Child and Adolescent Mental Health: Building a System of Care

Collins, Barbara G.; Collins, Thomas M.

doi:10.1002/j.1556-6676.1994.tb00928.x

Cited by 23 publications

(20 citation statements)

References 9 publications

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“…NIH-PA Author Manuscript NIH-PA Author Manuscript reimbursement, lack of providers, or eligibility requirements prevent children from accessing these needed services; consequently, options for aftercare are often limited (Collins & Collins, 1994).…”

Section: Nih-pa Author Manuscriptmentioning

confidence: 99%

The influence of clinical, treatment, and healthcare system characteristics on psychiatric readmission of adolescents.

Fontanella

2008

American Journal of Orthopsychiatry

103

124

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This study examined predictors of readmission for a sample of 522 adolescents enrolled in Medicaid and admitted to three inpatient psychiatric hospitals in Maryland. Comprehensive data on clinical, treatment, and health care system characteristics were collected from archival sources (medical records, Medicaid claims, and Area Resource File). Predictors of readmission were examined with bivariate (Kaplan Meier) and multivariate (Cox Regression) survival techniques. One year readmission rates were 38% with the majority occurring within 3 months after discharge. Adolescent demographic (age and gender), clinical (severity of symptoms, comorbidity, suicidality) and family characteristics (level of family risk) were associated with readmission. However, treatment factors including type of aftercare, post-discharge living environment, medication noncompliance, and hospital provider were among the strongest predictors of readmission. Study findings underscore the importance of careful discharge planning and linkage to appropriate aftercare. The differing rates of readmission across hospitals also suggest that organizational level factors may play a vital role in determining treatment outcomes. Keywords inpatient psychiatric hospitalization; adolescents; readmissionIt is estimated that 24% to 37% of youths will be readmitted to a psychiatric hospital within one year after discharge, and latest data suggest that rates of readmission are increasing despite cost-containment efforts and emphasis on community-based treatment alternatives (Blader, 2004;Fontanella, Zuravin, & Burry, 2006;Pavkov, Goerge, Lee, & Howard, 1994; Soloman, Evans, & Delaney, 1993). In the United States, inpatient services account for about 33% ($3.9 billion) of the total mental health expenditures for children and adolescents; across age groups adolescents are the highest users of inpatient services (Ringel & Sturm, 2001).Some researchers speculate that the increased readmission rates can be attributed to premature discharges resulting from shortened lengths of stay (Appley, Desai, Luchins, Gibbons, & Hedeker, 1993;Lien, 2002;Wickizer, Lessler, & Boyd-Wickizer, 1999). In fact, studies on Medicaid populations (Callahan, Shepard, Beinecke, Larson, & Cavanaugh, 1995;Dickey, Normand, Norton, Rupp, & Azeni, 2001;Saunders & Heflinger, 2003) have shown increasesCorrespondence concerning this article should be addressed to Cynthia A. Fontanella, College of Social Work, The Ohio State University, 1947 College Road, Columbus, Ohio 43210. E-mail: fontanella.4@osu.edu. Publisher's Disclaimer: The following manuscript is the final accepted manuscript. It has not been subjected to the final copyediting, fact-checking, and proofreading required for formal publication. It is not the definitive, publisher-authenticated version. The American Psychological Association and its Council of Editors disclaim any responsibility or liabilities for errors or omissions of this manuscript version, any version derived from this manuscript by NIH, or other third parties. ...

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Section: Nih-pa Author Manuscriptmentioning

confidence: 99%

The influence of clinical, treatment, and healthcare system characteristics on psychiatric readmission of adolescents.

Fontanella

2008

American Journal of Orthopsychiatry

103

124

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“…A second component to the goal attainment model included commitment to follow-up. The need for follow-up upon discharge from crisis-residence is well documented (Balkin & Roland, 2005, 2007Collins & Collins, 1994;Cornsweet, 1990;Pfeiffer & Strzelecki, 1990). Roberts and Ottens (2005) included similar elements in a seven-stage crisis model: (a) planning and conducting a danger assessment, (b) establishing a collaborative relationship, (c) identifying problems, (d) encouraging explorations of feelings, (e) identifying coping strategies, (f) implementing a plan, and (g) establishing a follow-up plan.…”

Section: Introductionmentioning

confidence: 99%

Assessing the relationship between therapeutic goal attainment and psychosocial characteristics for adolescents in crisis residence

Balkin

Leicht

Sartor

et al. 2011

Journal of Mental Health

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“…Among youth in foster care, burden reported by caretakers as a result of youths' troublesome but nonacute symptomatology is associated with increased hospitalization referrals (Bickman, Foster, & Lambert, 1996). Finally, youth in substitute care are often served by multiple agencies and government entities (e.g., school, juvenile justice), making it more difficult to assign and monitor accountability (Collins & Collins, 1994).…”

Section: Foster Carementioning

confidence: 99%

Evaluating Psychiatric Hospital Admission Decisions for Children in Foster Care: An Optimal Classification Tree Analysis

Snowden

Leon

Bryant

et al. 2007

Journal of Clinical Child & Adolescent Psychology

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This study explored clinical and nonclinical predictors of inpatient hospital admission decisions across a sample of children in foster care over 4 years (N = 13,245). Forty-eight percent of participants were female and the mean age was 13.4 (SD = 3.5 years). Optimal data analysis (Yarnold & Soltysik, 2005) was used to construct a nonlinear classification tree model for predicting admission decisions. As expected, clinical variables such as suicidality, psychoticism, and dangerousness predicted psychiatric admissions; however, several variables that are not direct indications of acute psychiatric distress, such as the presence of family problems and the location of the hospital screening, impacted decision making in a subsample of cases. Further analyses indicated that the model developed in Year 1 reliably and consistently predicted admission decisions (with 64%-68% overall accuracy) across the next 3 years. Policy, research, and clinical implications are discussed.

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Child and Adolescent Mental Health: Building a System of Care

Cited by 23 publications

References 9 publications

The influence of clinical, treatment, and healthcare system characteristics on psychiatric readmission of adolescents.

The influence of clinical, treatment, and healthcare system characteristics on psychiatric readmission of adolescents.

Assessing the relationship between therapeutic goal attainment and psychosocial characteristics for adolescents in crisis residence

Evaluating Psychiatric Hospital Admission Decisions for Children in Foster Care: An Optimal Classification Tree Analysis

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