(PS3-53) Children’s First 24-hours in Inpatient Psychiatric Hospital Care: Acuity Profiles and Experiences in Care Among Foster and Non-foster Youth

Abstract Text:

Objective:
Identify distinct profiles of youth’s psychiatric acuity and experiences with emergency interventions (seclusion, restraint, emergency medication) and contact with caregivers and relatives during the beginning of their inpatient hospital stays. Based on these profiles, investigate whether youth in child welfare vary in rates of group membership and emergency interventions compared to the remainder of the sample.

Background:
Most research investigating inpatient treatment outcomes focuses on length of stay and readmission. While these measures offer a glimpse of youths’ experiences, they obscure unique ways in which children present to and respond to inpatient hospitalization. Youth in foster care are at increased risk of adverse mental health outcomes and inpatient psychiatric hospitalization. Despite high service utilization, little is known about these youth’s acuity or experiences in care.

Method:
This longitudinal study measured children’s (N = 524, ages 3-12, 63.7% male, 36.3% female) psychiatric acuity, experience of emergency interventions, and contact with guardians or relatives at three psychiatric hospitals in the Midwest. Of the youth in this study, 35 were involved in the child welfare system (ages 3-12, 71.4% male, 28.6% female). Each day of their stay, milieu therapists documented youth’s acuity using the Acuity of Psychiatric Illness, Child/Adolescent version (CAPI) which consists of 17-items spanning three domains: risk behaviors, symptoms, and functioning. Staff also recorded use of seclusion, restraint, or emergency medication and whether youth had contact with guardians or relatives by phone or in-person. Results investigate youth’s outcomes for their first 24-hours in care.

Results:
Using latent class analysis, four distinct profiles emerged: a low-needs profile (68.0%), a high impulsive-disruptive, low aggressive profile (15.8%), a moderate aggressive-impulsive-noncompliant profile (11.2%), and a high aggressive-impulsive-noncompliant profile (5.0%). Examination of fit statistics concluded that four profiles were the best fit to the data. Those in the high aggressive-impulsive-noncompliant profile were more likely to be restrained, X2 (3, N = 514) = 60.115, p < 0.001. Those in the low-needs profile were more likely to have phone or face-to-face contact with loved ones, X2 (3, N = 488) = 60.115, p < 0.05. While foster youth’s membership to these four profiles did not significantly differ from the general sample, foster youth had significantly less contact with caregivers or relatives than their counterparts, X2 (1, N = 237) = 9.229, p < 0.05.

Conclusion:
Results suggest that children present to or respond to inpatient psychiatric hospitalization with distinct acuity profiles. These profiles are related to distinct treatment experiences: use of restraint and contact with loved ones. While foster youth seem to fall into similar four profiles compared to non-foster youth, they differ in that they experience less contact with loved ones.

Implications:
Findings expose foster youth’s risk for low support while in acute-stay inpatient care. Based on the profiles identified, future research should investigate how first-day acuity relates to outcome trajectories throughout youths’ stays.