Psychiatric Day Hospitalization (PDH) offers treatment for elementary-age children facing severe mental health challenges, necessitating their withdrawal from regular classrooms in community schools. The PDH programs employ a classroom-based approach to align service intensity with severity, providing daily treatment in a specialized hospital setting until children can reintegrate into their community school. Despite its significance, there is limited robust evidence indicating the effectiveness of PDH for school-aged children and the duration of its impact. Little is also known about which children would benefit from PDH and whether these benefits persist during the transition to less intensive or no care. The scarcity of evidence has resulted in fewer such programs, creating gaps in mental health care for children with high needs. Addressing these questions is imperative for the continued and expanded provision of PDH services elsewhere. Without such services, children with severe disorders face an elevated risk of enduring negative outcomes, including persistent severe mental disorders, school dropout, delinquency, and substance use.

The OUI-CARE (OUI Child PsychiAtry Response Evaluation) project addresses the above- mentioned questions in two phases, with the active participation of parents and children accepted into the PDH programs. Child assessments take place at four timepoints using questionnaires completed by multiple informants: at intake (i.e., prior to the psychiatric evaluation, Time 1), upon admission into PDH (Time 2), at discharge (Time 3), and at the 6-month follow-up (Time 4).

In Phase 1 of the study, we assessed the effectiveness of PDH in reducing the more disruptive symptoms and improving three factors: family functioning, baseline severity, and comorbid disorders associated with outcome in 261 children. We found significant improvement between intake (Time 1) and discharge (Time 3) in externalizing problems. Moreover, at Time 3, parents reported improvements in their children’s functioning at home (73%), school (88%) and with peers (76%). Children with lower symptom severity levels showed less attention problem improvements, and those with comorbid developmental problems showed less aggressive and rule-breaking behaviour improvements (Balvarid et al, 2021).

In Phase 2, we will examine improvements in symptoms and function at discharge (Time 3) and at six months follow-up (Time 4), to identify factors associated with treatment response, and measure the cost-effectiveness of the PDH program. More specifically, the following questions will be examined.

Research questions:

1. Does PDH improve the symptoms and function of children?
2. Are improvements stable in 6 months after discharge?
3. Which children have better outcomes? Which have poorer outcomes?
4. Is the treatment cost effective?

Variables:

Outcomes: Symptoms of psychopathology (general and specific factors), and child’s functioning.

Predictor: Child’s sex and gender, sensitivity, family functioning, and comorbidity and severity.

Covariates: Child’s age, household income, and parental education.

Implications:
Children attending PDH programs are at high risk for developing serious mental disorders later in life. Evaluating the effectiveness of the PDH will help implement best practices and will enrich the treatment process by providing feedback for clinicians and staff for improvement. Further, understanding treatment response factors can inform individualized treatment plans and inform about risks for less optimal response. A cost-effectiveness analysis of PDH, in comparison with non-institutional treatment, will inform a national dialogue about treatment needs and gaps for child severe psychopathology.