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Measuring children’s response to inpatient treatment: use of practice-based evidence
Scott C Leon1, Alison M Stoner, Amy M Lyons Usher
1Department of Psychology, Loyola University Chicago, Coffey Hall, Chicago, IL 60626, USA. sleon@luc.edu
Insights
Practice-based evidence using the Acuity of Psychiatric Illness, Child and Adolescent Version (CAPI) measure can improve children's inpatient psychiatric treatment response. Intake behaviors and hospital unit significantly impact treatment trajectories.
Area of Science:
- Child and Adolescent Psychiatry
- Healthcare Quality Improvement
- Mental Health Services Research
Background:
- Inpatient psychiatric care for children requires effective methods to monitor and improve treatment response.
- Practice-based evidence offers a framework for utilizing real-world data to enhance clinical practice.
Purpose of the Study:
- To assess the feasibility of using practice-based evidence to enhance children's treatment outcomes in psychiatric hospitals.
- To identify clinical factors and hospital characteristics that influence treatment trajectories.
Main Methods:
- A cohort of 524 children (aged 4-12) in three psychiatric hospitals were monitored daily using the Acuity of Psychiatric Illness, Child and Adolescent Version (CAPI) from Oct 2009 to Oct 2010.
- Trained staff administered the CAPI, a validated measure of risk behaviors, symptoms, and functioning.
- Hierarchical linear modeling and growth curve modeling were employed to analyze CAPI score trajectories.
Main Results:
- Significant variations in CAPI acuity score trajectories were observed among children.
- Intake clinical variables, including externalizing behaviors (e.g., aggression) and internalizing symptoms (e.g., self-harm, suicidal ideation), predicted changes in acuity scores.
- The specific hospital unit moderated the impact of intake characteristics on treatment response trajectories.
Conclusions:
- Regularly measuring psychiatric acuity with validated tools can enable real-time monitoring and data-driven treatment improvements.
- This practice-based evidence approach can promote accountability and identify hospital-specific strengths and weaknesses in addressing child psychiatric needs.
Objective:
The study tested the feasibility of using practice-based evidence to improve children’s treatment response to inpatient care in psychiatric hospitals.
Methods:
A total of 524 children (aged four to 12 years) who were patients at three psychiatric hospitals with child units were studied between October 1, 2009, and October 1, 2010. The Acuity of Psychiatric Illness, Child and Adolescent Version (CAPI), a reliable and valid measure of risk behaviors, symptoms, and functioning, was completed each weekday by trained frontline staff on the milieu.
Results:
Growth curve modeling via hierarchical linear modeling was used, and linear trajectories were fit to children’s CAPI scores over days in care. Trajectories of CAPI acuity scores varied significantly among the children, and changes in scores (slope of the trajectories) were predicted by several clinical variables at intake. These variables included externalizing behavior, such as aggressive behavior toward others and objects and sexual aggression, and internalizing symptoms, such as self-mutilation behaviors and suicidal ideation or gestures. Further, moderation analyses revealed that the hospital unit serving the youths moderated the effect of intake clinical characteristics on the trajectories of acuity scores.
Conclusions:
Regular measurement of psychiatric acuity using a reliable and valid measure has the potential to monitor an episode of care in real time and provide data that can be used to improve treatment. This approach may hold promise as a method to promote accountability across hospital systems and to identify the core competencies and deficits of hospitals in addressing specific problems presented at intake.
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