and Predicting Outcomes of Psychiatric Hospitalizations
increasing pressure to perform rigorous evaluations of the
outcomes of services. The pressure to perform outcome evaluations
is especially acute for psychiatric hospitalizations of children
because of the severity and life-threatening nature of the
disorders, the high cost of hospital care, and controversies
over whether hospitalizations help or hurt disturbed children.
There are many obstacles to comparing hospitalization with
other interventions via rigorous randomized controlled trials.
As an alternative, a British team has used a waiting-list
control condition, plus multi-informant assessments to evaluate
severely disturbed 6- to 17-year-olds at referral, admission
to two hospitals, discharge, and 6-month follow-ups (Green
et al., 2001). Assessments between referral and admission
showed no significant changes in symptoms. However, the CBCL/4-18,
TRF, and ratings by clinicians and researchers showed significant
improvements from admission to discharge and follow-up. The
significant improvements in TRF scores from admission to follow-up
were regarded as especially important, because they were based
on ratings by teachers at schools external to the hospitals.
To test predictors of improvement, the researchers regressed
changes from admission to follow-up TRF scores on measures
of parental engagement and the degree of therapeutic alliance
by the child. Parental engagement showed an especially strong
contribution to improvements in TRF Internalizing scores,
while child alliance contributed significantly to improvements
in TRF Externalizing and Total Problems scores. Green et al.
concluded that " The teacher ratings thus give useful
information on treatment process and independent support to
the therapeutic impact of hospitalization on social adjustment
in the child's community of origin" (p. 330). Among the
clinical implications of the study, Green et al. stated pointed
out that "There was particular value in the external
teacher ratings of symptoms, both because it was external
to the treatment process and because the teacher rating forms
an important measure of the child's general social adaptation
outside the unit" (pp. 331-332).
Reference: Green, J., Kroll, L., Imrie, D.,
Frances, F.M., Begum, K., Harrison, L., & Anson, R. (2001).
Health gain and outcome predictors during inpatient and related
day treatment in child and adolescent psychiatry. Journal
of the American Academy of Child and Adolescent Psychiatry,