Factors Associated with Inpatient and Outpatient Treatment for Children and Adolescents with Serious Mental Illness

KATHLEEN POTTICK, Stephen Hansell, ELANE GUTTERMAN, Helene White 1995

This study describes the distribution of children and adolescents in psychiatric inpatient and outpatient facilities and identifies factors associated with the selection of individuals into inpatient versus outpatient care. Sample Data: The data are from a 1986 nationally representative sample surveyed by the National Institute of Mental Health. Results indicate that the vast majority of children and adolescents with psychiatric problems receive outpatient treatment rather than inpatient care. Factors that predict psychiatric hospitalization rather than outpatient care are (1) public or private insurance coverage versus no insurance; (2) previous hospitalization; (3) psychiatric diagnosis of affective or psychotic disorders versus conduct disorders, adjustment disorders, drug and alcohol abuse, and other disorders; and (4) age, with adolescents more likely to be hospitalized than children. Further research is needed to explore the role of insurance in mental health sorting processes. Moreover, systematic, controlled research is needed to determine how different financing strategies affect mental health outcomes for children and adolescents.


Child and adolescent outcomes of inpatient psychiatric services: A research agenda

Kathleen Pottick, Stephen Hansell, Dorothy Gaboda, Elane Gutterman 1993

Psychiatric inpatient hospitalization is viewed generally as an expensive, most-restrictive treatment setting which should be replaced by communitybased alternatives for children and adolescents. But little is known about the outcomes of psychiatric hospitalization, and evidence that the alternatives are more effective is inconclusive. We describe the distribution of services provided to children and adolescents in psychiatric inpatient, outpatient and partial care facilities from 1986 national estimates. We find that over the course of a year, 682,756 children and adolescents receive treatment in inpatient (16.4%), outpatient (80.8%), or partial care (2.6%) facilities in a year. We then review the research literature and find that the existing research on outcomes of hospitalization is methodologically inadequate, severely limiting the causal inferences that can be made. However, trends in the evidence suggest that treatment and aftercare are important predictors of better psychiatric outcomes, controlling for organicity, symptoms, and diagnosis. Finally, we recommend testing treatment and aftercare services explicitly; using systematic, controlled research designs with comparison groups; and developing more refined descriptions of services in order to replicate effective interventions, and to generate and test theory about causes and effects of services and outcomes.


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