Milieu Management and Therapeutic Groups in Inpatient Child and Adolescent Psychiatry Units - 06/11/24

Doi : 10.1016/j.chc.2024.03.019

Caroline Hodgson, PhD ^a,^⁎ , Rajeev Krishna, MD, PhD, MBA ^b, Kento Akasaka, DO ^b
^a Department of Pediatrics, Nationwide Children’s Hospital, The Ohio State University Wexner College of Medicine, 444 Butterfly Gardens Drive, Columbus, OH 43215, USA
^b Department of Psychiatry and Behavioral Health, Nationwide Children’s Hospital, The Ohio State University Wexner College of Medicine, 444 Butterfly Gardens Drive, Columbus, OH 43215, USA

^∗Corresponding author.

Résumé

The therapeutic milieu has long been considered an essential mechanism of recovery for youth requiring inpatient psychiatric admissions. However, with increasing demand for crisis services, shrinking length of stay, rising patient acuity, and critical workforce shortages, innovation is necessary to maintain the goals of the therapeutic milieu (and equip the workforce to meet this challenge). This review surveys the evolution of the goals of milieu therapy over time, evidence for increasing challenges, and initial evidence for possible solutions. The study concludes with a case example detailing efforts to improve milieu therapy and empower frontline staff at a Midwestern pediatric hospital.

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Keywords : Milieu therapy, Psychiatric inpatient, Group psychotherapy