Brief inpatient psychiatric treatment of adolescents: Outcomes and effectiveness
Herdzik, Karen M.
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Research on outcomes of emergency hospitalization of adolescents in the United States is scant. In this study, a sample of 60 adolescents admitted to an inpatient unit was administered self-report measures of symptoms and functioning at admission, during hospitalization and discharge. The goals was to determine (1) whether participants improved; and how the following factors affected outcome: (2) patient characteristics; (2) problem characteristics; (3) treatment characteristics; and (4) patient perceptions of treatment components. Measures used include Behavior Assessment System for Children, 2nd edition Self-Report of Personality--Adolescent (BASC-2 SRP-A); Children's Depression Inventory (CDI); Family Adaptability and Cohesion Evaluation Scale--4th Edition (FACES-IV); and the Schwartz Outcome Scale (SOS) among others. Results suggest that significant improvement occurred for the majority of participants, but that a minority of participants worsened and that there was wide variability in outcomes. Factors associated with improvement were: more severe symptoms at admission, prior hospitalization, prior legal involvement, high exposure to trauma and abuse, low SES, high family satisfaction, high family flexibility, and low family chaos. Symptoms at admission appeared to be among the greatest predictors of variance in improvement. Diagnosis, treatment alliance, and participant ratings of treatment effectiveness were not significantly related to degree of improvement. The relationship between length of stay and outcome appeared cubic (to have two changes in slope). The greatest amount of improvement appears to occur early in treatment. Participants who did not receive a change in dosage or type of medication reported some better outcomes and were more likely to show good response to treatment. Findings did not match prior outcome research. It is suggested the psychiatric stabilization processes are different than outpatient model of psychological and psychiatric improvement. Clinical implications and directions for future research are discussed.