Health gain and outcome predictors during inpatient and related day treatment in child and adolescent psychiatry

Objective: To investigate health gain and its predictors during inpatient a nd associated day patient treatment. Method: Consecutive admissions to two inpatient units for children and young adolescents in northwest England wer e studied (N= 55). Ascertainments were made from multiple perspectives, inc luding family teacher, clinician, and an independent researcher. Measures w ere taken at referral, admission, discharge, and 8-month follow-up; health gain was inferred from change scores on measures. Recruitment lasted from l ate 1995 to 1997; follow-up was completed during 1998. Independent variable s tested as predictors included assessments of presenting symptoms, therape utic alliance, and family functioning. Results: Significant health gain dur ing hospitalization was found on most measures and sustained to follow-up. There was no symptom change during the waiting-list control condition. Heal th gain was predicted independently by child and parental therapeutic allia nce with the unit early in hospitalization and by preadmission family funct ioning. Externalizing problems did well if accompanied by good alliance. Co nclusions: Assessment of health gain from multiple perspectives is possible and valuable. Inpatient treatment has significant therapeutic effect. Pred ictors for health gain lie in process variables of therapeutic alliance and family functioning rather than presenting symptoms. The results are discus sed in relation to clinical practice and future research.