Hospitalization of emotionally disturbed children: Who gets hospitalized and why.

Abstract

Children admitted to a psychiatric hospital were compared to emotionally disturbed children receiving services in special classes within the public schools. There were few differences found between the groups. The presence of a "critical event" leading to the need for hospitalization was explored. Implications for practice are discussed.

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

“…For instance, Barack (1986) found that increased age was related to psychiatric admissions; however, Hillard and colleagues (1988) found that younger ages were related to admissions. Consequently, future research is necessary to determine the effect of demographics on psychiatric admissions.…”

“…Based on earlier research, we expected that level of suicidal ideation, dangerousness, psychosis, and impulsivity would predict psychiatric admissions (Hillard, Slomowitz, & Deddens, 1988;Leon et al, 1999). Other externalizing behaviors, such as conduct or oppositional behaviors and delinquency might also be expected to predict psychiatric admissions (Barack, 1986;Perry et al, 1992); however, some research has suggested that in a more evolved system of care, conduct or oppositional behaviors might actually predict lower hospitalization rates (Leon et al, 1999).…”

Separation Anxiety Disorder

“…The overarching issue appears to be unequivocally establishing that hospitalization represents the most efficient and least invasive available therapeutic approach to remedying the clinical problems. Interestingly, limited data suggest that the decision to hospitalize minors is frequently tied to a critical precipitating event that convinces the family, social agencies, or medical providers of the urgency of hospitalization, rather than a thorough weighing of all options (Barack, 1986). In addition, critics have noted that the decision to hospitalize minors may often be a product of convenience, third-party reimborsement, or pressure to maintain the financial well-being of a hospital or clinician instead of the most rational choice of treatment (Dalton & Foreman, 1987).…”

“…Hospitalization has several potential deleterious consequences that must be seriously considered when deciding whether to take this treatment route: (1) a child's negative reaction to hospitalization, which may aggravate SAD; (2) the disruption of the child's family and community relationships; (3) substantial expense; (4) the reinforcement of parental uninvolvement, denial, or guilt; (5) confused and distorted perceptions by the patient's siblings; (6) removal of the child from a regular education system; (7) the predictable stigmatism of labeling; and (8) the potential for unresolved dependency on the institution (Stone, 1979). Also, psychiatric hospitalization has been associated with the placement of a large proportion of children (54%) in more restrictive educational settings after release, although objective differences in intellectual and academic achievement did not exist between hospitalized and disturbed nonhospitalized children (Barack, 1986). Finally, complex issues are involved in ensuring that the ethical and legal rights of parents, and especially minors are fully respected in the course of hospitalization (Appelbaum, 1989;Brewer &Faitak, 1989).…”

Besluitvorming over uithuisplaatsing in de jeugdzorg

“…Het verschil tussen wel en niet geplaatste kinderen is in een aantal gevallen niet aan te tonen. Barack (1986) vergeleek twee groepen met ernstige sociaal-emotionele stoornissen (N = 92), waarbij de ene groep verbleef op de kinder-en jeugdafdeling van de Psychiatrische Universiteitskliniek van Pittsburg (VS), terwijl de andere groep extra aandacht kreeg in het onderwijs door plaatsing in een zogenaamde 'special class'. Barack ontdekte dat het enige verschil tussen beide groepen is dat de opgenomen kinderen gemiddeld ouder zijn en dat zich bij hen voorafgaand aan de plaatsing veel vaker een 'critical incident' (zoals stelen, een dier doden, iemands arm breken, brand stichten) heeft voorgedaan.…”