The hospital as predictor of children's and adolescents' length of stay.
ABSTRACT To predict psychiatric hospital length of stay (LOS) for a sample of Illinois Department of Children and Family Services wards across 4 fiscal years.
A prospective design was implemented using the Children's Severity of Psychiatric Illness scale, a reliable and valid measure of psychiatric severity, risk factors, youth strengths, and contextual/environmental factors. Data were collected for 1,930 hospital episodes across 44 hospitals from fiscal year 1998 through fiscal year 2001. Youths were screened for admission appropriateness by the Illinois Screening, Assessment, and Supportive Services (SASS) program. The Children's Severity of Psychiatric Illness was completed by SASS workers upon conclusion of their crisis interviews. In addition to completing the Children's Severity of Psychiatric Illness, SASS workers reported on demographic information and LOS.
The sample of 1,930 youths was randomly split to form development (n = 983) and validation (n = 947) samples. LOS was predicted using ordinary least squares regression. Thirty percent of the variance (F(19,666) = 16.6, p < .0001) in LOS was predicted for the development sample and 22% (F(14,657) = 14.6, p < .0001) was predicted for the confirmation sample. Hospital was the largest and most consistent predictor of LOS for both samples after controlling for clinical variables. Two hospitals accounted for approximately 10% of the variance in both samples (development beta = .273, p < .01 and beta = -.169, p < .01). Two SASS agencies also consistently predicted LOS (development beta = -.134, p < .05 and beta = .102, p < .05). No consistent changes in predictors of LOS occurred over time (FY98-FY01).
These findings suggest that nonclinical variables are the primary predictors of LOS in the Illinois system of care. In addition, these variables are consistent predictors over time. Quality assurance efforts might seek to further understand potential practice pattern variations across hospitals and SASS agencies.
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ABSTRACT: Many children and adolescents who require psychiatric hospitalization have been physically or sexually abused, yet the association between reported histories of abuse and the complexity and severity of mental illness among psychiatrically hospitalized youth is poorly described with regard to current inpatient psychiatric practice. We sought to determine the association between histories of abuse and psychiatric complexity and severity in psychiatrically hospitalized youth including comorbidity patterns, psychotropic medication use, reason for admission and length of hospitalization. A systematic chart review was performed on 1433 consecutive psychiatric hospitalizations of children and adolescents that occurred over a 10-month period. Children with a history of abuse were more likely to be diagnosed with multiple DSM-IV-TR disorders than non-traumatized children. A history of sexual abuse was associated with more medication use than in their non-traumatized peers and a higher likelihood of treatment with antipsychotic medications, both at admission and discharge. Physical and sexual abuse were independently associated with increased length of stays, with exposure to both physical and sexual abuse associated with a 2-day increase in duration of hospitalization compared to non-traumatized patients. The findings from this study draw attention to the adverse impact of abuse on psychiatric morbidity and complexity and suggest the need for trauma-informed treatment in psychiatric hospital settings.Child abuse & neglect 09/2013; DOI:10.1016/j.chiabu.2013.08.013 · 2.34 Impact Factor
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ABSTRACT: Individual differences in behavioral regulation system (BRS) and stress response system (SRS) functioning may reflect greater biological sensitivity to context. The current study tested whether children's cortisol, a measure of the SRS, was related to observed dysregulated behavior, an indicator of the BRS, in a sample of children admitted for acute psychiatric inpatient care. In addition, cortisol and dysregulated behavior were tested as unique predictors of length of hospitalization over and above demographic factors, prior treatment history, and caretaker-reported psychiatric symptoms. The latter variables were tested as potential moderators of the relations of BRS and SRS functioning to length of hospitalization. Plasma cortisol was collected on the morning following hospital admission for 544 children (ages 6-12; 73% boys; 61% ethnic minority). Dysregulated behavior was operationalized as the mean number of timeouts administered by staff for noncompliant behavior per day of hospitalization. Caretakers reported on youth internalizing and externalizing symptomatology. Higher cortisol was modestly associated with greater dysregulated behavior. In a model including both cortisol and dysregulated behavior, each predicted longer hospitalization. Cortisol was positively related to length of stay only for children previously hospitalized, and the relation of dysregulated behavior to length of stay was stronger for older children. Dysregulated behavior and cortisol are related but independent predictors of acute psychiatric hospitalization duration. Direct measures of the SRS can add to the clinical picture regarding hospitalization in ways that observed behavior and caretaker report alone cannot.Journal of Clinical Child & Adolescent Psychology 03/2012; 41(2):227-38. DOI:10.1080/15374416.2012.652000 · 1.92 Impact Factor
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ABSTRACT: The purpose of this study was to compare clinical and service utilization profiles of adolescents admitted to inpatient treatment with and without a psychotropic medication regimen, and estimate correlates of medication use separately for the two groups. Comprehensive data on clinical characteristics and service utilization of 517 adolescents enrolled in Medicaid who were admitted to three inpatient hospitals (one for-profit and two nonprofit) in a mid-Atlantic state were used. Medication correlates were examined with bivariate statistics (chi-square and t-test) and multivariate logistic regressions. Psychotropic medication was prescribed for the majority (90.5%) of adolescents at discharge. During their inpatient stay, 76.3% of the youths who were not on medication at admission (n = 190) initiated medication use, and 45% admitted with prior medication (n = 327) had a medication change. Adolescents admitted with and without medication differed on all sociodemographic and clinical characteristics except age, suicidality, and hospital. Controlling on demographic, clinical, and service history characteristics, hospital setting was the only correlate significantly associated with both initiation and change. Institutional factors may be more important than clinical factors in appraising medication patterns in inpatient settings. Interventions to ensure the development and implementation of medication management guidelines may need to be tailored to the climate and culture of the provider organization as well as directly to individual practitioners, parents or adolescents themselves.Journal of Child and Adolescent Psychopharmacology 11/2007; 17(5):701-12. DOI:10.1089/cap.2007.0120 · 3.07 Impact Factor