Green, J. and Jacobs, B. and Beecham, J.K. and Dunn, G. and Kroll, I. and Tobias, C. and Briskman, C. (2007) Inpatient treatment in child and adolescent psychiatry - an exploratory prospective study of health gain and costs. Journal of Child Psychology and Psychiatry, 48 (12). pp. 1259-1267. ISSN 0021-9630.
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Background: Inpatient treatment is a complex intervention for the most serious mental health disorders in child and adolescent psychiatry. This is the first large-scale study into its effectiveness and costs. Previous studies have been criticised for methodological weaknesses. Methods: A prospective cohort study, including economic evaluation, conducted in 8 UK units (total n ¼ 150) with one year follow-up after discharge. Patients acted as their own controls. Outcome measurement was the clinician-rated Childhood Global Assessment Scale (CGAS); researcher-rated health needs assessment; parent- and teacher-rated symptomatology. Results: We found a significant (p < .001) and clinically meaningful 12-point improvement in CGAS following mean 16.6 week admission (effect size .92); this improvement was sustained at 1 year follow-up. Comparatively, during the mean 16.4 week pre-admission period there was a 3.7-point improvement (effect size .27). Health needs assessment showed similar gain (p < .001, effect size 1.25), as did teacher- and parent-rated symptoms. Improvement was found across all diagnoses. Longer stays, positive therapeutic alliance and better premorbid family functioning independently predicted better outcome. Mean cost of admission was £24,100; pre-admission and postdischarge support costs were similar. Conclusions: Inpatient treatment is associated with substantive sustained health gain across a range of diagnoses. Lack of intensive outpatient-treatment alternatives limits any unqualified inference about causal effects, but the rigour of measurement here gives the strongest indication to date of the positive impact of admission for complex mental health problems in young people. Keywords: Child, adolescent, psychiatry, inpatient, outcomes, costs.
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|Uncontrolled keywords:||Child • adolescent • psychiatry • inpatient • outcomes • costs|
|Subjects:||H Social Sciences > HV Social pathology. Social and public welfare
B Philosophy. Psychology. Religion > BF Psychology
|Divisions:||Faculties > Social Sciences > School of Social Policy Sociology and Social Research > Personal Social Services Research Unit|
|Depositing User:||Rosalyn Bass|
|Date Deposited:||24 Apr 2008 13:40|
|Last Modified:||03 Mar 2010 11:32|
|Resource URI:||http://kar.kent.ac.uk/id/eprint/2816 (The current URI for this page, for reference purposes)|
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