PROSPECTIVE FOLLOWUP OF CHILD PSYCHIATRIC INPATIENTS

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Children hospitalized for psychiatric conditions are at risk for chronic and severe behavioral dysfunction after discharge. They also use mental health and social services in greater quantities and intensities than nonhospitalized child psychiatric patients. The principal purposes of acute psychiatric inpatient care of children are stabilization, evaluation, and assessment of which treatments and services after discharge can help them function in the least restrictive setting. Knowledge of postdischarge clinical course can help hospital care more efficiently achieve these goals. First, knowing whether stabilization attained in hospital persists after discharge is an important consideration in determining the level of improvement hospital care should aim for. Second, evaluation includes consideration of factors that may influence prognosis, for which longitudinal data are clearly necessary. Third, accurate appraisal of postdischarge needs requires valid prediction of functioning in several settings. Because no longitudinal study has evaluated these patients' functioning across settings at several in the year after discharge, decisions about postdischarge services lack an empirical basis. This project's long-term objective is to enable clinicians to estimate postdischarge clinical course based on knowledge of selected patient, family, hospital course, and aftercare characteristics, leading to more efficient use of hospital care and improved service delivery after discharge. The study will examine two questions relating to the postdischarge functioning of child psychiatric inpatients: 1. What is the postdischarge clinical course of child psychiatric inpatients? 2. What characteristics of the child, family, hospital course, and aftercare services predict these patterns of postdischarge clinical course? More specifically, this is a longitudinal, prospective follow-up of approximately 120 child psychiatric patients with three predischarge assessments: at admission, during initial hospitalization, and right before discharge. In the year after discharge, there will be three follow- up assessments, at three, six, and twelve months after discharge. Assessments of preadmission and postdischarge condition will evaluate functioning at home and at school. The same of similar instruments will be completed by hospital staff, teachers, and caregivers during hospitalization. Data analyses will evaluate changes over time for the sample as a whole, and evaluate predictors of follow-up status suggested in previous research. These analyses will be supplemented with methods to develop individual growth curves of clinical course over time, and to discern how these curves are correlated with patient, family, course-in- hospital, and aftercare characteristics.