The decisions of indication for inpatient child and adolescent psychiatric treatment

Objectives: To date there has been little empirical investigation of the indications for hospitalising children in child and adolescent psychiatry wards. Therefore we analysed the decision making models used to establishthe criteria for admission to child and adolescent psychiatric clinics. It is assumed that the clinical experience and social orientation of the specialists involved, as well as the standpoint of their respective institutions of health care, play a significant role. Methods: The decision-making models of 71 specialists working in the field of in- and outpatient child and adolescent psychiatry were recorded using an adapted structuring process. The hypotheses were examined by comparing the models used by the different professional groups working in inpatient units and by child and adolescent psychiatrists working in private practice to the decision-making models used by assistant medical directors and head physicians. Results: The factors <<"clinical experience" and "profession group orientation" were found to be of only marginal importance. Only the inpatient nursing staff considered social factors in arriving at an indication. The influence of such "setting" variables is also evident in the fact that the outpatient staff used more nar-, rowly defined criteria and rated their outpatient service as being more sustainable than did the physicians in the inpatient departments. The criteria used by all professions included being a danger to oneself and others, severity of symptoms, the assessment of outpatient resources and efficiency, prospects of success, and the need for intensive treatment. Conclusions: The results of this study provide a basis for further research and indicate the need for additional discussion of the indication criteria currently in use.