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Hawthorn Children's Psychiatric Hospital and Residential Treatment Center

Hawthorn (HCPH) is a 28-bed inpatient facility accredited by Joint Commission for accreditation of Healthcare Organizations (JCAHO) serving children and adolescents (ages six through 18) from St. Louis City and a 31-county region of Southeastern Missouri. Children are referred by mental health centers, juvenile courts, doctors and Division of Family Services (DFS). Youth are hospitalized who are assessed to be dangerous to themselves or others or who are adjudged to have an under-controlled severe psychiatric disturbance which so imperils their judgment or capacity to control behavior that a non-specific risk is posed. These disorders may include Bipolar, acute Post-traumatic Stress Disorder, Schizophrenia, and Psychotic Disorders-NOS. Most patients qualify for multiple diagnoses as developmental disorders, learning disabilities and developing personality disorders are common in this population, as are life circumstances representing extreme psychosocial stressors, frequently physical or sexual abuse and neglect.

The inpatient program consists of separate children's and adolescents' units. Average length of stay for the eight bed Children's Unit is approximately 20 days; average length of stay for the 20 bed Adolescents' Unit is approximately 50 days. Both inpatient units function within a behavior management system and comprehensive care is afforded by multidisciplinary teams consisting of Psychiatrists, Psychologists, Nursing staff, Social Workers, Recreational and Art Therapists and Teachers as well as Interns of these various professions. All interns are assigned to the Adolescent Unit and have an option to join the Children's unit.

Hawthorn Residential consists of three co-ed cottages with teenagers who require long term care that can not be provided adequately in a more natural environment. Length of stay varies from approximately six months to two years. Interns may become active in the Residential program by being the primary therapist for individuals, or a as a psychotherapy group co-leader. Opportunities to conduct family therapy with a co-leader are available.

Becoming part of a team is most enhanced by participation in Rounds, treatment planning and discharge meetings, and being present in the unit's milieu. Over the course of their hospital stay, effort is made to facilitate changes in the patients' mental health and welfare that will have a positive "ripple effect" post hospitalization. Interns learn how to be therapeutic at all times and how to provide interventions that make a "difference" despite the severity and complexity of these youth's conditions.

Interns, respected as junior staff members, serve as primary therapists for individuals and as co-therapists for family and/or group psychotherapies. In addition to providing psychological services for their units of affiliation, interns may also offer services across all areas of the hospital and residential center. Doing so not only presents interns with opportunities to work with a more varied population in differing roles, but also to receive supervision from others than their primary supervisor. Supervision is abundant, typically more than three hours weekly.

Interns may act as consultants to the Residential Center serving youth ages 13 through 18 who may reside there for approximately six months to one year. This patient population represents youth who are less acutely impacted by their mental illnesses but are unable to safely and successfully reside with their families or surrogate families. The program emphasizes the development and/or improvement of social skills, academics, vocational preparation and the pro-social use of leisure time. Interns may also be involved in co-leading groups or family therapy with students in the Day Treatment Program, a cooperative venture between the Department of Mental Health and Special School District. Youth in this program commonly have developmental disorders and interns gain valuable appreciation for the challenges facing youth on the spectrum of Pervasive Developmental Disorders as well as the challenges of their families, teachers and peers.

Hawthorn presents a unique opportunity for specialized training in child and adolescent psychology. Psychology interns learn a great deal about severe psychopathology, utility of psychotropic medications, and complex intervention for complicated situations. Hawthorn provides an excellent opportunity for becoming more skillful in differential diagnosing and psychological assessment as well as becoming more adept at adapting psychotherapeutic interventions to the particular capacities of the youth within time constraints posed by variable lengths of stay.