Psychiatric hospital service utilization of children and adolescents in state custody

Objective: To examine factors related to psychiatric hospitalization decisi on and length of stay of wards of the Illinois Department of Child and Fami ly Services. Method: A prospective design was implemented using the Childho od Severity of Psychiatric Illness (CSPI), a reliable, quantitative measure of psychiatric severity and its mediating factors. The CSPI was completed by hospital screeners upon conclusion of their crisis interviews. In additi on to completing the CSPI, workers reported on demographic information. DSM -IV diagnoses, prescreening living arrangements. and length of hospital sta y. Results: CSPI variables could effectively predict decision to admit vers us deflect. The overall accuracy of this statistically significant predicti on model was 77.9%, which was replicated on a new sample. Factors associate d with decision to hospitalize are clinical in nature; ratings of suicidali ty, dangerousness, and impulsivity contributed the most to the model. Predi cting length of stay was only moderately successful. Despite achieving sign ificance, the model accounted for just 15.1% of length of stay Variance usi ng a multiple regression. Factors associated with length of stay were large ly nonclinical in nature: living arrangement stability, region of the hospi talization, and age. Conclusions: These results can be used to assess how d ecisions regarding level and duration of care are currently being made as a point of departure for quality improvement efforts.