Expansion of the multidisciplinary team, improvement of outpatient care, play therapy, modern therapeutic and educational activities, construction and equipping of two unique therapeutic gardens or strengthening of parental awareness, this is how the further expansion of psychiatric care for adolescents looks like, which the General University Hospital (VFN) in Prague has undertaken as part of the project "Educational Therapeutic Center of the General University Hospital" at the Psychiatric Clinic. The project for adolescents for more than 14.5 million crowns is financed from the EEA Grants 2014-2021.

The current pressure on psychiatric and psychological services is extraordinary and the entire system is experiencing a crisis. Care for mentally ill children and adolescents requires further capacity building within psychiatric care and the inclusion of modern approaches in treatment. “The mental health of children is undoubtedly deteriorating due to a number of factors. These include a number of problematic socio-political phenomena, such as Covid, the economic crisis, migration and others. The development of multimedia technologies and social networks must also be mentioned as a very significant factor,” emphasizes Prof. PhDr. Radek Ptáček, Ph.D., MBA, clinical psychologist at the First Faculty of Medicine of Charles University and the General University Hospital.

Motivating environment of the Day care center

Currently, the Center for Adolescent and Developmental Psychiatry at the Psychiatric Clinic primarily provides a day therapeutic program within the Day Care Center for Adolescents, which is a unique facility in our country for the diagnosis and treatment of mental disorders in adolescents. The outpatient part of the center provides outpatient psychiatric and therapeutic care to discharged patients. A multidisciplinary team of experts consisting of not only psychiatrists and psychologists, but also social workers, educators, addiction specialists, general psychiatric nurses, nutritional therapists, occupational therapists and others is dedicated to the treatment of disorders in adolescence, such as emotional, adaptation, psychosomatic, neurotic disorders, eating disorders and post-covid consequences.

"Thanks to the extended team of healthcare professionals and the multidisciplinary approach, we have been able to adapt the program to the individual needs of adolescents and have fulfilled the goals of the offered activation programs, such as restoring, maintaining and improving social relationships, improving performance, increasing self-confidence and improving the psychological state of clients," highlights the successes of the therapy, MUDr. Eva Kitzlerová, Ph.D., head of the Psychiatric Clinic of the 1st Faculty of Medicine of Charles University and the General University Hospital of Prague, adding that during the implementation of the project "Educational Therapeutic Center of the General University Hospital of Prague", the day care program was expanded and a therapeutic group for adolescents with eating disorders was opened. "The activities include yoga lessons led by a lecturer and other physical activities led by a physiotherapist, as well as occupational therapy, art therapy, canine therapy and other therapies specifically aimed at this diagnostic group. For example, this involves creating a food pyramid, a fact board - planning a menu, its presentation, evaluating the therapist and the group, or purchasing supplies for table training," says Head Nurse Kitzlerová, who lists the range of options. She adds that therapy takes place in the adapted premises of the inpatient unit and outpatient clinic, including the possibility of family and other caregivers participating, a group of addiction specialists, a nutritional therapist, and a thematic educational group focusing on sleep hygiene, a healthy lifestyle, and family therapy.

"Currently, we are observing a completely insufficient capacity in the area of ​​psychiatric and psychological services for children and adolescents. In this sense, the General University Hospital in Prague is responding to a real need. The adolescent inpatient center is therefore a significant benefit," says Prof. Radek Ptáček, who appreciates its operation.

Patients are carefully selected

Patients aged 14 to 19 attend the day care center for eight weeks. The stay can then be repeated again after a year. "The basic prerequisite for entering the inpatient facility is the adolescent's motivation to work on themselves therapeutically within the program. It is also necessary that the level of mental illness is manageable in outpatient care," explains Mgr. Tereza Podávková, psychologist and coordinator of the Day Care Center for Adolescents of the Psychiatric Clinic of the 1st Faculty of Medicine, Charles University and the General University Hospital.

The Adolescent Day Care Center cannot accept adolescents who are actively using addictive substances or are at high risk of suicide. Other contraindications for admission to the center include mental retardation, autism spectrum disorders, or psychotic disorders. "If a patient is interested in participating in the psychotherapy program of the Day Care Center for Adolescents, then it is necessary for their legal representative/parent, in the case of a minor patient, to send a message describing the child's difficulties and attach a report from an outpatient psychiatrist, a discharge report from hospitalization, or a report from a psychological examination," specifies Mgr. Podávková.

Functional and modern equipment with aids for creative activities creates a motivating environment here. "The inpatient unit is equipped with, for example, emotion cards, supplies for multisensory therapy, art therapy, relaxation equipment, including bean bags. Various tools are used to practice social skills, with which patients practice table manners, home cooking, waste sorting, and as part of relaxation activities, they have music therapy tools and board games at their disposal," adds Bc. Zuzana Fišarová, head nurse of the Psychiatric Clinic of the 1st Faculty of Medicine, Charles University and General University Hospital.
 

Presentation of project results April 2024 and Easter fair April 2023

 

Safe background of therapeutic gardens

As part of improving existing therapeutic and social rehabilitation methods, the General Hospital has undertaken the complete reconstruction, renewal and equipment of two gardens on the premises of the Psychiatric Clinic – a sports-therapeutic-relaxation garden and a garden containing an outdoor classroom.
"In the sports-therapeutic-relaxation garden, we practice practical skills in a real environment. We practice social habits, clients engage in gardening, watering, raking, and learning about plants and trees. The garden also includes a fireplace used for therapeutic activities and practicing outdoor dining. Equipment for relaxation, games, and physical activities has also been purchased," describes head nurse Eva Kitzlerová, adding that the second garden is used by therapists primarily for teaching and implementing closed group activities, such as psychotherapy, music therapy, psychogymnastics, and canistherapy. "Environmental therapy affects the intellectual, emotional and will-activated component of a person's personality, develops skills and communication. Part of it is the maintenance of greenery or planting flowers and caring for them," adds Eva Kitzlerová, head of the program in therapeutic gardens.

Therapeutic gardens of the Psychiatric Clinic of the General Universtiy Hospital of Prague

 

Project „Educational Therapeutic Center of the General University Hospital“

The implementation of the project "Educational Therapeutic Center of the General University Hospital" lasted from 2021 to March 2024. 200 patients were involved in the day care program during the project implementation. In addition to supporting and developing multidisciplinary care for mentally ill children and adolescents and improving the quality of the care provided, an edition of educational materials was also created for healthcare professionals caring for children with mental disorders, non-healthcare professionals, informal caregivers, educators and family members, which were previously missing from the offer.
Thematically, the educational materials relate to eight diagnostic areas: affective disorders, anxiety disorders, eating disorders, autism spectrum disorders, ADHD, sleep disorders, psychotic disorders, and addictive diseases.

The project, worth more than 14.5 million crowns, is financed from the EEA Funds 2014-2021 (Health Program).

About the Project:

Project start and end date: 1. 5. 2021 - 31. 3. 2024
Duration of the project: 35 months
Grant amount: CZK 14 530 385
Professional guarantor: Psychiatric Clinic (Center for Adolescent and Developmental Psychiatry)
Project number: ZD-ZDOVA1-017
The project was supported in an open call for applications for grants for projects from the EEA Grants 2014-2021 within the Health Programme.

project web: https://www.vfn.cz/pacienti/kliniky-ustavy/psychiatricka-klinika/edukacne-terapeuticke-centrum-vfn-v-praze/

Project outputs: https://www.vfn.cz/pacienti/kliniky-ustavy/psychiatricka-klinika/edukacne-terapeuticke-centrum-vfn-v-praze/

Text: VFN Praha

Photo: EEA ane Norway Grants