Outcome of short-term child psychiatric hospitalization: teacher evaluation at 5-month and 12-month follow-up

The direct and interactive effects of physical abuse severity and negative affectivity on length of psychiatric hospitalization: evidence of differential reactivity to adverse environments in psychiatrically high-risk youth

The current study examined the interactive influence of multiple factors (i.e., physical abuse severity and negative affectivity) in predicting youth's inpatient psychiatric length of stay (LOS), extending previous research focused on identification of only single LOS predictors. Elevated physical abuse severity was hypothesized to predict longer youth LOS, and negative affectivity was anticipated to exacerbate this relationship. This study included 42 youth. Clinicians rated youth temperament, whereas physical abuse severity and LOS were coded from youth medical records. Controlling for other previously determined predictors of LOS (i.e., age, gender, and GAF), moderation analyses confirmed hypotheses, revealing a temperament by environment interaction. Specifically, physical abuse severity was positively associated with LOS only in the context of high negative affectivity. Findings highlighted the importance of disentangling the interactive effects of multiple factors in predicting LOS. Moreover, critical clinical implications involving prioritized trauma assessment and treatment for inpatient youth are discussed.

Can standardized diagnostic assessment be a useful adjunct to clinical assessment in child mental health services? A randomized controlled trial of disclosure of the Development and Well-Being Assessment to practitioners

PURPOSE

While research demands standardized diagnostic assessments as an indication of sufficient methodological rigour, there is debate about their application to clinical practice. The Development and Well-Being Assessment (DAWBA) provides a structured assessment of psychiatric disorder. Since it can be completed on-line, it could be used by Child and Adolescent Mental Health Services with few additional demands on staff. Access to the standardized diagnostic information as an adjunct to clinical assessment could reduce the number of appointments spent on assessment, free up practitioner time to work on engagement and improve clinical outcomes by increasing the accuracy of assessment and thus access to the appropriate evidence-based treatment.

METHOD

Randomized controlled trial of the disclosure of the DAWBA to the assessing practitioner (n = 117) versus assessment at normal (n = 118) and analysed by "intention to disclose".

RESULTS

Exposure to the DAWBA may increase agreement between the DAWBA and practitioners about some anxiety disorders, but detected no other statistically significant increased agreement for other disorders, nor a reduced need for further assessment, the number of difficulties recognised or influence on outcomes.

CONCLUSIONS

The results may be explained by the inadequacy of the DAWBA, lack of statistical power to detect any effects that were present or a reluctance of some practitioners to use the DAWBA in their assessment. Future research might benefit from exploring the use of the DAWBA or similar assessments as a referral rather than an assessment tool, and exploring how practitioners and parents experience and use the DAWBA and what training might optimise the utility of the DAWBA to clinical practice.

Evaluating outcomes of the child and adolescent psychiatric unit: A prospective study

Background

The aims of this prospective study are to clarify the outcomes of child psychiatric inpatient treatment and to identify factors associated with patient improvement.

Methods

The attending psychiatrist used the Children's Global Assessment Scale (CGAS) to assess youths at admission to and discharge from a child and adolescent psychiatric unit in Japan(N = 126, mean age = 12.8, SD = 1.9). Hospital records gathered sociodemographic and clinical variables. In addition, youths and their primary caregivers assessed themselves using the Youth Self Report (YSR) and the Child Behavior Checklist (CBCL), respectively. Longitudinal analyses compared each scales' baseline and discharge scores. We also examined factors associated with changes in functioning (CGAS).

Results

Longitudinal comparisons revealed that CGAS, CBCL and YSR scores showed improvement over time (CGAS: t = -14.40, p = 0.00; CBCL: t = 3.80, p = 0.00; YSR: t = 2.40, p = 0.02). Linear regressions determined that the factors associated with improvement in CGAS included age, lower CGAS scores at admission, frequency of group therapy and psychiatric diagnosis.

Conclusions

This evaluation of children and adolescents in an inpatient unit demonstrated clinical improvement over time and identified factors associated with said improvement.

Patients who do well and who do less well in an inpatient adolescent unit

OBJECTIVE

The primary aim of the study was to investigate whether patient characteristics such as age, sex, length of inpatient stay and reason for admission were related to positive or negative treatment outcome at an adolescent inpatient unit.

METHOD

This study employed a prospective cohort design in the form of a clinical audit. Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) pre- and post-admission scores were compared for the whole sample and across diagnoses.

RESULTS

While there was a significant reduction overall in symptoms following an inpatient stay, patient characteristics and reason for admission were not related to outcomes at a statistically significant level.

CONCLUSIONS

This inpatient unit generally functions as a short stay unit and as a result it is difficult to draw any meaningful conclusions as to what sort of patient would benefit most from an admission to the unit.

The clinical course of children treated in a short-term inpatient programme

Forty-six children admitted to short-term, usually 4-6-week child psychiatric inpatient treatment were evaluated from multiple perspectives on admission, at discharge, and at 5-month, one-year, and 3-year follow-ups. The majority of the patients showed an improvement in functioning over the course of the 3-year follow-up. However, the 3-year stability of parent, teacher and clinical ratings of the child was very high. Furthermore, the majority of children had a high level of symptoms at follow-ups. Conduct problems had the highest stability and predicted the poorest outcome. The results stress the importance of long-term follow-up of children discharged from child psychiatric tertiary services. In many of these cases, the problems were persistent chronic problems that require continued monitoring and evaluation over many years. Short-term hospitalization should be seen as a pathway to further assistance rather than a complete form of treatment.

Variables related to outcome following child psychiatric hospitalization

Children (N = 110) hospitalized on a child psychiatric unit improved significantly in psychological functioning at discharge and 1- and 6-months follow-up relative to their functioning at admission. Children who were more impaired at admission made more progress during admission but were more impaired at follow-up than children who had milder symptoms at admission. Children without a behavior disorder had a better outcome than children with a behavior disorder. None of the other variables, alone or in combination, was significantly related to admission progress or follow-up outcome, including specific diagnoses, gender, race, age, IQ, family functioning, negative life events, parent education and employment, biological family history, length of hospitalization, parent involvement during admission and follow-up services.

Outcome following child psychiatric hospitalization

Admission, discharge, and follow-up evaluations of 110 children admitted to a child psychiatric unit (mean 14 days) showed that the children's psychological functioning improved significantly during hospitalization. Gains were not fully maintained at follow-up (1 and 6 months), but the children were still significantly less impaired after discharge than at admission. A nonsignificant difference existed between follow-up scores, indicating no loss of progress or decline in functioning from 1- to 6-month follow-up. The results are consistent with an ABA (A = no inpatient intervention, B = inpatient intervention, A = no inpatient intervention) treatment effect. They are not explained by removal from and return to an unsatisfactory home environment. Psychological functioning after admission was significantly better than after 1 to 6 months of post-discharge psychiatric services. This study offers a clinically feasible approach to evidence-based practice by documenting patient improvement during and after inpatient treatment using a simple, empirically supported assessment instrument.