Electroconvulsive therapy (ECT) is a safe and effective treatment of psychiatric disorders in children and adolescents. The authors discuss brief history of this procedure, legal and ethical considerations, common indications and contraindications, appropriate referrals, details of the procedure, and adverse effects in this population. ECT is mainly used for treatment of treatment-resistant mood disorder/psychosis and catatonia although it has been effectively used for other conditions including neuroleptic malignant syndrome, refractory self-injurious behavior. A careful consideration of patient's medical and psychiatric history is important before considering ECT. Informed consent should involve patient and parents and patient's assent is crucial before initiating the procedure.

Sleep and mental health have a strong relationship. There is a lack of training in Sleep Medicine for Psychiatrists. Sleep problems often accompany mental health issues, especially in children and adolescents on inpatient psychiatry units. Recognizing common sleep disorders is important in these settings. It is also important to involve pediatric sleep specialists when needed. This article addresses common sleep disorders observed in inpatient child and adolescent psychiatry units and outlines optimal management strategies.

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.

The inpatient treatment of youth in care with severe emotional or behavioral disorders is complicated by systemic factors unique to foster care, for example, placement shortages and relinquishment of custody, and clinically by factors more prevalent in these highly vulnerable youth such as in utero exposure to alcohol, exposure to domestic violence, neglect, and physical, sexual, and emotional abuse. The authors discuss prolonged lengths of stay and boarding in emergency rooms, medical units, government offices, and detention centers. We also discuss working with foster families, biological families, and the child welfare system.

The complexity of child behavioral health and the importance of transitioning from the most restrictive to an intermediate level of care such as a partial hospitalization program (PHP) for high-risk youth is highlighted in this study. While inpatient hospitalization stabilizes youth in imminent danger, PHPs offer intensive treatment of those requiring more support than traditional outpatient care but less intensive than inpatient hospitalization. The transition between levels of care is determined by the severity of symptoms, high-risk behaviors, and clinical progress with planned step-downs from inpatient settings to a PHP and crisis-driven step-ups from a PHP to inpatient.

An inpatient psychiatric stay for youth should go beyond acute containment of risk and pharmacologic changes and, instead, offer tailored evidence-based treatments in a manner that is individualized for the patient and caregivers. A unique, transdiagnostic guidebook can be utilized within the inpatient hospitalization structure in a way that adds value to the treatment but does not burden the clinical floor staff. This study describes the process of creating a patient-centered youth guidebook, implementation, and recommendations for others wanting to consider the use of a similar modality.

Inpatient psychiatry for child and adolescents came about from the concept of the asylum for adults. Although the asylums were made isolate the adults from the community, the inpatient hospitalization for youth was needed to keep the child safe from the environment. The concept of the inpatient unit is filled with controversy and all people involved in the experience have mixed feelings about being admitted to the hospitalization. Despite that, the inpatient hospitalization should continue to be a valued part of the options to help children and adolescents of mental health diagnoses.

Measurement-based care (MBC) has not been routinely incorporated into the inpatient setting in child and adolescent psychiatry. This article discusses who should be measuring the outcomes and what needs to be considered in selecting outcome measurement scales in the inpatient setting. Characteristics of inpatient populations may pose challenges in selecting appropriate measurements to track outcomes. However, even young patients and patients with psychosis can contribute to the MBC. This article also discusses barriers and possible solutions for implementing MBC in the inpatient setting.

Child and adolescent psychiatry (CAP) inpatient units are a common site in academic settings for trainee education. The authors review the foundational aspects of education that should be covered during these rotations. Trainees should begin with a solid foundation of child and adolescent development and learn how this impacts risk assessment, formulation, and treatment planning. In addition, the authors review milieu considerations, agitation management, legal considerations, family involvement, systems of care, trainee supervision, transference, countertransference, and the Accreditation Council for Graduate Medical Education requirements as they relate to resident and fellow education on a CAP inpatient unit.

As the landscape of psychiatry evolves, psychiatric clinical pharmacists are positioned to use their expertise to enhance the quality of care on inpatient child and adolescent units. By playing key roles in comprehensive medication management, psychotropic stewardship, transitions of care, and educational initiatives, they can help not only interdisciplinary teams but also greater health care systems improve outcomes and address unmet needs. It is in the best interest of patients, providers, and broader health care systems to advocate for the inclusion of psychiatric clinical pharmacists, operating at the fullest extent of their licensure and training, on every interdisciplinary care team.

