Interventions and Differentiation in a 

Psychiatric Inpatient Unit School 

Paige Brennan, Mary Gunsalus, M.S.

Introduction



Yale Childrens Psychiatric Inpatient Unit

The Childrens Psychiatric Inpatient Services is a 15-bed unit serving children
ages 4-14 with a variety of psychiatric disorders including mood and anxiety
disorders, psychotic disorders, pervasive developmental disorders, and PTSD.

The Multidisciplinary Team works together to develop a comprehensive
discharge plan, help the child develop positive coping strategies, learn to
navigate their road blocks, provide a comfortable environment for the child and
families and evaluate the childs medical needs.

In total, for the 2013-2014 year, 302 children stayed on the unit with an
average of an 8 day inpatient hospitalization

The Childrens Psychiatric Inpatient Unit School

All children attend the unit, certified special education school

The school is divided into two classes depending on age and developmental
level

The children in the school are assessed on their cognitive, academic, socialemotional, and adaptive functioning, are able to receive more attention due to
the small student-teacher ratio, and participate in an individualized cognitivebehavioral program.

The goal of the school is to facilitate independence and increase behaviors
which are essential for adjustment in their Least Restrictive Environment

Aims

To define Collaborative Problem Solving in a classroom setting and
determine the ways in which teachers find it to be most effective in certain
situations

To explore the ways in which each childs IEP and developmental level effect
the classroom management and procedure.

To determine the most effective classroom interventions, especially social
and emotional, used for children with developmental and mental health
disorders in this un

Interview Questions

1. In which ways do you differentiate for the different levels of the
students?

2. What are the most effective practices you have noticed for the students
with an intellectual disability?

3. Have you seen any behavioral differences between the students with
developmental delays versus typically developing students?

4. How do you ensure the developmental needs of the children are met
given their mental health conditions?

5. Have you noticed a significant relationship with intellectual disabilities
and mental health status or length of stay on the unit?

6. Do you follow their IEPs or make alternate accommodations for the
children?

7. How is Collaborative Problem Solving implemented? Examples?

Collaborative Problem Solving

Social-Emotional Interventions

Collaborative Problem Solving (CPS) is a model of care used on the unit and in the
school to replace consequence-based and limit-setting interventions (1). Adapted from
Ross Green, Ph.D., and Stuart Ablon, Ph.D., it is a cognitive behavioral approach
focused on adults defusing situation by encouraging positive coping skills.

Philosophy of CPS: Children will do well if they can. (2,3)

Due to this unique school setting, therapeutic interventions and positive coping
methods are taught to the children on the unit and in school.



As much as they need to know math and reading, the also need to know how
to be a good person and that it is okay to make mistakes.

-Colleen Ryan, M.A., Classroom Teacher



The school incorporates principles of Cognitive Behavioral Therapy (CBT) to
lower stress levels and defuse/replace maladaptive or aggressive behavior.

The students practice positive coping skills and interventions that will be useful
once the child returns to their Least Restrictive Environment (LRE).

These interventions include:

Deep breathing

Taking Space

Motor Breaks

Muscle Relaxation

Processing with Adults

Feelings Journal

Provide alternate task to reduce anxiety

Breaks between tasks



Children will do well if they can and you have to figure out why they are
not and be able to help them or teach them to manage better and in a more
positive way.



It [CPS] is not engaging in a power struggle, it is being flexible and identifying what
is going on with that child.

- Colleen Ryan, M.A., Classroom Teacher

The recreational therapy groups teach the patients the 5 major roadblocks and skills that
aid in altering these thoughts/behaviors before they escalate. The patients are taught in
usomh animal characters to help them realize their own deficits.

CPS identifies 5 major pathways that if a roadblock occurs, explosive behavior may
occur

1. Executive Function Skills Cloudy Chameleon

2. Language Skills Word Worm

3. Emotion Regulation Skills Moody Moose

4. Cognitive Flexibility Skills Routine Rabbit

5. Social Skills Lonely Lion 

We take all the clinical information-the psychiatric diagnosis,
medications, side effects- and translate it into educational
objectives to help with school planning.

-Mary Gunsalus, M.S., School Director

CPS identifies 3 ways adults could respond to situations with a child. Plan B is the
optimal approach to problem solving with the child (2,3)

Plan A: Adult direct request to take over control due to a safety concern

Plan B: Adult and child engage in problem solving process and addresses roadblocks



We work more closely to understand the child, who they are, what their levels
are, what the appropriate expectations of them are, and try to get them to work
on appropriate coping skills to replace the maladaptive behaviors.

-Mary Gunsalus, M.S., School Director



Plan C: Planning ignoring of a certain behavior


If you have to stop everything youre doing just to pay attention to that 1

kid to solve that situation, the other kids are missing out on valuable

learning experiences.

-Tammie Goodmaster, M.S., Classroom Teacher

Differentiated Instruction

The school is divided into two sections, creating a large age and achievement gap
among the students in both classes, especially since many students are diagnosed with
an intellectual disability.

Work must be individualized according to each students specific learning,
developmental, and mental health needs.

Individualized Education Plans (IEPs) are obtained from previous schools and they are
implemented as well as reviewed during their time on the unit.

After a 3 week stay, the child is reevaluated and recommendations are made to their
public schools on the most effective interventions due to their mental health condition

Providing each child with an opportunity to learn to their fullest potential, independent
of the other students level and work, is key in this school setting.

Some examples of differentiation include:


Preferential seating

Verbal answers vs. written answers

Breaking down to task analysis

Modifying quantity of work

Interview with a Child on the Unit

I sat down with an 11 year old female student to hear her opinion on the differences
between the inpatient school and her public, middle school.

The student told me that she liked the hospital school better because there are more
teachers and less kids so the children are guaranteed more individual attention which
she needs as a struggling learner. She stated that she wants to learn and was getting
the help she needs in this smaller classroom setting

She told me that there is less drama at the inpatient school and she feels more
accepted.

My dream is to have every kid be nice to me not just because of how I

look or dress. What really matters is personality and soul.

Everybody gets help. It makes them want to learn more and it makes
them smarter. It wasnt like that at my old school.

- 11-year-old female student

We need to modify within the classroom setting so some kids would have a lot of
work to do and some would have a little. Some students might circle a letter and try
to write it while others will write a whole sentence.

-Tammie Goodmaster, M.S., Classroom Teacher





References

1.
2.
3.

Martin, A., Heidi Krieg, H., Esposito, F., Stubbe, D., Cardona, L. (2008). Reduction of Restraint and Seclusion Through Collaborative Problem Solving: A FiveYear Prospective Inpatient Study. Psychiatric Services. Dec;59(12):1406-1412.

Green, R. (2001) The Explosive Child. New York: Harper Collins

Green, R., Ablon, J.S. (2006) Treating Explosive Kids, The Collaborative Problem-Solving Approach. New York: The Guilford Press