Variations in the clinical presentations of children and adolescents at eight psychiatric hospitals

Objective: Clinical presentations of children and adolescents admitted to eight psychiatric hospitals were examined to determine variation in symptoms and severity of illness. Methods: A prospective design was implemented using the Childhood Severity of Psychiatric Illness (CSPI) scale, a reliable measure of psychiatric severity and factors thought to affect decision making about mental health services. The CSPI was completed by mobile crisis workers after interviews with 875 children and adolescents to assess whether hospitalization was appropriate. All the children were wards of the state in Cook County, Illinois, and all were subsequently hospitalized. Results: A factor analysis of the CSPI revealed three distinct factors: caregiver problems, externalizing symptoms, and internalizing symptoms. Children were classified as having mild, moderate, or severe problems or symptoms in the areas covered by the three factors. Chi square analyses revealed that significant variation existed between hospitals in the proportions of children with problems or symptoms in the three factor areas and in the severity of their problems or symptoms. Conclusions: The major finding of variation among the eight hospitals on measures of severity of children's psychiatric illness and caregiver problems empirically supports the importance of adjusting for severity before implementing initiatives to manage performance and outcome across a system of hospitals.