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Inpatient treatment in child and adolescent psychiatry – a prospective study of health gain and costs
Author(s) -
Green Jonathan,
Jacobs Brian,
Beecham Jennifer,
Dunn Graham,
Kroll Leo,
Tobias Catherine,
Briskman Jackie
Publication year - 2007
Publication title -
journal of child psychology and psychiatry
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.652
H-Index - 211
eISSN - 1469-7610
pISSN - 0021-9630
DOI - 10.1111/j.1469-7610.2007.01802.x
Subject(s) - mental health , child and adolescent psychiatry , prospective cohort study , psychiatry , medical diagnosis , psychology , global assessment of functioning , intervention (counseling) , medicine , psychological intervention , pediatrics , cognition , surgery , pathology
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 = 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 post‐discharge 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.