Use of a relevance assessment tool in therapeutic residential care: A real world study

In the FondationSanté desEtudiants de France (FSEF) "Soins-études" refers to therapeutic residential care. It concerns long-term psychiatric hospitalisations that include schooling provided by the national education system, the duration of which is often questioned. A tool for assessing the relevance of continuing hospitalisation for each patient was developed and scored during multidisciplinary meetings at various stages of the hospitalisation. The aim of this study was to describe the use of this tool in determining the extent to which the clinical decision to discharge is related to non-relevance scores and the clinical characteristics of the young people.

All young people hospitalised in therapeutic residential care at the FSEF clinic in Aire-sur-l'Adour between 01/01/2011 and 31/12/2017 were included. A composite indicator of non-relevance of hospitalisation was constructed from the clinical scores of the assessment tool. At each multidisciplinary meeting, the subjects were divided into three groups based on whether continuing hospitalisation was deemed relevant, and if not, whether discharge actually occurred. These three groups were compared based on their clinical characteristics using Kruskal-Wallis and Fisher's exact tests.

The study included 219 young people, aged 16.7 years (± 1.4) and hospitalised for an average of 13.7 months (± 9.18). About half of the adolescents were discharged after their stay was deemed non-relevant according to the assessment tool. The relevance of continuing hospitalisation and discharge were linked to the psychiatric diagnosis at the first meeting and to age at the third meeting.

Evaluating a non-relevance indicator enables hospitalisation duration to be regularly assessed to avoid prolonging care when the risk-benefit ratio is no longer favourable. This tool thus promotes the adaptation of care plans throughout hospitalisation.