CHILD AND ADOLESCENT OUTCOMES OF INPATIENT PSYCHIATRIC-SERVICES - A RESEARCH AGENDA

Psychiatric inpatient hospitalization is viewed generally as an expens ive, most-restrictive treatment setting which should be replaced by co mmunity-based alternatives for children and adolescents. But little is known about the outcomes of psychiatric hospitalization, and evidence that the alternatives are more effective is inconclusive. We describe the distribution of services provided to children and adolescents in psychiatric inpatient, outpatient and partial care facilities from 198 6 national estimates. We find that over the course of a year, 682,756 children and adolescents receive treatment in inpatient (16.4%), outpa tient (80.8%), or partial care (2.6%) facilities in a year. We then re view the research literature and find that the existing research on ou tcomes of hospitalization is methodologically inadequate, severely lim iting the causal inferences that can be made. However, trends in the e vidence suggest that treatment and aftercare are important predictors of better psychiatric outcomes, controlling for organicity, symptoms, and diagnosis. Finally, we recommend testing treatment and aftercare s ervices explicitly; using systematic, controlled research designs with comparison groups; and developing more refined descriptions of servic es in order to replicate effective interventions, and to generate and test theory about causes and effects of services and outcomes.