title: Inpatient treatment in child and adolescent psychiatry--a prospective study of health gain and costs.
abstract: BACKGROUND
  Inpatient treatment is a complex intervention for the most serious mental health disorders in child and adolescent psychiatry. This is the first large-scale study into its effectiveness and costs. Previous studies have been criticised for methodological weaknesses.
  
  
  METHODS
  A prospective cohort study, including economic evaluation, conducted in 8 UK units (total n = 150) with one year follow-up after discharge. Patients acted as their own controls. Outcome measurement was the clinician-rated Childhood Global Assessment Scale (CGAS); researcher-rated health needs assessment; parent- and teacher-rated symptomatology.
  
  
  RESULTS
  We found a significant (p < .001) and clinically meaningful 12-point improvement in CGAS following mean 16.6 week admission (effect size .92); this improvement was sustained at 1 year follow-up. Comparatively, during the mean 16.4 week pre-admission period there was a 3.7-point improvement (effect size .27). Health needs assessment showed similar gain (p < .001, effect size 1.25), as did teacher- and parent-rated symptoms. Improvement was found across all diagnoses. Longer stays, positive therapeutic alliance and better premorbid family functioning independently predicted better outcome. Mean cost of admission was pound 24,100; pre-admission and post-discharge support costs were similar.
  
  
  CONCLUSIONS
  Inpatient treatment is associated with substantive sustained health gain across a range of diagnoses. Lack of intensive outpatient-treatment alternatives limits any unqualified inference about causal effects, but the rigour of measurement here gives the strongest indication to date of the positive impact of admission for complex mental health problems in young people.
authors: University of Manchester, UK. jonathan.green@manchester.ac.uk
authors: Jonathan
authors: J
authors: Green
authors: Brian
authors: B
authors: Jacobs
authors: Jennifer
authors: J
authors: Beecham
authors: Graham
authors: G
authors: Dunn
authors: Leo
authors: L
authors: Kroll
authors: Catherine
authors: C
authors: Tobias
authors: Jackie
authors: J
authors: Briskman
mesh_terms: D000293:Adolescent; D000296:Adolescent Psychiatry / Q000191:economics; D000328:Adult; D000367:Age Factors; D002648:Child; D002665:Child Psychiatry / Q000191:economics; D015331:Cohort Studies; D005260:Female; D017048:Health Care Costs; D006304:Health Status; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D001523:Mental Disorders / Q000191:economics* / Q000628:therapy*; D020380:Needs Assessment; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D016896:Treatment Outcome