Several existing structures, specialized in the care for adolescents suffering from psychological disorders are affiliated with the network of Action for Teens.
I. - La Maison de Solenn (France) :
II.- The Adolescent Unit of the hospital "La Ramée" (Belgium)
Doctor Serge GOFFINET, head of service. Doctor Judith DEREAU, assistant-head of the psychiatric unit
Part of the Groupe Hospitalier Fond'Roy-La Ramée, based in Uccle (Brussels), Belgium
Brief description: Open unit with 15 beds. Admission of patients from age 12 to age 19 on a voluntary basis. 50% of the adolescents suffer from eating disorders and 50% of general psychiatric troubles.
For those youngsters, a house called "lycée thérapeutique" located near but separated from the hospital offers individual or class lessons given by three official teachers for 50 % of the day, and 50 % of therapeutic workshops, individual therapeutic sessions, group sessions... The theoretical references of the unit are psycho analytic and systemic.
An additional 10 beds are reserved for young adults (age 20 to age 25) which show the same characteristics as adolescents (50 % eating disorders and 50% general psychiatric troubles). A specific program is developed for those young adults. The accent is put on individual sessions and family session, focused on autonomy and creativity.
III- Marseille : "Espace Mediterranéen de l'Adolescence (EMA): a network policy for the care of adolescents"
"Marseille is a large agglomeration requiring the installation of a network to facilitate synergies between different areas. Pr Rufo describes hereafter the various aspects of his project, including full or partial hospitalization, consultations or emergency services.
In any case, the project maintains the specificities of cultural care, and emphasizes research and education." Prof. Marcel Rufo.
1.Network deployment
Pr.Marcel Rufo’s project is based on network deployment: the various services offered will actively collaborate according to their specificities.
The project should enable the various teams in charge of the adolescents to articulate the care conditions around an accommodating place and to group on one single site a variety of actors such as care personnel, educators, teachers, leisure professionals, cultural actors, socio educative personnel, while offering patients and families a framework of accommodation and care adapted to the complex situations of adolescents.
The low number of beds in Marseille and on the health territories serviced by the university hospital dedicated to hospitalization of adolescents reinforce the necessity of this project which answers a public health need set out by the regional schemes of care functioning (SROS) and the psychiatry and mental health plan.
Partnerships
Such project is only conceivable through consolidated partnerships with different hospital, institutional and associative actors, and with recourse to private funds.
In order to build its network, the Salvator hospital maintains privileged relationships with the following structures: the fondation des hôpitaux de France, Hôpitaux de Paris, Fondation Santé des Etudiants de France, Mutualité Française, Faculté de Médecine et l’Université d’Aix-Marseille, services de soins hospitalo-universitaires somatiques et psychiatriques de l’Assistance Publique des hôpitaux de Marseille, Centre de lutte Contre le Cancer, Institut Paoli Calmette, INCA, éducation nationale, territorial collectivities and their youth services.
The project also establishes links with the associative world (health and culture) and with the networks active in this area.
Furthermore, links will be reinforced with the unit currently being installed on the site of the Salvator hospital dedicated to adolescents and young adults in a situation of handicap who will benefit from the entire scheme and in particular the spaces for cultural care.
These partnerships materialized by a direct participation to the functioning of the hospital must enable not only the high quality of care but also to open the establishment to the city.
Site
The site of the Salvator hospital in the 9th arrondissement of Marseille (south hospitals) offers a framework, surfaces and a location adapted to this project. It is easily accessible (bus in front of the establishment and nearby metro), its park of several hectares and its surfaces of free buildings on one plateau enable the development of adapted care conditions leading directly (level access) to the outside.
Finally, its great proximity with the hospital of Sainte Marguerite and the régional de lutte anti-cancéreuse will enable a reinforced articulation of its functioning.
2/ Components of the project
The project includes several means of care for adolescents in relation with psychological and somatic spheres.
ARTHUR AREA
Hospitalization unit accommodating adolescents aged between 11 and 19 currently located in the premises of the Saint Marguerite hospital.
The individual rooms are sized to accommodate an accompanying person and include a working area. It constitutes a place of secured care as well as a place of living.
Adolescents suffering from personality disorders, severe depressions, suicidal behaviors, food disorders, behavioral disorders, school phobia…
The unit includes "adolescent club" activity rooms.
This unit is located next to a hospitalization unit for patients presenting disorders due to severe somatic diseases, including cancer (15 rooms). The two floors dedicated to care shall therefore find a synergy of common running.
