Changing patterns of inpatient care for children and adolescents at the Menninger Clinic, 1988–1994.

Abstract

The authors describe trends in inpatient psychiatric length of stay (LOS) and admissions for the population of children and adolescents (N = 784) at the Menninger Clinic from 1988 to 1994. During this period. median LOS declined dramatically from 7 months to 3 weeks, whereas admissions increased 4-fold. The diagnostic case mix changed substantially, with a crossover in modal principal diagnosis from personality disorder to affective disorder. Use of medications became almost universal. Diagnosis and medication use became less important determinants of LOS over time. The practical implications of these patterns include higher patient turnover, fewer inpatient clinical contact hours, and heightened importance of continuity with outpatient care. Research should center on the impact of declining LOS on clinical and functional outcomes for children and adolescents.

Provider-Level Effects on Psychiatric Inpatient Length of Stay for Youth With Mental Health and Substance Abuse Disorders

“…For example, several prior studies of LOS limited the sample to patients treated within a single facility. 14,15 These studies were able to explain roughly half of the variation in LOS using patient-level factors. However, if the bulk of the variance in LOS occurred between facilities then studies such as these are misleading.…”

“…Child characteristics such as gender and race predicted little to no variation in LOS. 1,2,[15][16][17][18] Individuals not familiar with mental health may find it even more surprising that clinical diagnoses often have not predicted LOS either. 1,2,16,18,19 In fact, what emerged from these studies was the strong relationship between LOS and factors external to the child such as hospital type or region.…”

“…In fact, many of the studies are based on samples of patients from within a single facility and thus between-facility variation is impossible to study (eg, Refs. [13][14][15].…”

Behavioral Managed Care and its Effects in the Readmission to a Children's Residential Treatment Center

“…Recidivism, managed care, premature discharge, shorter lengths of stay, residential treatment for youth It is estimated that 10-20% of children and adolescents suffer from a psychological disorder (Child Welfare League of America, 2004;Mash & Dozois, 2003;Pottick, Barber, Hansell, & Coyne, 2001). Yet, although the number of children who need psychiatric services is steadily increasing, the mental health services designed to help them are in a state of crisis (Department of Health and Human Services, 2000;Waugh and Kjos, 1992).…”

Relation of Callous-Unemotional Traits to Length of Stay Among Youth Hospitalized at a State Psychiatric Inpatient Facility

“…Unfortunately, the available research on this question is largely contradictory. For example, male gender [9,10], younger age [8,11], overall levels of functioning and psychopathology [12], ethnic minority status [13], and the diagnosis of a Conduct Disorder or Oppositional Defiant Disorder [4,8] all have been associated with length of stay in some studies, but for each of these factors there are also findings that indicate no significant association with length of stay [13][14][15][16][17]. Moreover, when significant results are found, the patterns of association (i.e., longer vs. shorter lengths of stay) often differ from study to study.…”