Change Trajectories: Children's Patterns of Improvement in Acute-Stay Inpatient Care

Area of Science:

• Child and Adolescent Psychiatry
• Mental Health Services Research
• Quantitative Psychology

Background:

• Understanding psychiatric acuity trajectories in children during acute care is crucial for effective treatment.
• Previous research has not fully characterized the diverse patterns of change in children's psychiatric illness severity during inpatient stays.

Purpose of the Study:

• To identify distinct classes of children's acute-stay psychiatric acuity trajectories.
• To examine the shapes (linear, quadratic, cubic) and rates of change in psychiatric acuity.
• To explore associations between acuity trajectories and clinical outcomes.

Main Methods:

• Latent class growth analysis was applied to weekday Children's Acuity of Psychiatric Illness (CAPI) ratings.
• Data included 788 children (ages 4-12) from three child psychiatric units.
• Seven distinct acuity trajectory classes were identified as the most parsimonious fit.

Main Results:

• Four classes showed significant quadratic (non-linear) acuity changes, one showed linear change, and two showed no significant change.
• Acuity trajectory classes differed in survival time to rehospitalization.
• Classes also varied in pre-treatment community service use and in-episode seclusion, restraint, and emergency medication rates.

Conclusions:

• Children in acute psychiatric care exhibit identifiable and distinct patterns of psychiatric acuity change.
• Non-linear, specifically quadratic, acuity trajectories are present in a significant subset of pediatric acute-stay patients.
• These findings suggest that individualized treatment approaches may be necessary based on identified acuity trajectory patterns.