Pediatric Rheumatology Online Journal → August 2003 → Pain / Health-Related Quality of Life → Abstract #186

CHRONIC PAIN SYNDROMES IN ADOLESCENTS: THE EFFECTIVENESS OF A PRE-ADMISSION ASSESSMENT DAY

C. Pilkington, M. De Sousa, S. Phillips, A. Griffin, A. Volkert, J. Boylan

¹Middlesex Adolescent Unit, University College London Hospitals, London, United Kingdom

Chronic pain syndromes in adolescents are difficult to treat. At the Middlesex Adolescent Unit, a multidisciplinary team (MDT) pre-admission assessment day was set up to assess the necessity for admission. These patients had been admitted for assessment, often resulting in inappropriate and lengthy admissions. The least successful of the admissions focussed on medical issues whilst starting a therapy programme.
In 1999, the MDT set up a nurse-led assessment clinic for these patients. In 2000, 16 patients were seen (7 admitted for an average of 2 weeks), and in the first [frac12> of 2001, 7 patients were seen (3 admitted). This prevented 13 admissions (26 weeks of bed use). The nurse-led clinic now runs weekly and assesses one patient per day, after local professionals and school have been contacted. The nurse specialist, physiotherapist, occupational therapist, psychologist, hospital teacher, and youth worker see the patient alone and with their family to review their past and to see what they have found helpful in the past. This may be the first time the patient has been consulted on their own. Most patients have long histories of negative contact with local services. The team has developed a systemic psychotherapy approach, embracing positive connotation: this considers that people"s ways of coping reflect the best solutions available to them at the time.Adolescents are asked about their strengths and resources, highlighting their resilience and coping mechanisms.
A management plan is agreed with the family at the end of the day: either an admission for intensive rehabilitation, or liaison with local services. If admitted, clearly agreed goals are set, so that the programme starts immediately on admission. Parents are actively encouraged not to be resident.
The MDT has altered the emphasis from a medical to a therapeutic model, with promising results. Patients and staff report a higher level of satisfaction with these admissions since the introduction of the clinic.