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Health Gain and Outcome Predictors During Inpatient and Related Day Treatment in Child and Adolescent Psychiatry

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ABSTRACT

Objective

To investigate health gain and its predictors during inpatient and associated day patient treatment.

Method

Consecutive admissions to two inpatient units for children and young adolescents in northwest England were studied (N = 55). Ascertainments were made from multiple perspectives, including family, teacher, clinician, and an independent researcher. Measures were taken at referral, admission, discharge, and 6-month follow-up; health gain was inferred from change scores on measures. Recruitment lasted from late 1995 to 1997; follow-up was completed during 1998. Independent variables tested as predictors included assessments of presenting symptoms, therapeutic alliance, and family functioning.

Results

Significant health gain during hospitalization was found on most measures and sustained to follow-up. There was no symptom change during the waiting-list control condition. Health gain was predicted independently by child and parental therapeutic alliance with the unit early in hospitalization and by preadmission family functioning. Externalizing problems did well if accompanied by good alliance.

Conclusions

Assessment of health gain from multiple perspectives is possible and valuable. Inpatient treatment has significant therapeutic effect. Predictors for health gain lie in process variables of therapeutic alliance and family functioning rather than presenting symptoms. The results are discussed in relation to clinical practice and future research.

Section snippets

Clinical Sample

Consecutive admissions to two inpatient child and adolescent units over an 18-month period were sampled. Unit 1 was a 12-bed regional unit with upper age limit of 15 years, and unit 2 a 6-bed subregional unit with age limit 16 years. The units served adjacent areas, both containing a mixture of urban, semiurban, and rural populations. The consultant on unit 2 (L.K.) had trained on unit 1, and the units had similar treatment philosophies. Referrals to both came from other child mental health

Characteristics of the Sample

Fifty-five children were recruited into the study, 42 from unit 1 and 13 from unit 2. There were 33 (60%) males and 22 (40% females), with a mean of age 11.4 years (range 6–17 years). At referral, 25.9% were not attending school and an additional 24.1% had partial attendance. Fifteen percent had had previous day patient or inpatient admission, and 3.6% were in nonfamily care. In 72% there was a family history of mental illness in first-or second-degree relatives.

Waiting-list time between

DISCUSSION

This study set out to apply a multiple-perspectives methodology to the conceptualization and measurement of health gain during child inpatient treatment and to investigate a range of variables predicting outcome. The design addressed unmodified clinical practice in an unselected sample. We used multiple perspectives on health gain and standardized instruments with which to measure them. The presence of a researcher independent of the clinical process and blind to clinical ratings and the

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