Randomised comparison of the effectiveness and costs of community and hospital based mental health services for children with behavioural disorders

Objective To test the hypothesis that a community based intervention by sec ondary child and adolescent mental health services would be significantly m ore effective and less costly than a hospital based intervention. Design Open study with two randomised parallel groups. Setting Two health districts in the north of England. Participants Parents of 3 to 10 year old children with behavioural disorder who had been referred to child and adolescent mental health services. Intervention Parental education groups. Main outcome measures Parents' and teachers' reports of the child's behavio ur, parental depression, parental criticism of the child, impact of the chi ld's behaviour on the family. Results 141 subjects were randomised to community (n = 72) or hospital (n = 69) treatment. Primary outcome data were obtained on 115 (82%) cases a yea r later. Intention to treat analyses showed no significant differences betw een the community and hospital based groups on any of the outcome measures, or on costs, Parental depression was common and predicted the child's outc ome. Conclusions Location of child mental health services may be less important than the range of services that they provide, which should include effectiv e treatment for parents' mental health problems.