How Much Is Enough and Who Should Decide? Opinions of Pediatric Youth Suicide Attempt Survivors, Their Caregivers, and Providers about the Appropriate Level of Family Involvement during Inpatient Psychiatric Treatment Stays

Background and Purpose: Defined as approach to the planning, delivery, and evaluation of health care that is grounded in mutually beneficial partnerships among health providers, patients, and families, family-centered care is a top priority for pediatric health care organizations. While family involvement is a critical component of family-centered care, little is known about the optimal amount of family involvement for pediatric patients who have been hospitalized for a suicide attempt. This study explores the perspectives of youth, their caregivers, and inpatient psychiatric providers approaches to and opinions about family involvement in inpatient psychiatric treatment following a youth’s suicide attempt.

Methods: Drawing upon data collected during the first phase of an intervention development study designed to adapt and test a family-based intervention for suicidal adolescents for use on inpatient psychiatric settings, we conducted qualitative interviews with youth who had recently been hospitalized for a suicide attempt (n=15), their caregivers (n=15), and mental health providers employed on the unit in which youth participants were hospitalized (n=15). Interviews were designed to understand the experiences of inpatient psychiatric hospitalization with a particular focus on family involvement in care throughout the youth’s stay on the unit. All youth participants were between the ages of 11 and 18 and had been discharged from the inpatient psychiatric unit within the previous six months. All data was coded in Atlas.ti and analyzed using reflexive thematic analysis.

Results: Several salient themes pertaining to family involvement emerged from our analyses. While caregivers universally expressed desires to be more involved in their child’s inpatient care, and frequently did not feel included in care process during their child’s recent stay, providers indicated that the extent of family involvement relied heavily on clinical judgment, family availability and motivation, and youth patient preference. Many providers noted that restrictive but necessary COVID-19 visitation policies limited their capacity to involve caregivers. Among youth, there was more variation in opinions about the participants about the degree of parent involvement desired; youth described several barriers to involving caregivers in treatment that centered primarily around intra-familial communication difficulties and perceptions about caregiver beliefs pertaining to mental health. Despite these challenges, most youth supported the notion that families should be involved in the care process to some degree and specifically with respect to safety planning.

Conclusions and Implications: Findings indicate that there is substantial variation across three stakeholder groups of pediatric patients who have been hospitalized for a suicide attempt, their caregivers, and those who provide them with psychiatric care in the inpatient setting. The months following discharge from an inpatient psychiatric unit have been identified as an acute risk time period. Given that caregivers are often tasked with managing aspects of their child’s psychiatric care and frequently function as gatekeepers to treatment following their child’s discharge, it is critical to consider their input when developing new strategies to facilitate access to and continuity of care.