Informal caregiver burden and burnout can cause worsened outcomes of care for both the recipient of care and the caregiver’s overall health. Experiencing increased levels of distress by the caregiver may be the deciding factor for the elder remaining in the home or being placed in a long-term facility for care. Thus, healthcare professionals must be diligent in assessment for presence of a caregiver on admission, as well as identifying needs and providing education of resources within the community upon discharge. The purpose of this project is to implement admission screening for caregiver presence during the inpatient stay, with the goal of early communication to the interdisciplinary team. The project aims are as follows: a) to integrate the “Preparing for Caring” screening tool into the electronic health record, b) for nursing to provide education to the caregiver and assist with identification of needs during the inpatient stay, c) for nursing and the interdisciplinary team to collaborate with the caregiver during the inpatient stay to prepare for discharge, d) to provide education of resources available within the community upon discharge, and e) to include discussion of caregiver presence during the daily interdisciplinary team meeting. Program outcome measures will include use of aggregate data reports to determine the percentage of compliance for screening conduction, case review of identified caregivers, discharge education, and provision of a resource list upon discharge. Specified outcomes are being measured weekly during the implementation phase. As a result of the above, it will be determined if identification and subsequent intervention for informal family caregivers reduces readmission rate to an inpatient facility and the caregiver’s overall sense of burden in providing care upon discharge. Expected outcomes will be reduction in 30-day readmission to the inpatient geropsychiatry unit due to caregiver distress.

Mental health is a growing concern for adolescents. Billions of dollars are spent annually on mental services for youth. Many adolescents experience abuse, suicidal ideations, psychotic disorders, substance abuse, and other challenges. Recurring inpatient psychiatric hospitalizations are increasing among adolescents. The recurring admissions impact adolescents significantly socially, psychologically, and financially. Social workers are a vital part of this treatment process from admission to discharge. The research question asked what were the issues and challenges social workers encounter when conducting discharge planning with adolescents receiving recurring inpatient psychiatric treatment. The purpose for this doctoral project was to carefully examine the discharge planning process while identifying ways social workers can positively impact the process. Key concepts for this project were adolescent, inpatient hospitalization, recurring hospitalization, and discharge planning. Systems theory was used to inform the project. This action research study allowed social workers to share their experiences and perspectives about the role of social workers in discharge planning. Seven participants were identified using purposive sampling. One focus group provided data for project. Data analysis consisted of in vivo and process coding. Four participant-inspired themes identified related to issues and challenges in discharge planning include (a) adequate resources, (b) insurance restrictions, (c) rapport with adolescents, and (d) parental participation. Social work practice and positive social change implications include establishing follow-up protocol for all adolescent discharges from inpatient settings and increasing the use of encouragement and engagement strategies for rapport building with adolescents.