Measuring children's response to inpatient treatment: Use of practice-based evidence

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.