Day treatment program meets needs of teens
Pediatric hospital, rehab center share expertise
When Bryn Mawr Rehab decided to set up an adolescent day treatment program to complement its successful adult day program and expand its brain injury continuum, administrators turned to a pediatric hospital for expertise in treating young patients.
DuPont Hospital for Children in Wilmington, DE, also a partner in the Philadelphia-based Jefferson Health System, teamed up with Bryn Mawr to establish the day treatment program at the Malvern, PA, hospital. The arrangement gives Bryn Mawr, which typically treats patients 16 and older, a new source of patients and gives eastern Pennsylvania families the services they need close to their own communities. The adolescent day treatment program is so popular with payers that Bryn Mawr admitted two patients ahead of the anticipated opening day.
DuPont provides the medical and program leadership and helped modify Bryn Mawr’s successful adult day treatment model to fit teen-age needs. Bryn Mawr provides the location, the clinicians, and management expertise.
Before the program was established, teen-age brain injury patients discharged from Bryn Mawr’s inpatient program received individual treatment sessions at an outpatient center. "They didn’t have the advantage of the team approach, and they didn’t receive therapy for the whole day," says Donna Gregory, program manager.
Bryn Mawr administration noted the need for a comprehensive day program for adolescents through patient and family focus groups and feedback from the hospital’s payer advisory group. The hospital conducted a competitor analysis and determined that the only options available to a family with an adolescent with a brain injury were to travel to Philadelphia or Wilmington for treatment or not get the services, says Jan Bergen, senior vice president.
"It appeared to us that there were teen-agers in our service area who were referred for inpatient brain injury but didn’t have an appropriate follow-up service," she says. "After acute inpatient rehabilitation, these teen-agers have limited options, particularly if they need assistance reintegrating into the home and school environment."
Bryn Mawr advertised the positions for the new program internally and found enough personnel with pediatric experience to staff the program with people already were working at Bryn Mawr. It has offered a comprehensive day treatment program for brain injured adults for two years, but adolescents typically have different goals from those of adult patients, Gregory says.
"These teens have a goal of getting back to high school. The re-entry process is different from going back to work or the parenting role. A regular day for a teen-ager is quite different from a regular day for an adult," Gregory points out.
Like all brain injury patients, the teen-agers have problems that must be addressed within the context of their environment, which is the classroom, the home, and the community, Bergen says. For instance, the teen-agers need experience in in solving problems around their impairment across these different settings, with visits to the mall, to the home, and working within their home study area, she adds.
What was missing from the adult day treatment model was a peer group for the teens, a chance for social interaction with other teen-agers, Gregory says.
Having such a program allows young patients to be discharged sooner from the acute rehab hospital, Bergen says. The cost of the day treatment program is about 40% less than for inpatient treatment.
"If you don’t have a comprehensive day treatment program, you have to accomplish some of the objectives in a hospital setting," she adds.
Here are some pointers for setting up an adolescent day program:
• Understand your reimbursement market and make sure your services will be covered. Many pediatric day programs have struggled because insurance wouldn’t cover them, Bergen says.
• If your facility treats mostly adults, consider partnering with a children’s facility to get the expertise you need in treating young people.
"There aren’t a lot of pediatric physiatrists out there. They are unique in terms of the special expertise and orientation they bring to the program," she adds.
The therapy staff in an adolescent program require special training to deal with the physical and emotional needs of young people. Social workers should have experience in helping with the transition back to school.
• Don’t try to set up a program for teens in the space you use for adults.
"It’s really important to create a separate space appropriate for the population you are serving," Bergen says.
• Don’t just add teen-agers to your adult program.
The needs of the populations are vastly different, Bergen says. For instance, adults don’t need to learn to function in the classroom setting. The vast majority of adolescents live at home and don’t need make the transition to independent living, but that’s a big issue for adults.
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