Evaluating the use of psychiatric hospitalization by residential treatment centers.
OBJECTIVE
To examine differences in risk levels of psychiatric hospital referrals received from residential treatment centers (RTCs) as a measure of service quality.


METHODS
This prospective study used the Childhood Severity of Psychiatric Illness (CSPI), a reliable measure of psychiatric severity and factors thought to affect decision-making. Psychiatric referrals were wards of the state from the 10 largest RTCs in one metropolitan county and were screened by mobile crisis workers for admission appropriateness. After interviewing clients, the independent crisis workers completed the CSPI.


RESULTS
Referrals were placed into 1 of 2 categories based on CSPI ratings: high-risk or low-risk. Referrals were deemed high-risk if they displayed moderate or severe levels of suicidality, dangerousness to others, or psychotic symptoms on the CSPI. Results showed statistically significant variation in the level of risk of referrals received from the 10 RTCs. In addition, RTCs that had high rates of low-risk referrals were rated by crisis workers as demonstrating poorer supervision of their clients.


CONCLUSIONS
The residential treatment providers in our sample are expected to provide intensive treatment to children and adolescents with serious emotional and behavioral problems. Our finding that some RTCs are making low-risk referrals suggests that they are struggling to meet the needs of some of their clients. Our findings can be used to inform quality improvement efforts at RTCs that are currently struggling.
Leon
S C
SC
Department of Psychiatry and Behavioral Sciences, Northwestern University Medical School, Chicago, USA.
Lyons
J S
JS
Uziel-Miller
N D
ND
Rawal
P
P
Tracy
P
P
Williams
J
J
D000293:Adolescent; D002648:Child; D005260:Female; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data*; D006801:Humans; D007087:Illinois; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D011446:Prospective Studies; D011787:Quality of Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012114:Residential Treatment; D020379:Risk Adjustment / Q000379:methods; D014600:Utilization Review