School Reintegration Post-Psychiatric Hospitalization: Protocols and Procedures Across the Nation

  • Marisa E. MarracciniEmail author
  • Seungeun Lee
  • Andrew J. Chin
Original Paper


Youth returning to schools following psychiatric hospitalization are at high risk for mental health crises and rehospitalization. Yet, little is known about the current practices schools use to support student reintegration. This study administered a self-report questionnaire to 133 school psychologists across the nation to identify the prevalence and scope of school reintegration protocols and procedures in middle and high schools. Sixteen percent of respondents identified having a formal (i.e., written) school reintegration protocol in place, 45% reported having an informal procedure, and the remaining 38% reporting no such protocol or procedure. Respondents identified several components to successful reintegration including (1) establishing communication with the hospital, (2) meeting with the family prior to the student’s return, and (3) developing an individualized re-entry plan. Having a school reintegration protocol was positively associated with perceived quality of services for students returning from psychiatric hospitalization. Implications for schools considering adopting a consistent strategy for supporting students during this transitionary time are discussed.


School reintegration Psychiatric hospitalization Middle school High school School mental health 


Compliance with Ethical Standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was conducted in compliance with the Institutional Review Board Office of Human Research Ethics and all participants completed informed consent.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. Asarnow, J. R., Baraff, L. J., Berk, M., Grob, C. S., Devich-Navarro, M., Suddath, R., et al. (2011). An emergency department intervention for linking pediatric suicidal patients to follow-up mental health treatment. Psychiatric Services, 62(11), 1303–1309.CrossRefGoogle Scholar
  2. Ascher, B. H., Farmer, E. M. Z., Burns, B. J., & Angold, A. (1996). The child and adolescent services assessment (CASA) description and psychometrics. Journal of Emotional and Behavioral Disorders, 4(1), 12–20.CrossRefGoogle Scholar
  3. Becker, B. E., & Luthar, S. S. (2002). Social-emotional factors affecting achievement outcomes among disadvantaged students: Closing the achievement gap. Educational Psychologist, 37(4), 197–214. Scholar
  4. Blader, J. C. (2004). Symptom, family, and service predictors of children’s psychiatric rehospitalization within one year of discharge. Journal of the American Academy of Child & Adolescent Psychiatry, 43(4), 440–451.CrossRefGoogle Scholar
  5. Blader, J. C. (2011). Acute inpatient care for psychiatric disorders in the United States, 1996 through 2007. Archives of General Psychiatry, 68(12), 1276–1283.CrossRefGoogle Scholar
  6. Blizzard, A. M., Weiss, C. L., Wideman, R., & Stephan, S. H. (2016). Caregiver perspectives during the post inpatient hospital transition: A mixed methods approach. Child and Youth Care Forum, 45(5), 759–780.CrossRefGoogle Scholar
  7. Canter, K. S., & Roberts, M. C. (2012). A systematic and quantitative review of interventions to facilitate school reentry for children with chronic health conditions. Journal of Pediatric Psychology, 37(10), 1065–1075.CrossRefGoogle Scholar
  8. Carney, J., & Porter, P. (2009). School reentry for children with acquired central nervous systems injuries. Developmental Disabilities Research Reviews, 15(2), 152–158.CrossRefGoogle Scholar
  9. Clemens, E. V., Welfare, L. E., & Williams, A. M. (2010). Tough transitions: Mental health care professionals’ perception of the psychiatric hospital to school transition. Residential Treatment For Children and Youth, 27(4), 243–263.CrossRefGoogle Scholar
  10. Clemens, E. V., Welfare, L. E., & Williams, A. M. (2011). Elements of successful school reentry after psychiatric hospitalization. Preventing School Failure: Alternative Education for Children and Youth, 55(4), 202–213.CrossRefGoogle Scholar
  11. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Earlbaum Associates.Google Scholar
  12. Cook-Cottone, C. (2004). Childhood posttraumatic stress disorder: Diagnosis, treatment, and school reintegration. School Psychology Review, 33(1), 127–139.Google Scholar
  13. Costello, E. J., He, J. P., Sampson, N. A., Kessler, R. C., & Merikangas, K. R. (2014). Services for adolescents with psychiatric disorders: 12-Month data from the National Comorbidity Survey-Adolescent. Psychiatric Services, 65(3), 359–366.CrossRefGoogle Scholar
  14. Crepeau-Hobson, F. (2013). An exploratory study of suicide risk assessment practices in the school setting. Psychology in the Schools, 50(8), 810–822.CrossRefGoogle Scholar
