• July/August 2018
  • Vol. 19, No. 6

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Predictors of Admission to Psychiatric Residential Treatment Facilities

Children who have adverse experiences, such as abuse, neglect, and other forms of maltreatment, have a greater risk of developing behavioral and mental health problems compared with children who do not. For many of these children, the child welfare system may open the door to the mental health services they need, including admittance to psychiatric residential treatment facilities (PRTFs), which are the most expensive and restrictive settings for children in need of extensive, long-term mental health care. Given the costly and restrictive nature of PRTFs, a recent study in the International Journal of Environmental Research and Public Health sought to determine the factors that contribute to a child investigated for maltreatment being admitted into a PRTF—after taking into account clinical need based on the behavioral and mental characteristics of the child—with the goal of informing policy discussions regarding the best strategies to ensure children receive appropriate care in the appropriate setting as well as prevent unnecessary placements in PRTFs.

For the study, there were three determining factors for PRTF use—predisposing factors, enabling factors, and need, and research was guided by questions such as the following:

  • What behavioral health characteristics, behavioral health services utilization (e.g., family, group, and individual therapy; care in residential service settings; psychiatric services; and substance use treatment services), and psychotropic and antipsychotic drug prescriptions were associated with PRTF admission?
  • What types of child maltreatment findings are associated with subsequent PRTF admission?
  • Are patterns of foster care placement, permanency, and return to care associated with subsequent PRTF admission?

After data analysis, the researchers found that receiving a trauma-associated behavioral health diagnosis, having received care in a less restrictive service setting, and being prescribed one or more antipsychotic drugs were associated with a greater risk for PRTF admission. However, a history of substantiated maltreatment was not associated with admission to a PRTF. Taken together, the findings suggest that the strongest determining factor for being placed in a PRTF was mental health need, although other social service factors, and particularly child welfare-related factors, were independently associated with admission after accounting for this need.

"A longitudinal study of child maltreatment and mental health predictors of admission to psychiatric residential treatment facilities," by Roderick A. Rose and Paul Lanier (International Journal of Environmental Research and Public Health, 14), is available at http://www.mdpi.com/1660-4601/14/10/1141/htm.

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