Evaluating the use of psychiatric hospitalization by residential treatmentcenters

Objective: To examine differences in risk levels of psychiatric hospital re ferrals received from residential treatment centers (RTCs) as a measure of service quality. Method: This prospective study used the Childhood Severity of Psychiatric Illness (CSPI), a reliable measure of psychiatric severity and factors thought to affect decision-making. Psychiatric referrals were w ards of the state from the 10 largest RTCs in one metropolitan county and w ere screened by mobile crisis workers for admission appropriateness. After interviewing clients, the independent crisis workers completed the CSPI. Re sults: Referrals were placed into I of 2 categories based on CSPI ratings: high-risk or low-risk. Referrals were deemed high-risk if they displayed mo derate or severe levels of suicidality, dangerousness to others, or psychot ic symptoms on the CSPI. Results showed statistically significant variation in the level of risk of referrals received from the In RTCs. In addition. RTCs that had high rates of low-risk referrals were rated by crisis workers as demonstrating poorer supervision of their clients. Conclusions: The res idential treatment providers in our sample are expected to provide intensiv e treatment to children and adolescents with serious emotional and behavior al problems. Our finding that some RTCs are making low-risk referrals sugge sts that they are struggling to meet the needs of some of their clients. Ou r findings can be used to inform quality improvement efforts at RTCs that a re currently struggling.