An inpatient measure of adolescent and child psychosocial services and treatment

Abstract

Now more than ever there exists an urgent need to develop and test conceptually grounded, theoretically differentiated measures of mental health services because of the rapid adoption of managed mental health care throughout the United States. This article presents the results of testing a new research instrument, the Inpatient Measure of Adolescent and Child Services and Treatment (I-MACST). The instrument assesses eight psychosocial mental health service strategies for psychiatrically hospitalized children and adolescents and provides an understanding of the therapeutic and case management service orientations of inpatient facilities. Data collected from three hospitals, one of them at two time points, demonstrate reliability for the eight scales. In addition, results show that the I-MACST differentiates between services in child and adolescent inpatient units and that it detects differences in services that reflect changes in the organization of one hospital. The I-MACST characterizes the treatment practices of an entire facility with little demand on staff time. Key words: children and adolescents; inpatient psychiatric; measurement; services and treatment Researchers of mental health services today are tracking a moving target (Barber, 1995). In 1995 managed mental health care covered more than 100 million insured people (Frank, McGuire, & Newhouse, 1995), and in many states managed mental health companies are expanding care to Medicaid populations and other public mental health clients (Essock & Goldman, 1995). Nevertheless, we know little about how managed care, in its various forms, affects the delivery of services to clients and how the outcomes of these services affect the clients themselves (Mechanic, 1995). It is crucial to develop instruments to document and monitor services and related outcomes under changing financial and organizational arrangements. The research instrument developed here, the Inpatient Measure of Adolescent and Child Services and Treatment (I-MACST), measures the psychotherapeutic and case management activities that we argue are at the heart of any good treatment regimen. This instrument can document what organizations actually do, not what stakeholders think they do. Such a measure is especially important in an era when institutional treatment goals may be displaced inadvertently as a function of the financing of care. Are hospitals that had traditional psychotherapeutic orientations shifting to case management orientations under managed care and other financial pressures? This is an empirical question, and the I-MACST provides a means for assessing these two orientations. This article describes the development of the I-MACST, an instrument designed to measure basic psychosocial dimensions of treatment in behavioral terms. This research built on an existing measure developed to assess services for schizophrenic adults in psychiatric facilities in New York State (Olfson et al., 1997). The findings reported here focus on inpatient services to seriously mentally ill children and adolescents, rather than adults. In fact, we know little about the care that mentally ill children and adolescents receive when they are hospitalized for psychiatric problems. This article does not assess issues such as therapeutic milieu, specialized psychopharmacologic treatments, or formal cognitive-behavior psychotherapy for children with particular diagnosed disorders. Instead, it focuses on case management and psychotherapeutic activities. These activities were chosen because there is sufficient empirical evidence to justify their utility in the treatment of children and adolescents with serious mental illnesses. The research justifying each of the scale's dimensions will be reviewed below. Items are included when they are general enough to apply to children and adolescents with a wide variety of mental health problems and their families with very different levels of functioning. …