A Reexamination of Trends in Acute Care Psychiatric Hospitalization for Adolescents: Ethnicity, Payment, and Length of Stay

Article excerpt

The purpose of this study was to identify current trends for adolescents in acute care psychiatric hospitalization with respect to ethnicity, insurance coverage, and length of stay. Data were collected on 89 adolescents admitted to acute care psychiatric hospitalization. Contrary to previous research, adolescent clients with Medicaid, as opposed to private insurance, had longer lengths of stay and minority youths stayed significantly longer in the hospital than did white youths. No relationship was found between either clients' diagnosis or payment source and clients' length of stay. Implications related to the role of managed care and multicultural issues in counseling are discussed.

A Reexamination of Trends in Acute Care Psychiatric Hospitalization for Adolescents: Ethnicity, Payment, and Length of Stay

Historically, ethnic minorities have been under represented with respect to accessing services in the mental health system. Minority youths tend to lack private healthcare insurance, be at greater risk of psychological and behavioral disorders, and are more likely to be placed in juvenile detention facilities than in psychiatric hospitals (Brinson, & Kottler, 1995; Constantine, 2002; Harley, Jolivette, McCormick, & Tice, 2002; Liao, 2001; Mason, & Gibbs, 1992; Pottick, Hansell, Miller, & Davis, 1999; Sourander, Korkeila, & Turunen, 1998). Mason and Gibbs (1992) described the adolescent mental health care as "a two-tier system . . . in which uninsured low income and minority adolescents tend to be 'handled' by the juvenile justice system while middle-class and white adolescents tend to be 'treated' in the mental health system" (p. 447). Separating the issues of payment and length of stay versus ethnicity and length of stay may be difficult, as financial resources and ethnicity appear tied together.

Psychiatric hospitalizations, in particular, are an area of concern. Due to the impact of managed care, increased financial pressures on treatment providers, and decreased lengths of stay (Heflinger, Simpkins, & Foster, 2002; Pottick et al., 1999), as well as the documented deficiency in services to ethnic minorities, a reexamination of adolescent psychiatric hospitalization is pertinent. The purpose of this study was to identify current trends for adolescents in acute care psychiatric hospitalization with respect to ethnicity, insurance coverage, and length of stay (LOS).

Acute Care Psychiatric Hospitalization and Length of Stay

An admission to an acute care psychiatric program may be necessary when clients' safety is compromised, either because of a crisis situation or the possibility of harm to self or others (American Academy of Child and Adolescent Psychiatry, 2002). For adolescents, acute care psychiatric programs are short-term (usually fewer than 15 days) crisis intervention programs in which clients receive 24-hour supervision. Length of stay in acute care psychiatric programs has decreased from 3 to 4 weeks to approximately 1 week over the past decade in response to managed care (Heflinger et al., 2002). Rather than emphasizing treatment, hospitals seek to achieve client stabilization, that is, assuring the client is safe from harming self or others (King, Hovey, Brand, & Ghaziuddin, 1997).

Pottick et al. (1999) identified several factors that influence LOS in psychiatric hospitalization for children and adolescents. Ethnic minorities, particularly Hispanic youth, had significantly shorter LOS. Diagnosis was also a factor. Clients diagnosed with disruptive behavior disorders stayed significantly longer than clients with depression or adjustment disorders. Youths with private insurance were more likely to stay longer than youths with Medicaid or no insurance.

Length of Stay and Payment

Rinsley (1990) described the trend of shortened hospitalizations as the "phenomenon of de-institutionalization," and identified this trend as dangerous to clients. …