Transitioning Back to School After Psychiatric Hospitalization
By Jacqui Springer PhD, Assistant Dean of Students, University of Rhode Island
Hospital, school, and community-based providers all strive to reduce gaps in teen psychiatric care and to improve post-hospitalization outcomes. To achieve this, we first need to understand the challenge and the barriers to successful transitions.
Several factors may impede a smooth transition for adolescents and young adults.
The period of time between when an adolescent no longer meets criteria for hospitalization, but has not yet demonstrated readiness for academic learning within the school setting is arguably one of the most vulnerable. Students’ schools may not have had sufficient time to prepare or staff the transition plan created for a recently hospitalized student. The adolescent may not be prepared for the reality of returning to a physical school environment. Nearly one third of school-based youth changed schools following hospitalization due to transition and reintegration difficulties that are based on social-emotional experiences, academic experiences, and parent engagement.
Despite decades of research focused on inpatient and outpatient treatment and mental health in schools, focused research on the transition back to school has only gained traction within the last 15 years. In 2014, two foundational resources were introduced into the hospital to school transition landscape. First, the Center for Mental Health in Schools at UCLA (now the UCLA School Mental Health Project) was founded as the first national training center for mental health service provision in schools. Second, researchers Savina, Simon, and Lester published the first school reintegration plan template- a milestone which highlighted the importance of considering the relationships between stakeholders involved in an adolescent’s transition(Bronfenbrenner’s bioecological model of human development). Recent students have sought to improve upon the original research by focusing specifically on psychiatric hospitalization to community based school transitions and have provided a refined school transition plan template.
Key Challenges
Researchers and practitioners have continued to revisit important elements of the school transition, but remain challenged in many ways. First, by the ever-growing and competing priorities of the school system. Second, mental health concerns among youth and adolescents have exacerbated during the COVID-19 pandemic, creating increased burden on all providers. Finally, we lack insurance coverage for many transition support services.
The key thing is that the manner in which school, community, and hospital providers collaborate directly impacts student attitudes and beliefs around successful re-entry.
Success Factors
The most recent comprehensive review of hospital to school transition literature identified four key factors in creating a transition plan framework. Schools should:
Give everyone a voice. Ensure that students, caregivers, the hospital treatment team and the school team are all heard as part of the planning process.
Establish a point person in each setting. The hospital, school and community provider should all make someone clearly accountable for the success of the transition.
Make clear recommendations and accommodations. Think carefully about both informal and formal supports.
Have a transition planning meeting that brings everyone together.
When should communication begin?
Ideally, communication should begin once it’s determined that an adolescent needs a higher level of care. A school point person should be identified and work with caregivers to determine what schoolwork can be completed in an alternate setting. Once the treatment setting is identified, releases of information should be signed at intake. The hospital setting should outline “touchpoints” of communication that can be expected throughout the adolescent’s treatment.
Who should be involved?
Stakeholders should include, at minimum, the adolescent, their caregiver(s), a school point-person, hospital case manager, assigned clinician, and any community-based provider. If the adolescent identifies others who they find to be supportive, these individuals should be included as well.
What happens at discharge?
Prior to discharge, a transition meeting should take place with all key stakeholders, including but not limited to the adolescent, caregiver, hospital point person, school point person, and an outpatient therapist.
At what pace should the transition take place?
Consensus among researchers suggests that the first few days to the first few weeks post-discharge are the most critical for reestablishing adolescents in the school environment. Bridge programs such as BRYT and Student Transition Program allow students to transition through structured steps, but informal transition plans can also improve students' opportunities for success.
