Applying the psychological mediation framework to the children's partial hospitalization setting

Abstract

Children's partial hospitalization programs offer an encompassing approach to treatment for patients presenting with a range of needs. In an effort to organize the treatment approach and environmental stressors impacting children, we have looked into modifying known frameworks. One such framework is the Psychological Mediation Framework (PMF). Developed by Hatzenbuehler, the framework suggests that stigma-related stressors trigger maladaptive psychological processes which exacerbate and maintain psychopathology. Hatzenbuehler organized these maladaptive psychological processes into three categories: cognitive; social and interpersonal; and coping and emotion regulation. He argues that this framework helps to explain what mediates the relationship between stigma, such as discrimination, and psychopathology (Figure 1). Despite this framework originally created for LGBTQ+ adults and only used with non-clinical contexts, “these psychological processes … are not unique to LGBT persons but may be experienced by anyone. For instance, chronic stress exposure (e.g., from stigma) may reduce one's capacity for adaptive coping and may increase maladaptive coping strategies by contributing to emotion regulation deficits. This framework does not claim that cognitive, social, and coping deficits are indicative of a psychiatric disorder. Rather, challenges in all three areas make it more likely that a full diagnosis would be present. We propose that the PMF could be a useful model for providers in partial hospitalization programs (PHPs) in designing treatment plans. Mental health providers outside of partial programs could use this visual to explain to families the integrative nature of PHPs. This could further be used as a self-evaluative tool for children's PHPs structured similarly to ours through Bradley Hospital in East Greenwich, RI.