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Child and Adolescent Psychiatry Services

CAPS team

Jan. 10, 2020 – Today I met with a highly experienced team of specialists who provide comprehensive psychiatric care through our Child and Adolescent Psychiatry Services (CAPS) program, an inpatient unit for children and adolescents up to age 18 diagnosed with mental and behavioral health concerns. Conditions treated include depression, psychosis, anxiety disorders and substance abuse.

Performing a simulated safety check

My tour began in an intake room where patients (and their belongings) undergo a safety check to make sure there are no objects that could cause harm, either to themselves or others. Ordinary items such as shoelaces and even hair brushes can be dangerous, so staff have to be vigilant during intake, which can take up to an hour-and-a-half. Most of the patients come to CAPS from Rady Children’s emergency department or San Diego County’s Emergency Screening Unit, which provides emergency mental health services for youth under age 18 who are experiencing a mental health crisis.

Established in 2012, CAPS has 24 operational beds, four crisis stabilization beds and 11 beds contracted with San Diego County. Patients, who tend to be 15 to 17 years old, stay for an average of three to five days. There are about 70 CAPS team members with more than 200 years of combined experience, and 50 percent of the psychiatric certified nurses are trained in crisis prevention.

Upon admission to CAPS, all patients undergo a comprehensive psychiatric, medical, occupational and dietary assessment. Specialized assessments are also available, which include biological and nutrition tests, imaging, electrophysiological measures, and neuropsychological testing. These evaluations allow the multidisciplinary treatment teams to quickly identify and target problem areas, and to develop an individualized treatment plan to meet each patient’s specific needs. Individualized services include medication management, behavioral programs, specialized therapies, eating programs and occupational therapy.

Checking out a patient room

Our tour continued in a patient room, which is designed not only to lower risks of self-harm with features such as a soft tear-away bathroom door, but to provide an outlet for creativity — each room has a floor to ceiling wall painted like a chalkboard. Physical exercise is also encouraged here, and patients have access to an outdoor space where they can run around and just have fun. When I visited, some of the kids were playing a high-energy game of tic-tac-toe that involved doing pushups, jumping jacks and sit-ups, among other exercises. Next, I visited an indoor space where some teenagers were getting a mental workout trying to solve rebus puzzles (text and graphics that contains a hidden word, phrase or idiom). These were quite challenging! The idea is to always have plenty of activities available to keep kids busy and engaged without feeling like they are in a lockdown facility. The team here also practices de-escalation techniques and therapeutic strategies when kids are having trouble, and avoids secluding or restraining patients when possible.

Chatting with team members in the break room

We then headed to the staff break room, where a delicious spread of donuts and coffee was waiting for me! Here, I had the pleasure of meeting more members of this amazing team. I learned that CAPS brings in expertise from many different places, including former travel nurses and staff from other organizations who are attracted to this difficult but rewarding work. It is a real testament to the care this team provides that, even in a place where patients are dealing with serious mental and behavioral health issues, the patients here look just like any other kids who are playing and learning.