Outcomes of inpatient psychiatric treatment for adolescents: A multiple perspectives evaluation

Abstract

Adolescent inpatient psychiatric treatment was evaluated from the multiple perspectives of clinicians, young people and parents using standardised measures and goal-based outcomes (GBOs). The sample included cases ( N = 128) discharged from a London adolescent unit between April 2009 and December 2015. Measures were completed at admission and discharge, and change in ratings was analysed to assess treatment outcomes. Ratings of clinicians and young people on the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) were compared. Adolescents demonstrated significant improvement across all measures from admission to discharge. Correlation between clinicians' and adolescents' HoNOSCA ratings was weak at admission ( r = .25) but stronger at discharge ( r = .63). Standardised effect sizes were larger for GBOs ( d = 1.73 and 3.16 for adolescent and clinician-rated goals, respectively) compared to all standardised measures ( d = 0.31-0.93). Improvement was observed across all measures of functioning and symptoms following inpatient treatment. Clinicians and young people developed better shared understanding of the problems from admission to discharge. GBOs are more sensitive to change compared to standardised measures and may be meaningfully adopted by inpatient units for routine outcome monitoring.

Predictors of change in global psychiatric functioning at an inpatient adolescent psychiatric unit: A decade of experience

“…Our findings were consistent with previous research, indicating inpatient treatment leads to significant improvement in global functioning for most adolescents (Green et al, 2007; Hayes et al, 2018; Lee et al, 2018; Pfeiffer & Strzelecki, 1990). Psychiatric symptoms measured on all four HoNOSCA subscales also reduced significantly.…”

“…The study was limited to a single unit, limiting the sample size and preventing detailed analysis as well as preventing generalisation of the findings. We did not measure the attitudes to admission of the YP, who may have a different view from clinicians (Lee et al, 2018). The sole use of clinician measures is a key limitation of this study which is likely to be especially relevant for measures such as the quality of peer relationships.…”

The unheard voice of the clinician: Perspectives on the key features of an adolescent inpatient model of care

“…Of the dearth of studies examining adolescent inpatient units, most have used quantitative methods of inquiry (Hayes et al, ; Indig et al, ; Lee, Martin, Hembry, & Lewis, ; Patterson et al, ; Rouski, Hodge, & Tatum, ; Seckman et al, ). Whilst this approach might be appropriate for some effectiveness and outcome studies, there are limitations when attempting to understand a specialized inpatient service.…”

“…Of the dearth of studies examining adolescent inpatient units, most have used quantitative methods of inquiry (Hayes et al, 2018;Indig et al, 2017;Lee, Martin, Hembry, & Lewis, 2018;Patterson et al, 2015;Rouski, Hodge, & Tatum, 2017;Seckman et al, 2017).…”

Use of self-report outcome measures in an acute inpatient CAMHS setting

“…Symptom measures may be a more specific measure of change, but may not be applicable to all service users. Goal-based outcome measures (increasingly used in clinical practice) do not lend themselves to comparisons between services due to their idiosyncratic nature (Lee et al, 2018). Yet others have argued that measures of resilience, quality of life or subjective recovery may be more meaningful concepts to index service impact (Bastiaansen, Koot, Ferdinand, & Verhulst, 2004; Phillips, Lawler Whatson, Wells, Milson, & Hartley, 2018).…”