This is the Parque Goya Children's and Youth Day Hospital: "The context has a therapeutic effect"

They serve more than 20 boys and girls between the ages of 6 and 18. The waiting list does not go below 10. "We always have double or more," say its professionals.

It is 9.30:XNUMX in the morning on a Friday. They should be in class, at the institute, but due to different circumstances, what they have to do today Marina, Rigoberta, Gema, Natalia, Juan, Víctor and Tsuki (fictitious names that some of them have chosen) is to attend therapy at the Children and Youth Day Hospital Goya Park 2. 

For several of these adolescents, from Huesca and Teruel, coming to this health center in Zaragoza means more than an hour and a half by car. There are also those who arrive by ambulance, if their parents cannot bring them. families. "They are children who have serious emotional and psychological problems, which is why at first it is difficult for many of them to be able to attend the Day Hospital program"confirms María Dolores Vázquez, psychiatrist of this specialized service that was opened in 2018 to reinforce care for these smaller.

Their biographies have been broken due to the pandemic at a time of special vulnerability, as is adolescence. However, many of them have symptoms since childhood that have gone unnoticed. "The health situation derived from covid-19 has aggravated these problems and their symptoms," comments this specialist.

Others have a different vision of what confinement was for them. "The pandemic was a blessing because I didn't have to see the faces of my colleagues. What do you see wrong with that?" asks another young woman. Then she reflects and clarifies her opinion. "Spending so much time at home and locking myself up for two whole days and not being noticed in my surroundings made me very sad. One day I exploded and started crying. I hurt myself. Income started and there came a point where I couldn't take it anymore," he adds.

El Child and Youth Mental Health Day Hospital es a reference resource for all of Aragon, so patients from all three provinces come. "This is a resource continued care, intensive and structured treatment, limited in time and oriented towards continuity of care in the Community", explains psychiatrist María Dolores Vázquez.

The average stay in this community resource is 3 to 6 months. "Upon admission - their professionals point out - there are three weeks of assessment, after which the Individualized Care Plan (PAI) for each child is established." Although the time spent in this resource is limited to four months, in specific cases can be expanded depending on severity and psychopathological complexity of the minor and/or the socio-educational and family situation in which he or she is found. 

In this Day Hospital, a reference in Aragon in child and adolescent mental health, they treat pathologies such as severe depression, phobias, psychoses, autism, language disorders, pathologies of motor behaviors, psychosomatic alterations, behavioral expression disorders that manifest at certain ages with suicide attempts, isolation, early school leaving and absenteeism. Several young people present signs of symptoms that were not detected in childhood. According to the center's psychiatrist, the children who come to the Day Hospital They are generally undergoing treatment in Child and Adolescent Mental Health Units. or admitted to the hospitalization ward. "Referral to this service is usually marked by a worsening of the pathology, disturbed socio-familial circumstances or a crisis situation that requires an intensive comprehensive approach," they explain.

The problem of absenteeism

Many of them, in addition to severe emotional suffering that aggravates various pathologies, have in common the problem of absenteeism, a question that they also debate in the hospital classroom of this day center. Only two of the six students who attended therapy this Friday go to class. "I know it's important, that I should attend some days and that beyond the notice that you receive, it is essential to go, but in my case I am a person who finds it very difficult to leave the house. The commitment to come here is good for me and doing activities is helping me. We find more support here than at the institute, where no one understands you. Although many of them have good intentions, it is not the same... Here we are among equals, with people who truly understand you"argues another teenager. 

His classmate Víctor (not his real name) likes Mathematics, Physics and History. But he doesn't go to class either. He says there are teachers who he feels don't like teaching. Others, however, They get people who don't like to study interested in that subject and learn. "It depends a lot on the teachers... It really doesn't help me when someone comes to me saying that I miss class a lot or that I'm thinking I'm sick...", comments, for her part, another young woman who has made several friends at this Hospital de Day. "Here you make friends and they understand you because similar situations are happening and different activities are done.", defends another young woman, who like several colleagues comes daily from another geographically remote location. The hour and a half trip every day they assure that "it does not help" much to overcome laziness, but the support of the professionals who are in charge of this service. 

"It was good for me. Only in my course there have been other cases very similar to mine, and there are more than 100 people in the institute. The counselor helps us and here we started coming with the idea of ​​being able to return to school."says another young man, who also goes to his reference mental health unit. "I started going after leaving school with self-harm and things like that... I've been like this for a little over a year. From the first moment my family noticed and I was lucky that there was no waiting list. "They see me every one or two weeks," he says. 