  15. Doll, B., Spies, R., & Champion, A. (2012). Contributions of ecological school mental health services to students’ academic success. Journal of Educational and Psychological Consultation, 22(1–2), 44–61.CrossRefGoogle Scholar
  16. Frankenberg, E. (2009). The demographic context of urban schools and districts. Equity and Excellence in Education, 42(3), 255–271.CrossRefGoogle Scholar
  17. Friedman, K., Ramirez, A. L., Murray, S. B., Anderson, L. K., Cusack, A., Boutelle, K. N., et al. (2016). A narrative review of outcome studies for residential and partial hospital-based treatment of eating disorders. European Eating Disorders Review, 24(4), 263–276.CrossRefGoogle Scholar
  18. Goldston, D. B., Daniel, S. S., Reboussin, B. A., Reboussin, D. M., Frazier, P. H., & Harris, A. E. (2001). Cognitive risk factors and suicide attempts among formerly hospitalized adolescents: A prospective naturalistic study. Journal of the American Academy of Child and Adolescent Psychiatry, 40(1), 91–99.CrossRefGoogle Scholar
  19. Harpaz-Rotem, I., Leslie, D. L., Martin, A., & Rosenheck, R. A. (2005). Changes in child and adolescent inpatient psychiatric admission diagnoses between 1995 and 2000. Social Psychiatry and Psychiatric Epidemiology, 40(8), 642–647.CrossRefGoogle Scholar
  20. Harris, M. S. (2009). School reintegration for children and adolescents with cancer: The role of school psychologists. Psychology in the Schools, 46(7), 579–592.CrossRefGoogle Scholar
  21. Herman, K. C., Cho, E., Marriott, B. R., & Walker, L. Y. (2018). Bridging the gap in psychiatric care for children with a school-based psychiatry program. School Mental Health, 10, 1–9.CrossRefGoogle Scholar
  22. Horwitz, A. G., Czyz, E. K., & King, C. A. (2015). Predicting future suicide attempts among adolescent and emerging adult psychiatric emergency patients. Journal of Clinical Child and Adolescent Psychology, 44(5), 751–761.CrossRefGoogle Scholar
  23. Housing Assistance Council. (November, 2011). Rural research brief. Retreived November 15, 2018 from
  24. IBM Corp. Released 2016. IBM SPSS statistics for windows, version 24.0. Armonk, NY: IBM Corp.Google Scholar
  25. Iverson, P. (2017). Adolescents’ experiences returning to school after a mental health hospitalization. Retrieved from: All Theses, Dissertations, and Other Capstone Projects. 709.
  26. James, S., Charlemagne, S. J., Gilman, A. B., Alemi, Q., Smith, R. L., Tharayil, P. R., et al. (2010). Post-discharge services and psychiatric rehospitalization among children and youth. Administration and Policy in Mental Health and Mental Health Services Research, 37(5), 433–445.CrossRefGoogle Scholar
  27. La, E. M., Morrissey, J. P., Lich, K. H., Domino, M. E., Seibert, J., & Waller, A. (2017). Impact of state psychiatric hospital waitlists on monthly admissions. Psychiatric Services, 68(11), 1201–1204.CrossRefGoogle Scholar
  28. Lindsay, S., Hartman, L. R., Reed, N., Gan, C., Thomson, N., & Solomon, B. (2015). A systematic review of hospital-to-school reintegration interventions for children and youth with acquired brain injury. PLoS ONE, 10(4), e0124679.CrossRefGoogle Scholar
  29. Marrast, L., Himmelstein, D. U., & Woolhandler, S. (2016). Racial and ethnic disparities in mental health care for children and young adults: A national study. International Journal of Health Services, 46(4), 810–824.CrossRefGoogle Scholar
  30. Masia-Warner, C., Nangle, D. W., & Hansen, D. J. (2006). Bringing evidence-based child mental health services to the schools: General issues and specific populations. Education and Treatment of Children, 29(2), 165–172.Google Scholar
  31. Merikangas, K. R., He, J. P., Burstein, M., Swendsen, J., Avenevoli, S., Case, B., et al. (2011). Service utilization for lifetime mental disorders in US adolescents: Results of the National Comorbidity Survey-Adolescent Supplement (NCS-A). Journal of the American Academy of Child and Adolescent Psychiatry, 50(1), 32–45.CrossRefGoogle Scholar
  32. National Association of School Psychologists (NASP). (2018). Who are school psychologists? Retreived November 15, 2018 from
  33. Newell, M., & Looser, J. (2018). Does context matter? An analysis of training in multicultural assessment, consultation, and intervention between school psychologists in urban and rural contexts. Psychology in the Schools, 55(1), 85–92.CrossRefGoogle Scholar
  34. O’Brien, K. H. M. (2015). Rethinking adolescent inpatient psychiatric care: The importance of integrated interventions for suicidal youth with substance use problems. Social Work in Mental Health, 11(4), 349.Google Scholar
  35. Owens, A. (2018). Income segregation between school districts and inequality in students’ achievement. Sociology of Education, 91(1), 1–27.CrossRefGoogle Scholar
