Modeling Child and Adolescent Psychiatric Hospital Utilization: A Framework for Examining Predictors of Service Use

Heflinger, Craig Anne; Simpkins, Celeste G.; Foster, E. Michael

doi:10.1207/s15326918cs0503_2

Cited by 29 publications

(26 citation statements)

References 46 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, in the final multivariate model when demographic and clinical factors were controlled, availability of providers was not associated with readmission. These results are inconsistent with the Heflinger et al (2002) study that found that greater availability of community-based services reduced the likelihood of hospitalization. The discrepancy in findings may in part be attributed to differences in how study measures were operationalized.…”

Section: Summary and Interpretation Of Findingscontrasting

confidence: 88%

“…The most consistent findings involve service history factors. Studies indicate that prior hospitalizations (Heflinger, Simpkins, & Foster, 2002;Pottick, Hansell, Gutterman, & Raskin-White, 1995) Findings on length of stay are less consistent. Some studies have found shorter (Wickizer, Lessler, & Boyd-Wickizer, 1999) or longer lengths of stays (Pavkov et al, 1997) were associated with readmission; others (Blader, 2004; have found no such association.…”

mentioning

confidence: 99%

See 1 more Smart Citation

The influence of clinical, treatment, and healthcare system characteristics on psychiatric readmission of adolescents.

Fontanella

2008

American Journal of Orthopsychiatry

104

124

View full text Add to dashboard Cite

This study examined predictors of readmission for a sample of 522 adolescents enrolled in Medicaid and admitted to three inpatient psychiatric hospitals in Maryland. Comprehensive data on clinical, treatment, and health care system characteristics were collected from archival sources (medical records, Medicaid claims, and Area Resource File). Predictors of readmission were examined with bivariate (Kaplan Meier) and multivariate (Cox Regression) survival techniques. One year readmission rates were 38% with the majority occurring within 3 months after discharge. Adolescent demographic (age and gender), clinical (severity of symptoms, comorbidity, suicidality) and family characteristics (level of family risk) were associated with readmission. However, treatment factors including type of aftercare, post-discharge living environment, medication noncompliance, and hospital provider were among the strongest predictors of readmission. Study findings underscore the importance of careful discharge planning and linkage to appropriate aftercare. The differing rates of readmission across hospitals also suggest that organizational level factors may play a vital role in determining treatment outcomes. Keywords inpatient psychiatric hospitalization; adolescents; readmissionIt is estimated that 24% to 37% of youths will be readmitted to a psychiatric hospital within one year after discharge, and latest data suggest that rates of readmission are increasing despite cost-containment efforts and emphasis on community-based treatment alternatives (Blader, 2004;Fontanella, Zuravin, & Burry, 2006;Pavkov, Goerge, Lee, & Howard, 1994; Soloman, Evans, & Delaney, 1993). In the United States, inpatient services account for about 33% ($3.9 billion) of the total mental health expenditures for children and adolescents; across age groups adolescents are the highest users of inpatient services (Ringel & Sturm, 2001).Some researchers speculate that the increased readmission rates can be attributed to premature discharges resulting from shortened lengths of stay (Appley, Desai, Luchins, Gibbons, & Hedeker, 1993;Lien, 2002;Wickizer, Lessler, & Boyd-Wickizer, 1999). In fact, studies on Medicaid populations (Callahan, Shepard, Beinecke, Larson, & Cavanaugh, 1995;Dickey, Normand, Norton, Rupp, & Azeni, 2001;Saunders & Heflinger, 2003) have shown increasesCorrespondence concerning this article should be addressed to Cynthia A. Fontanella, College of Social Work, The Ohio State University, 1947 College Road, Columbus, Ohio 43210. E-mail: fontanella.4@osu.edu. Publisher's Disclaimer: The following manuscript is the final accepted manuscript. It has not been subjected to the final copyediting, fact-checking, and proofreading required for formal publication. It is not the definitive, publisher-authenticated version. The American Psychological Association and its Council of Editors disclaim any responsibility or liabilities for errors or omissions of this manuscript version, any version derived from this manuscript by NIH, or other third parties. ...

show abstract

Section: Summary and Interpretation Of Findingscontrasting

confidence: 88%

mentioning

confidence: 99%

The influence of clinical, treatment, and healthcare system characteristics on psychiatric readmission of adolescents.

