Sheppard Pratt’s new inpatient Adolescent Neuropsychiatry Unit is the only such unit in Maryland, and one of the few psychiatric hospital centers for developmental disabilities in this country. The program offers psychiatric evaluation and stabilization, and a behavioral approach to care for these dually diagnosed children and adolescents. Its service chief, Desmond Kaplan, M.D., possesses first-hand knowledge about the disabilities which afflict children, as he grew up with a family member who suffered from Cerebral Palsy and a seizure disorder as well as psychiatric difficulties. Other expertise comes from training on three continents: South Africa, where he attended medical school; Israel, where he trained for his board certification in child psychiatry; and the U.S., at Johns Hopkins, where he received his training (and board certification) in adult psychiatry. Dr. Kaplan worked in family medicine and pediatric oncology while in Israel, and he also counseled the families of children with developmental illness. This in part propelled him to focus his academic interest in neuropsychiatry. At the Kennedy Kreiger Institute, Dr. Kaplan took his fellowship while studying the neuroimaging of developmental disease.
Dr. Kaplan came to Sheppard Pratt to develop an inpatient unit that would be dedicated to the care of psychiatrically involved youngsters with developmental impairments. An 11-bed unit was modeled to his specifications, and referrals were almost immediate. Joining him were several other clinicians, including a behavioral psychologist and a neuropsychiatrist. The team, with its counselors and educators, diagnose and treat patients referred from agencies and institutions within and out of state.
The goal of the program is to provide care safely, in the least restrictive environment, stressing documentable clinical effectiveness, multi-disciplinary teamwork with the patient and family, and minimization of the cost per episode of care. Dr. Kaplan has established a therapeutic milieu supportive of the special needs population. He has implemented a formal classroom, insisted upon all patients eating together, set in motion least restrictive, effective policies and procedures to deal with disturbed patients, and even set up a weekly concert. The program is pursuing innovations such as technological aids for teaching disabled patients. Residents from the joint Sheppard Pratt and University of Maryland School of Medicine program will begin rotation on the unit in January, 2004.
Dr. Kaplan’s unit serves children and adolescents ages 10 to 18 whose intensity and/or frequency of maladaptive behaviors make them unsafe to self or others and who have sub-normal IQ’s or diagnoses of neurological illness or syndromes such as cerebral palsy, spina bifida, autism, pervasive developmental disorder, Asperger syndrome, Rett’s disorder, fragile X syndrome, Down syndrome, Prader-Willi Syndrome, Turner’s Syndrome, Lesch-Nyham Syndrome, and tuberous sclerosis complex. Criteria for admission include: IQ of between 70 and 35 or diagnosis of neurological illness or syndrome with severe impairment; Vineland Adaptive score of less than 70 (if available); and symptoms or behaviors that interfere with functioning at home, in school or in the community. The unit is geared to an average length of stay of three weeks. The higher staffing ratio, behavioral treatment philosophy, caregiver training and longer length of stay are all designed to result in extended periods of stability and an interruption in the cycle of repeated psychiatric hospitalizations for this population. A priority is to encourage positive change in the young patient’s life, focusing on the development of increased independence and self help skills, thereby effectively and efficiently reintegrating the developmentally disabled child or adolescent into his or her home community. One of the largest problems facing hospitalized patients is placement, and this effort requires the skills of a social worker assigned solely to the unit.
Referrals to Dr. Kaplan’s program can be made by calling 410-938-4983.