When they are admitted to the Day Hospital, Alba Angulo, therapeutic teacher and head of the hospital classroom, establishes coordination with the different educational centers in Aragon. The hospital classroom is divided into a group of schoolchildren from 6 to 12 years old and another of adolescents, who in turn form two different groups (one from 12 to 15 years old and another from 15 to 18). "There are moments that make joint activities, such as the solidarity market or the Halloween festivities, Easter and Christmas," says this teacher.

Among all the professionals at the Parque Goya Day Hospital, they are in charge of creating links with the school to facilitate their reintegration into the classroom of their educational center in a "least conflictive" way possible. "Our next challenge is that they can consider the projects these guys do in the hospital classroom within a didactic program as a criterion for subsequent evaluation and thus be able to promote", they indicate.

They ask to strengthen mental health services

El Parque Goya Day Hospital was created in 2018 with the intention of increasing the resources available until that date, in Aragon, for specialized care in child and adolescent mental health. Today, He has four recognitions for his work. "Last year we won the Exducere award -innovation in education- and the Great Initiatives award in the inclusion category with a project to raise awareness about mental health in children and adolescents," they highlight.

Due to the increase in demand for these services in recent years, The Child and Adolescent Mental Health Units (USMIJ) are currently "overflowed", and this causes the delay in getting a consultation to become longer, and the frequency of a child's care is not as desired by the different professionals.

"It would be convenient if devices similar to this could be launched in Teruel and Huesca, because there are kids coming to the center who have an hour and a half and two hours of travel just to come here," assesses a nurse. 

La psychiatrist María Dolores Vázquez For its part, it highlights the effort that all the professionals who make up this team dedicate daily to offering the best care to these children. "There should be a food service here, but for reasons of logistics it is not done, so we have managed to do a cooking workshop and thus resolve this issue," he says. 

Another example would be part of the furniture, which they had to rescue from a nearby residence that was going to throw them away. "The resources must be assembled and supplied with what is necessary. At this time, The most important thing is personal resources. It is necessary that sick leave and vacation periods of professionals be replaced", defends Vázquez

The example of this program

Despite the difficulties, the professionals of this unit defend the validity of a program that is based on the community model and networking, in coordination with Education and the Services of Minors. 

"From the hospital, activities are organized and designed that allow them to have different experiences., learn about other areas, that investigate topics of interest, thereby promoting a space that helps them and where they can look for alternatives to their conflicts", they point out. Among them, is the Mathematics Route, which was held last week, or the service-learning they do thanks to their teacher Alba Angulo, a teacher assigned to the CEE Jean Piaget who teaches them different active methodologies. In addition, they say that the hospital is "very integrated" into the neighborhood, it is "well received" among its neighborhood, and from the teachers of the different educational centers in the area (CEIP Catalina de Aragón, CEIP Agustina de Aragón, IES Clara Campoamor , CEE Jean Piaget) joint activities are also promoted.

The families of these minors also have a separate space or "parent group" independent event held every 15 days in this Day Hospital run by a nurse, a psychiatrist and a therapeutic teacher. "In therapeutic and educational interventions with these young people, it is essential that the family is also cared for. since conflicts usually affect the entire family unit. It is necessary support in parenting and accompaniment for them in their difficulties," the workers emphasize.

La improvement in clinical evolution with respect to the most visible changes (class attendance, return to activities, friendships...) in these treatments It usually occurs in the long term. "In the short and medium term there is usually a relief of symptoms, which is of great importance to be able to carry out the therapeutic work. And upon discharge, treatment is maintained in the mental health units," points out Dr. Vázquez. In this way, there are children who manage to leave the center after a few months of the program, while others with "more severe" problems prolong their treatment. "Here there are problems that have not been discussed elsewhere. The context here has a therapeutic and also educational effect. They are boys who go through difficult times in adolescence, sometimes due to pathology and other times due to difficulties in the family and social context. When they arrive at the Day Hospital it is difficult for them to talk about it, express it... Also in consultation it is very painful to talk about what is happening to you.. It is a matter of time, and what is observed in this type of resources is that after months, When there is that trust with the therapist, issues appear that had not been shared before in other consultations that cannot be attended to as frequently as these kids require."concludes this psychiatrist, insisting on the importance of extending and bringing this resource to other provinces.