ARTICLES
Psychiatric Hospital Service Utilization of Children and Adolescents in State Custody

https://doi.org/10.1097/00004583-199903000-00018Get rights and content

ABSTRACT

Objective

To examine factors related to psychiatric hospitalization decision and length of stay of wards of the Illinois Department of Child and Family Services.

Method

A prospective design was implemented using the Childhood Severity of Psychiatric Illness (CSPI), a reliable, quantitative measure of psychiatric severity and its mediating factors. The CSPI was completed by hospital screeners upon conclusion of their crisis interviews. In addition to completing the CSPI, workers reported on demographic information.

Results

CSPI variables could effectively predict decision to admit versus deflect. The overall accuracy of this statistically significant prediction model was 77.9%. which was replicated on a new sample. Factors associated with decision to hospitalize are clinical in nature; ratings of suicidality, dangerousness, and impulsivity contributed the most to the model. Predicting length of stay was only moderately successful. Despite achieving significance, the model accounted for just 15.1% of length of stay variance using a multiple regression. Factors associated with length of stay were largely non-clinical in nature: living arrangement stability, region of the hospitalization, and age.

Conclusions

These results can be used to assess how decisions regarding level and duration of care are currently being made as a point of departure for quality improvement efforts.

REFERENCES (20)

  • L Bickman et al.

    Who gets hospitalized in a continuum of care?

    J Am Acad Child Adolesc Psychiatry

    (1996)
  • C Patrick et al.

    Use of inpatient services by a national population: do benefits make a difference?

    J Am Acad Child Adolesc Psychiatry

    (1993)
  • JG Allen et al.

    Actual versus optimal length of psychiatric hospital stay

    Bull Menninger Clin

    (1985)
  • L Behar

    Financing mental health services for children and adolescents

    Bull Menninger Clin

    (1990)
  • BJ Burns et al.

    Examining the research base for child mental health services and policy

    J Ment Health Adm

    (1990)
  • RF Cole et al.

    Partnerships for Care: Systems of Care for Children With Serious Emotional Disturbances and Their Families

    (1993)
  • AJ Costello et al.

    A checklist of hospitalization criteria for use with children

    Hosp Community Psychiatry

    (1991)
  • JR Hillard et al.

    Determinants of emergency psychiatric admission for adolescents and adults

    Am J Psychiatry

    (1988)
  • R Livingston et al.

    Factors related to length of hospitalization of children with mental health disorders

    Hosp Community Psychiatry

    (1990)
  • JS Lyons

    Severity and Acuity of Psychiatric Illness: Child and Adolescent Version

    (1998)
There are more references available in the full text version of this article.

Cited by (47)

  • Rating Scales for Behavioral Health Screening System Within Pediatric Primary Care

    2021, Child and Adolescent Psychiatric Clinics of North America
  • Child wellbeing assessment in child welfare: A review of four measures

    2016, Children and Youth Services Review
    Citation Excerpt :

    Research studies regarding the CANS' concurrent validity stem from Illinois data using the CSPI completed prospectively by caseworkers for children and youths in foster care who were screened for crisis psychiatric hospitalization. Findings indicate that ratings on items from the CSPI could effectively discriminate between those youths admitted versus deflected from hospitalization (Epstein, Jordan, Rhee, McClelland, & Lyons, 2009; He, Lyons, & Heinemann, 2004; Leon, Uziel-Miller, Lyons, & Tracy, 1999; Leon, Snowden, Bryant, & Lyons, 2006; Snowden, Leon, Bryant, & Lyons, 2007). However, an important caveat for these studies is that information obtained during the crisis screening and used to complete CSPI ratings was part of admission decisions.

  • The hospital as predictor of children's and adolescents' length of stay

    2006, Journal of the American Academy of Child and Adolescent Psychiatry
  • Ten-year review of rating scales, VII: Scales assessing functional impairment

    2005, Journal of the American Academy of Child and Adolescent Psychiatry
View all citing articles on Scopus

Financial support for this article was provided by the Illinois Department of Child and Family Services. The authors thank Mary Case, Rachel Klein, and Rose Naseef for their assistance with this project.

View full text