The contemporary management of the adolescent patient on the psychiatric inpatient adolescent unit in the twenty-first century entails a new type of comprehensive and wide ranging familiarity with several types of clinically challenging co-occurring disorders including cannabis use disorder and eating disorders. In this article, there is a delineation of current understanding of the prevalence of these diagnoses in addition to a review of prevailing expert opinion as to principles of evaluation and management of these conditions in patients stabilized on the adolescent inpatient psychiatric unit.

Forced displacement can expose youth to unimaginable levels of traumatic life events. We discuss how home-based, school-based, and community-based services can be strategically situated to address the psychological sequelae of such events. Given the systemic challenges that refugee youth face when establishing trust in their new environments, are often from collectivist cultural backgrounds, espouse stigma towards professional help seeking, and must prioritize accessing services for their basic needs, these types of settings can be particularly relevant. In the administration of such services, we advocate for an intentional approach to addressing basic needs as well as using cultural brokers, validated measures, and family- and school-based interventions.

LGBTQIA+ youth are disproportionately affected by mental health issues including suicidal ideation and suicide attempts. Minoritized youth have numerous social and structural factors influencing their health, including a lack of access to care and resources. However, these youth and their caregivers also have many unique and individual cultural strengths. Awareness of special considerations and work toward dismantling structural drivers is essential in improving the health of these youth. Additionally, it is important to support minoritized youth and their caregivers through tailored evidence-based treatments in addressing social and structural drivers to influence individual, community, educational, institutional, and policy levels and prevent suicide in achieving mental health equity.

Medications for opioid use disorder (MOUD) are the most effective treatment for OUD. Many patients struggle with adherence, but young adults face unique developmental barriers and experience higher relapse rates. The Youth Opioid Recovery Support (YORS) intervention is a developmentally informed behavioral approach to increase medication adherence through assertive outreach, family involvement, low-barrier access to extended-release MOUD, and contingency management. Early studies have shown promising results, and a randomized controlled trial is underway. Here we describe the implementation of YORS using case examples, offer guidance on adapting YORS to real-world clinical settings, and explore future directions for research and practice.

Collaboration between the child welfare system and health care practitioners has become increasingly necessary in order to meet the often-significant health needs of system-involved youth. Child welfare medical directors and psychiatric medical directors have been implemented as a means to address this need in several state child welfare systems. Building on the core principles of the National Guidelines for Child and Youth Behavioral Health Crisis Care, medical and psychiatric medical directors can help ensure youth receive the least-restrictive, most appropriate level of behavioral health care; prioritizing care involvement with caregivers in community-based settings.

Children and adolescents in rural communities have statistically more unmet mental health needs and fewer mental health resources than their urban counterparts. The rural population is ill-served by the traditional medical model of hyperspecialization and would benefit more from a population-based approach. By embracing the community, including each area's distinct culture, mental health providers can best affect change in these areas. Increased pediatric integration via telepsychiatry, including clear and codified teleprescribing parameters for controlled substances, can reach more rural youth and eliminate current burdens to primary care providers who currently treat most rural mental illness.

Youth engagement in implementing mental health legislation and programming is an intuitive best practice. However, well-intentioned efforts to work inclusively with youth are often perfunctory. Drawing from select community partnership models and insights from providers, public health advisors, and youth, we examine the typology, processes, and outcomes of youth engagement. We critically apply the theory of partnership synergy to understand how the convergence of youth and adult experiences and knowledge can advance mental health programming beyond what could be achieved by a single group.

Systems of care (SOC) is a proven and community-based service network addressing the mental health needs of children and families. Child and adolescent psychiatrists play a crucial role in leading SOCs, utilizing skills such as partnership building and strategic planning. Barriers to mental health care, including access issues and stigma, can be tackled through multisector collaboration. Overcoming challenges such as cultural differences and fragmented systems requires effective leadership. In a SOC, core principles involve culturally competent care, evidence-based practices, collaborative decision-making, and smooth transitions of care. Championing these principles fosters a holistic and supportive environment for those facing mental health challenges.