Nursing, Feb 2006 by Regan, Kathleen M, Curtin, Carol, Vorderer, Lee

This article was completed while the senior author was supported by a Fellowship in Leadership Education Excellence in Caring for Children with Neurodevelopmental Disabilities at the Shriver Center/University of Massachusetts Medical School, and was funded by a grant from the Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services (#MCJ2591510)

TOPIC: This article describes the components of child- and family-centered care, including a review of the literature about the delivery of family-centered care and the barriers that often prevent the provision of such care. The article describes an inpatient child psychiatric unit that has implemented an approach to care that embraces these principles. The changes in structures and policies that the unit adopted are described, with specific examples cited as illustrations of the components of this care.

PURPOSE: To describe the elements of child- and familycentered care and the ways in which this model of care may be implemented on inpatient child psychiatric units.

SOURCES USED: Literature review including journal reports and articles and books.

CONCLUSIONS: Preliminary outcomes are encouraging in the decrease in use of practices such as restraint and seclusion, and physical holds. Further research examining parents' satisfaction is warranted in determining the success of such endeavors.

Search terms: Child- and family-centered care, paradigm shift in provision of care, psychiatric care of children and their families, trauma-sensitive care, restraint/seclusion reduction.

Introduction

Child- and family-centered care (CFCC) is a valued model of care to which most nurses aspire. CFCC is collaborative and respectful, is consistent with emerging values in health care, and is increasingly perceived to be essential to the provision of care for children. Outcomes research reveals that CFCC practices increase patient and family satisfaction, decrease child and parent anxiety, facilitate more rapid recovery from medical procedures, have a positive impact on the mental health of mothers who have children with chronic illness, decrease healthcare costs, and increase staff satisfaction (American Academy of Pediatrics and Institute for Family-Centered Care, 2003). However, the interpretation and implementation of CFCC differs among institutions and practitioners. Many, if not most, care providers take family consideration into account and seek to involve children and families in treatment planning. In order to provide care that is truly child and family centered, however, practitioners must radically alter the way in which institutional structures, clinical practices, and policies are devised and carried out.

The inpatient child psychiatric unit is one such setting where CFCC is not practiced consistently. Most inpatient child psychiatric units reflect a traditional model of care where practices and policies are seldom organized around child and family needs. This article will provide an overview of the components of CFCC and will describe practice and policy shifts that an inpatient child psychiatric unit in Cambridge, Massachusetts, underwent to deliver care that encompasses these principles. It will also review some preliminary outcomes on the unit that point to the clinical utility of this approach.

What Is Family-Centered Care?

The Institute for Family-Centered Care (IFFCC), a nonprofit organization founded to provide leadership to advance the understanding and practice of CFCC in service and healthcare settings, defines CFCC as "an approach to the planning, delivery, and evaluation of health care that is grounded in mutually beneficial partnerships among healthcare providers, patients, and families. It redefines the relationships between and among consumers and healthcare providers" (Ahmann & Johnson, 2000). CFCC is a philosophy of care, based on the following principles: (1) people must be treated with dignity and respect; (2) healthcare providers must communicate with and share complete and unbiased information with patients and families in ways that are affirming and useful; (3) individuals and families should be supported to build on their strengths and participate in experiences that enhance their control and independence in the process of receiving care; and (4) collaboration among patients, families, and providers should occur in policy and program development and professional education, as well as in the delivery of care (Ahmann & Johnson, 2000). Child-centered care is viewed here as an integral component of CFCC, as the patients receiving care are children. It is a term used in practice by child-care providers but is not clearly defined and would benefit from a clear definition that reflects consensus by child-care providers.

The literature review relies heavily on research from the pediatric and medical arenas of nursing where more extensive research has been conducted; however, many of the concepts are applicable to psychiatric nursing care of children. Research from the field of psychiatric nursing is integrated wherever possible.