Philadelphia Community Services for Children and Adolescents

VII. Inpatient Hospitalization

It may become necessary in some circumstances for your child to receive inpatient treatment at a hospital. This is the "most restrictive" treatment alternative available and is designed for extreme situations, when youngsters have serious disturbances - either acute or ongoing. Inpatient hospitalization is the most expensive of the services in the mental health system. Costs are typically at least $300 per day, plus psychiatrists' fees. Costs may run to as much as $1,000 per day, but generally all or most of this cost is covered by health insurance or Medical Assistance.

Inpatient hospitalization may be needed if a child or adolescent is:

Destructive to property.
Destructive to others.
Suicidal or hurts him or herself because of poor judgment.
Having a severe reaction to a difficult trauma.
Referred by a physician for purposes of conducting a comprehensive evaluation or adjustment of medication that cannot be done on an outpatient basis.

A. Voluntary Hospitalization

For information on involuntary hospitalization see Psychiatric Emergencies.

In Pennsylvania, "voluntary commitment" means a child under the age of 14 is placed by his or her parents into a hospital for psychiatric treatment. Placing your child in a hospital voluntarily gives you the right to withdraw him or her from that hospital at any time, unless that facility obtains an involuntary commitment order. Children age 14 and over can admit themselves or have their parents admit them with their consent. The child, however, must sign the admission form. The following paragraphs describe the parents' role in the total process of voluntary hospitalization: admission, hospital stay, and discharge.

B. Financial Aspects Of Hospitalization

Parents should be aware that insurance coverage plays a large part in the option of hospitalizing your child. There are limited psychiatric beds available for children and adolescents whose families are on Medical Assistance (also known as MA). Thus, a child or adolescent inpatient unit may have only a small percentage of beds "set aside" for patients on Medical Assistance. If the hospital has filled its portion of these beds, parents or professionals helping the child must either look elsewhere or, if the situation is not an emergency, have the child's name put on a waiting list until a bed becomes available. This may happen whether you have accessed the hospital directly or your child's therapist has done so.

Private insurance carriers, including HMOs, often have restrictions on mental health coverage as well. If possible, read your policy carefully and talk to your insurance carrier before your child needs inpatient services. Most hospitals ask you for information about your insurance over the telephone or an admissions staff member will sit down with you prior to the admission of your child.

It is possible to obtain funding from the County of Philadelphia if you do not have private insurance but do not qualify for Medical Assistance. To receive this funding you must apply for Medical Assistance and be turned down. You then submit the form to the hospital.

For more information on finances, see Financial and Health Care Benefits.

C. Admission

If your child's therapist advises a hospital stay, this professional will probably initiate the hospital admission arrangements. If your child does not have a therapist, you can (1) call your family physician (especially if your insurance coverage is through an HMO), (2) call your local community MH/MR center and explain the situation, or (3) contact the admissions department of the hospital and ask that your child be evaluated by their staff.

1. What To Bring With You When Admitting Your Child

The hospital will need all financial information for liability: proof of income, insurance card(s), or Medical Assistance card.

The hospital will also request as much information about your child as possible. This will include your child's health history, developmental history, and other information that will aid the hospital in providing care and treatment to your child.

2. What Is Required Of Parents During The Admission Process

Hospitals require that a child's legal guardian sign admission papers, although the child signs. Also, this signature is necessary if this is an older child (14 years or older). Even if the child is under the custody of the Department of Human Services or another adult family member, the signature of the child's legal guardian is required. The only exception to this is if the parent or legal guardian's parental rights have been terminated by the court.
You will be asked to give written consent for the hospital to receive information from your child's school and any other places where he or she has received treatment.
You will be asked to give written consent for the hospital to give medication to your child.
You and other family members may be asked to participate in therapy sessions.
If your child will be attending a classroom for children with serious emotional disturbances while in the hospital, you will be asked to sign papers giving temporary permission.
Depending on the hospital, you may be asked to sign releases allowing your child to participate in research projects. This is not mandatory, and you may refuse permission.

3. How to Prepare Your Child

Your child's therapist can help you explain to your child what is happening, why you feel it necessary that he or she be placed in a hospital at this time, and what to expect there. Your child may have many different reactions to your decision, ranging from anger to relief. It is important that you reassure your child that you will maintain very close contact by telephoning and visiting.

Questions for parents to ask staff at time of admission include:

When are visiting hours?
Who is my contact person, and how can I reach him or her?
How will I be involved in the treatment planning process?
How do you plan for discharge?

4. Your Child's Reactions to Being in the Hospital

Children are often angry at parents for putting them in a hospital. They may also feel homesick and tell you that the staff is not taking good care of them, hoping you will then take them home. If this happens, try to find out if there is any basis for your child's complaints. If you feel that there may be some truth to the charges, talk to the treatment team leader. If your child continues to complain, see the unit director. Every hospital has grievance procedures that must be followed in instances of alleged physical or emotional abuse. They are required by law to investigate any allegation that is made.

D. Discharge Procedures

Ten days prior to discharge, request meetings with the treatment team to discuss and plan for what will need to be in place before your child comes homes. For example, this may include intensive case management and wraparound services. Plan for your child's school program and make sure that it will be in place.

E. When Your Child Returns Home

After your child has been in the hospital, it is normal to feel apprehensive about his or her return to the family. Families have reported that each member has strong feelings and that talking openly about these feelings improved the situation. Each family is different, but it may be helpful for you to know how other families have felt about a child's return from the hospital.

"We needed to learn how to be together again."
"My other children were frightened that the same thing could happen to them."
"We all acted like we were walking on eggs."
"I expected that my son would be glad to be home, but he actually missed the hospital. That was hard for me to understand."
"It doesn't work to always zero in on the child with problems. We had to let her be herself again, within the family."
"The most important thing for us was learning to set limits on his behavior. We felt so guilty and sorry for him."
"Joining a support group of other parents was the best thing I ever did. It helped me sort out my feelings, and other parents gave concrete suggestions for easing the transition."

F. Inpatient Units for Children and Adolescents

Before calling an in-patient unit for your child, have the following ready:

All insurance information (carrier, subscriber, and policy number).
A list of where your child has previously received treatment and the names of therapists who have treated your child.
A description of his or her behavior.
Your explanation for why he or she needs to be hospitalized or the reason why his or her therapist recommends an inpatient setting at this time.
Also, be sure you tell the admissions office of the hospital your child's age, so they can refer you to the appropriate unit.