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

Kathleen Pottick, Stephen Hansell, Dorothy Gaboda, Elane Gutterman

Publication Date: 01/01/1993

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.