Saturday, 15 January 2005 - 4:00 PM

This presentation is part of: Assessing the Context of Mental Health Service Delivery for Youth: Opportunities for Targeted Intervention

Psychiatric Rehospitalization Among Adolescents: The Influence of Service Delivery Factors, Organizational, and Health Care System Characteristics

Purpose: The purpose of this study is to identify which individual, family, community, treatment, and health care system characteristics predict psychiatric rehospitalization of adolescents. Drawing from the ecological perspective and theories on risk and protective factors, this study expands upon prior research by examining contextual factors such as the influence of service delivery factors (prior service use, type of aftercare services, and post-discharge environment), organizational (facility ownership), and health care system characteristics (availability of community resources) on psychiatric rehospitalization.

Method: Data from three archival sources were merged to provide information on clinical profiles and service delivery factors (hospital case records), readmission patterns (Medicaid claims files), and availability of community providers such as child psychiatrists, psychologists, social workers, and pediatricians (Area Resource File). The universe of all Medicaid eligible adolescents, aged 11 to 17 consecutively admitted from July 1, 1997 to June 30, 1998 to three of Maryland's major private, acute care psychiatric hospitals, comprising 47% of the total adolescent bed population in the state, were selected for the study. Each of the 522 adolescents was followed for one year after their index admission to determine readmission status to any psychiatric facility in Maryland. Hierarchical logistic regression was used.

Results: The strongest predictor of readmission was type of aftercare services received post-discharge from the hospital. Adolescents discharged to therapeutic foster care (OR= 4.26, p<.01), day treatment (OR = 2.94 p<.01), and intermediate residential placements (group homes) (OR = 2.37, p<.05) were at increased risk for readmission compared to those who were discharged to residential treatment facilities, suggesting that youths with more serious emotional disturbances may fair better in highly structured, maximum intensity programs. When social workers intervened to change the living environment at discharge, adolescents were less likely to be readmitted (OR=0.38, p<.001). Youth in for-profit hospitals, and who stayed longer were 68% less likely to be readmitted (OR=0.32, p<.01). Other factors related to readmission were being younger, having more severe emotional and behavioral disturbances, comorbid mental retardation, and having a childhood history of abuse and/or neglect.

Implications for Practice: Study findings highlight the importance of continuity of care across and within youth service systems. The results raise questions about quality of care and the adequacy of community resources. Discussion will focus on collaborative opportunities for intervention.

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