Inpatient Treatment in Child and Adolescent Psychiatry--A Prospective Study of Health Gain and Costs

Autor/inn/en	Green, Jonathan; Jacobs, Brian; Beecham, Jennifer; Dunn, Graham; Kroll, Leo; Tobias, Catherine; Briskman, Jackie
Titel	Inpatient Treatment in Child and Adolescent Psychiatry--A Prospective Study of Health Gain and Costs
Quelle	In: Journal of Child Psychology and Psychiatry, 48 (2007) 12, S.1259-1267 (9 Seiten) PDF als Volltext Verfügbarkeit
Sprache	englisch
Dokumenttyp	gedruckt; online; Zeitschriftenaufsatz
ISSN	0021-9630
DOI	10.1111/j.1469-7610.2007.01802.x
Schlagwörter	Health Needs; Needs Assessment; Mental Health; Psychiatry; Adolescents; Patients; Measures (Individuals); Effect Size; Costs; Children; Intervention; Mental Disorders; Foreign Countries; Symptoms (Individual Disorders); Evaluation Methods; Psychiatric Hospitals; Outcomes of Treatment; United Kingdom + Suchen Sie Ihr Suchwort? Bedarfsermittlung; Psychohygiene; Psychiatrie; Adolescent; Adolescence; Adoleszenz; Jugend; Jugendalter; Jugendlicher; Patient; Messdaten; Cost; Kosten; Child; Kind; Kinder; Mental illness; Geisteskrankheit; Ausland; Psychiatrische Symptomatik; Phsychiatric institution; Psychiatrische Einrichtung; Großbritannien
Abstract	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 less than 0.001) and clinically meaningful 12-point improvement in CGAS following mean 16.6 week admission (effect size 0.92); 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 0.27). Health needs assessment showed similar gain (p less than 0.001, 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 British Pounds; 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. (As Provided).
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Erfasst von	ERIC (Education Resources Information Center), Washington, DC
Update	2017/4/10