Changing patterns of inpatient care for children and adolescents at the Menninger Clinic, 1988-1994

The authors describe trends in inpatient psychiatric length of stay (LOS) a nd admissions for the population of children and adolescents (N = 784) at t he Menninger Clinic from 1988 to 1994. During this period, median LOS decli ned dramatically from 7 months to 3 weeks, whereas admissions increased 4-f old. The diagnostic case mix changed substantially, with a crossover in mod al principal diagnosis from personality disorder to affective disorder. Use of medications became almost universal. Diagnosis and medication use becam e less important determinants of LOS over time. The practical implications of these patterns include higher patient turnover, fewer inpatient clinical contact hours, and heightened importance of continuity with outpatient car e. Research should center on the impact of declining LOS on clinical and fu nctional outcomes for children and adolescents.