Fontanella

2008

American Journal of Orthopsychiatry

104

124

View full text Add to dashboard Cite

show abstract

“…Research in the last 10 years has addressed who gets hospitalized and when [99][100][101][102], factors related to rehospitalization [103][104][105], predictors of length of stay [106], and outcomes [107,108]. The strongest finding was that "the majority of decisions to hospitalize were supported by the child's level of risk."…”

Section: Psychiatric Hospitalsmentioning

confidence: 99%

The Premature Demise of Public Child and Adolescent Inpatient Psychiatric Beds

Geller

Biebel

2006

Psychiatr Q

View full text Add to dashboard Cite

Psychiatric disorders are the leading reason for hospitalization among 5-19 year olds. Current data, however, suggest there are fewer than necessary available services for children and adolescents requiring intensive, inpatient psychiatric care. Children and adolescents with behavioral health problems, the majority of whom do not receive appropriate treatment, have increased risk of school failure, family disruption, out-of-home placements, poor employment opportunities, and poverty in adulthood. This paper will examine the challenges inherent in serving children and adolescents with serious emotional disturbances, avenues of financing for treatment and services, and various loci of intervention for high-risk children, including inpatient settings and systems of care. The goals of this paper are to illustrate the complexities of working with children and adolescents most in need of intensive psychiatric services, to explore how inpatient services "fit" into existing treatment approaches, and to discuss the efficacy of downsizing or closing inpatient psychiatric units for this population.

show abstract

“…8 Hence, stigma likely compounds the burden of care and affects caregiver's help-seeking behavior. For example, caregiver strain literature indicates an association between caregiver depression and child symptomatology.…”

Section: Introductionmentioning

confidence: 99%

The Stigma of Childhood Mental Disorders: A Conceptual Framework

Mukolo

Heflinger

Wallston

2010

Journal of the American Academy of Child & Adolescent Psych

Self Cite

101

119

View full text Add to dashboard Cite

Objective-To describe the state of the literature on stigma associated with children's mental disorders and highlight gaps in empirical work.Method-We reviewed child mental illness stigma articles in (English only) peer-reviewed journals available through Medline and PsychInfo. We augmented these with adult-oriented stigma articles that focus on theory and measurement. 145 articles in PsychInfo and 77 articles in MEDLINE met search criteria. The review process involved identifying and appraising literature convergence on the definition of critical dimensions of stigma, antecedents, and outcomes reported in empirical studies.Results-We found concurrence on three dimensions of stigma (negative stereotypes, devaluation and discrimination), two contexts of stigma (self, general public), and two targets of stigma (self/ individual, family). Theory and empirics on institutional and self stigma in child populations were sparse. Literature reports few theoretic frameworks and conceptualizations of child mental illness stigma. One model of help-seeking (the FINIS) explicitly acknowledges the role of stigma in children's access and utilization of mental health services.Conclusions-Compared to adults, children are subject to unique stigmatizing contexts that have not been adequately studied. The field needs conceptual frameworks that get closer to stigma experiences that are causally linked to how parents/caregivers cope with children's emotional and behavioral problems such as seeking professional help. To further research in child mental illness, we suggest an approach to adapting current theoretical frameworks and operationalizing stigma highlighting three dimensions of stigma, three contexts of stigma (including institutions), and three targets of stigma (self/child, family and services).

show abstract

Modeling Child and Adolescent Psychiatric Hospital Utilization: A Framework for Examining Predictors of Service Use

Cited by 29 publications

References 46 publications

The influence of clinical, treatment, and healthcare system characteristics on psychiatric readmission of adolescents.

The influence of clinical, treatment, and healthcare system characteristics on psychiatric readmission of adolescents.

The Premature Demise of Public Child and Adolescent Inpatient Psychiatric Beds

The Stigma of Childhood Mental Disorders: A Conceptual Framework

Contact Info

Product

Resources

About