Melissa Shafer is a school specialist, whose role is to support the patient’s transition back to the classroom.

“I reach out to the schools to gather collateral information about our patients and how they’re performing academically, socially and behaviorally,” she explains. “If they’re struggling in that environment, I teach them skills and give them tools to help them cope. We work on recognizing who their safe adult is at school and whom they’re going to go to if they’re experiencing suicidal ideation, thoughts of self-harm, anxiety or needing support of any kind.”

The classroom in the PHP unit is equipped with computers, books and everything a student needs.

“I like to start the group off teaching some kind of skill they can take back with them to school,” says Melissa. “It could be how to deal with test anxiety or bullies, or how to identify their school triggers. Then I’ll spend some one-on-one time with them, helping them with assignments or assisting them with contacting their teachers if they feel overwhelmed. Some of the kids are hesitant, wondering if their teachers will look at them differently knowing they’ve been here. We all work together as a team to identify those thoughts and feelings and help them work through it.”

Depending on the level of need, Melissa works with patients to develop a formal written transition plan that details their coping skills and goals for returning to school. This document is shared with the school as part of the handoff from the PHP at discharge.

The day ends with parents or a designated family member picking up their children between 3 and 3:30 pm.

Home Is Where the Heart Aches

For some children, school is their safe place, while home is more chaotic.

“We try to put what we see happening with the child on the table when we meet with families," says Scott. "Sometimes parents and guardians aren’t very excited about that, and they may not be ready to address those issues. But they might come around to it later. Our social workers do a really good job steering families in a direction where those needs can be met.”

Ashley adds, “We see many situations where the home environment is impairing the child’s functioning. In those cases, it’s important to build rapport with these families. We meet them where they are to establish realistic goals and expectations. We figure out what the barriers are and work through them by giving them parenting and other types of behavioral tools to help their child make progress. We may not get them to a 100% healthy function level, but we try to move the needle in a positive direction.”

Sometimes, it’s the child who resists being in the program. In those cases, it’s important to find what motivates them, like video games, getting good grades, or other rewards.

“We put the responsibility back on the patient and ask, ‘What’s the plan? When do you want to discharge?’” says Lisa. “Some patients aren’t ready for this program. In that case, we’ll refer them to another treatment option where they can engage. We will go the distance to work with any child who makes an effort, no matter how much they may struggle.”

Staff connect patients and families with outpatient resources so that work can continue after they are discharged from the PHP. About 15% of patients will return for treatment—usually the ones with chronic pathologies who have only found their way to the program in their mid-teens.

“These are kids who went back to their outpatient team and weren’t able to stay stable," says Ashley. "So, they come back to us because they felt comfortable here. But most of our patients do well with outpatient support.”

Secrets of Success

According to Scott, the PHP patient/family experience scores are high.

“The families really like what we do,” he says, “and we communicate with them constantly to make sure they have solid follow-up services when their kids leave the program.”

It’s that strong collaboration with families, community partners and among members of their multidisciplinary team that makes the program so successful.

“Having that collaborative care model, especially during rounds, enables us to obtain a lot of information about each patient efficiently,” says Ashley. “We use that information to develop a quality care plan and make changes for that patient and family to help them positively progress.”

Says Melissa, “It’s so rewarding to see the change happen in real time—even the small successes. We definitely work as a team. When I participate in treatment rounds, hearing the perspectives of the different disciplines gives me an understanding of how we can help the whole child.”

Scott agrees. “Our people are so passionate and skilled,” he says. “And we’re all on the same page about wanting the kids to get better.”

“I’ve been at Cincinnati Children’s for 17 years,” adds Lisa. “I love that we have the autonomy to do the work, that our leaders trust us to do what we are supposed to do. That’s what keeps me here—that and watching the patients come in needing help and then seeing them walk out of here feeling a little better than they did when they arrived.”