  36. Preyde, M., Parekh, S., & Heintzman, J. (2018). Youths’ experiences of school re-integration following psychiatric hospitalization. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 27(1), 22.Google Scholar
  37. Preyde, M., Parekh, S., Warne, A., & Heintzman, J. (2017). School reintegration and perceived needs: The perspectives of child and adolescent patients during psychiatric hospitalization. Child and Adolescent Social Work Journal, 34(6), 517–526.CrossRefGoogle Scholar
  38. Prinstein, M. J., Nock, M. K., Simon, V., Aikins, J. W., Cheah, C. S., & Spirito, A. (2008). Longitudinal trajectories and predictors of adolescent suicidal ideation and attempts following inpatient hospitalization. Journal of Consulting and Clinical Psychology, 76(1), 92.CrossRefGoogle Scholar
  39. Roeser, R. W., & Eccles, J. S. (2014). Schooling and the mental health of children and adolescents in the United States. In M. Lewis & K. Rudolph (Eds.), Handbook of developmental psychopathology (pp. 163–184). Berlin: Springer.CrossRefGoogle Scholar
  40. Savina, E., Simon, J., & Lester, M. (2014). School reintegration following psychiatric hospitalization: An ecological perspective. Child and Youth Care Forum, 43(6), 729–746.CrossRefGoogle Scholar
  41. Shaw, S. R., & McCabe, P. C. (2008). Hospital-to-school transition for children with chronic illness: Meeting the new challenges of an evolving health care system. Psychology in the Schools, 45(1), 74–87.CrossRefGoogle Scholar
  42. Simon, J. B., & Savina, E. A. (2010). Transitioning children from psychiatric hospitals to schools: The role of the special educator. Residential Treatment for Children and Youth, 27(1), 41–54.CrossRefGoogle Scholar
  43. Soto, E. C., Frederickson, A. M., Trivedi, H., Le, A., Eugene, M. C., Shekher, M., et al. (2009). Frequency and correlates of inappropriate pediatric psychiatric emergency room visits. The Journal of Clinical Psychiatry, 70(8), 1164–1177.CrossRefGoogle Scholar
  44. Spirito, A., Simon, V., Cancilliere, M. K., Stein, R., Norcott, C., Loranger, K., et al. (2011). Outpatient psychotherapy practice with adolescents following psychiatric hospitalization for suicide ideation or a suicide attempt. Clinical Child Psychology and Psychiatry, 16(1), 53–64.CrossRefGoogle Scholar
  45. Stensland, M., Watson, P. R., & Grazier, K. L. (2012a). An examination of costs, charges, and payments for inpatient psychiatric treatment in community hospitals. Psychiatric Services (Washington, DC), 63(7), 666–671.CrossRefGoogle Scholar
  46. Stensland, M., Watson, P. R., & Grazier, K. L. (2012b). An examination of costs, charges, and payments for inpatient psychiatric treatment in community hospitals. Psychiatric Services, 63(7), 666–671.CrossRefGoogle Scholar
  47. Stephan, S., Mulloy, M., & Brey, L. (2011). Improving collaborative mental health care by school-based primary care and mental health providers. School Mental Health, 3(2), 70–80.CrossRefGoogle Scholar
  48. Suldo, S. M., Gormley, M. J., DuPaul, G. J., & Anderson-Butcher, D. (2014). The impact of school mental health on student and school-level academic outcomes: Current status of the research and future directions. School Mental Health, 6(2), 84–98.CrossRefGoogle Scholar
  49. Tisdale, J. M. (2014). Psychiatric hospitalization to school transitions: Examining professional perceptions of effectiveness and fidelity. Retreived from: Open Access Dissertations. Paper 279.
  50. Truscott, D. M., & Truscott, S. D. (2005). Differing circumstances, shared challenges: Finding common ground between urban and rural schools. Phi Delta Kappan, 87(2), 123–130.CrossRefGoogle Scholar
  51. US Department of Health and Human Services, Substance Abuse and Mental Health Administration. (2017). Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health. Retrieved July 5, 2018, from
  52. White, H., LaFleur, J., Houle, K., Hyry-Dermith, P., & Blake, S. M. (2017). Evaluation of a school-based transition program designed to facilitate school reentry following a mental health crisis or psychiatric hospitalization. Psychology in the Schools, 54(8), 868–882.CrossRefGoogle Scholar
  53. Wolff, J. C., Davis, S., Liu, R. T., Cha, C. B., Cheek, S. M., Nestor, B. A., et al. (2018). Trajectories of suicidal ideation among adolescents following psychiatric hospitalization. Journal of Abnormal Child Psychology, 46(2), 355–363.CrossRefGoogle Scholar
  54. Yen, S., Fuller, A., Joel, S., & Spirito, A. (2014). Follow-up treatment utilization by hospitalized suicidal adolescents. Journal of Psychiatric Practice, 20(5), 353.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.School Psychology, School of Education, 105H Peabody Hall, CB# 3500University of North Carolina at Chapel HillChapel HillUSA

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