The "mix" of psychology and organic care consequently creates a real unit of mixed hospitalization, all pathologies confounded (as in the adolescent house of Cochin in Paris – Solenn’s house). It is about treating a subject, as opposed to an organ.
HOSPITALIZATION UNIT FURTHER TO SOMATIC DISEASES :
The hospitalization unit for patients presenting disorders due to severe somatic diseases, including cancer, aims at, among others, allowing adolescents to recover after a severe pathology and hospitalization periods often long and difficult, restoring their image and succeeding in their reinsertion process outside the hospital.
Conceived as a place to live and accommodate, very different from a classical hospitalization unit in order to differ from traditional care services, the unit shall constitute a bridge with the outside world.
The accommodation services and common activities at this age of life shall rank prior to care services that may be effected in the framework of treatments and follow-ups.
EMERGENCY CARING SERVICES
Adolescents and young adults in crisis needing acute caring services or of CAP 48 type (hospitalization of 48 hours).
Patients arriving, together with their parents or by emergency services will benefit from adapted caring services in a six box zone, of so-called stabilization or orientation, that will allow reception and orientation in accordance with theirs needs:
- to CAP 48 for a short hospitalization period in the very secured premises comprising, among others, eight hospitalization rooms and two isolation rooms;
- directly to a hospitalization unit of the site;
- to their domicile together with a post-emergency follow-up in the Part Time Therapeutic Accommodating Center of the site or to other non-clinical care structures.
This emergency accommodating structure, similar to the one recently created at the Saint Marguerite hospital for adult patients, shall prevent systematical stops by traditional emergency services prejudicing to their management and increasing the risk of incomprehension for adolescents, while guaranteeing examination conditions adapted to the crisis and allowing for calibrated reactions.
FONDATION SANTE DES ETUDIANTS DE FRANCE :
The 25 beds clinical department of the Fondation Santé des Etudiants de France is a structure designed around a school and/or university project relying on part-time presence and intended for adolescents with psychological and/or somatic issues which seriously hinder traditional school integration. It is intended for patients aged between 16 and 24 years old, from the secondary education to the general university studies diploma, with however no view to replace specialized schools or sections developed by the ministry of education. This unit includes 25 single rooms, each equipped with a working area.
PART-TIME THERAPEUTIC RECEPTION CENTER :
The Part Time Therapeutic Accommodating Center will allow the accommodation of patients who require follow-up care outside the traditional hospital care methods, directly after an emergency admission, a hospitalization or a scheduled appointment. The cultural healing area provides a support area to those treatments of which the frequency will depend on the patient’s condition. The psychiatric cares rely on cultural and/or ludic activities, which de-dramatize the place and re-socialize the adolescent.
CULTURAL HEALING AREA
The cultural healing area is the center of gravity of this “alternative” hospital. It will benefit from a central position and will be easily accessible. The day-to-day activities will be organized in this place. Both the de-dramatization of the treatment and the feeling of recognition of issues specific to adolescents partly depend on the existence and utilization of this special area. With an open access to the park, it will be composed of a calm area, activity rooms and a multifunctional area for meetings and light snacks and refreshments. The calm area will include classrooms, study rooms mainly accessible to the patients of the unit of the Fondation Santé des Etudiants de France and a multimedia and book library. The activity rooms will enable the practice of various activities ranging from music, photography and new technologies, to manual activities (drawing, pottery…) or even a “boredom” room (without any equipment)… a sports room will also be installed. The activities will be given by art specialists together with healthcare staff. The multifunctional area will include a meeting group for adolescents and/or parents groups, a teenager club, an area for the associations active on site, a multi-purpose room and an area for light snacks and refreshments accessible to the patients and their families or visitors.
MULTIDISCIPLINARY CONSULTATIONS
The multidisciplinary consultations should allow to welcome the adolescents in conditions adapted to their age, relying on ten to fifteen multi-purpose consultation offices and cultural areas. All types of consultations directly related to the most common pathologies of adolescents (psychiatric, psychological, gynecological, dermatological…) will be organized there. These consultations will be carried out in cooperation with the somatic medical specialties of the Public Hospitals of Marseille and namely the sites of Sainte Marguerite and of the central sector.
RESEARCH & EDUCATION
The research/education unit should allow researchers in cooperation with the medical school but also with the university and the ministry of education, to pursue research on the treatment of adolescents and to teach classes. |