Review of literature on aftercare services among children and adolescents.

OBJECTIVE: Psychiatric hospital lengths of stay have decreased for children and adolescents, in part because of the presumption that aftercare services in the community are effective and accessible. This review critically examines the literature that pertains to the rates of aftercare service use, the effectiveness of aftercare services, and predictors of aftercare service use. METHODS: Studies were selected on the basis of MEDLINE and PsychINFO computer searches, covering the period between January 1992 and August 2003. Reports that were selected (N=21) included data on outpatient aftercare service use among youths who were aged 18 years and younger and who were discharged from child and adolescent inpatient facilities. RESULTS AND DISCUSSION: A majority of youths received aftercare services after hospitalization, but many youths and families were not fully compliant with aftercare recommendations. Many youths and families continued to receive services up to three months after hospitalization. The literature documents only a small amount of evidence about the effectiveness of aftercare services, but the evidence suggested that aftercare services for youths with substance use problems may have beneficial effects. Few studies examined predictors of aftercare service use and discontinuation, but previous recent mental health service use and decreased family dysfunction appeared to be related to aftercare service use.

Rates and predictors of aftercare services among formerly hospitalized adolescents: a prospective naturalistic study.

OBJECTIVE: To examine rates and predictors of aftercare use, lengths of service use, and predictors of the duration of aftercare service use among 180 adolescents monitored for up to 8.1 years after discharge from an inpatient psychiatry unit. METHOD: Drawing upon the Anderson-Newman model of service use, severity of illness, enabling, and predisposing factors assessed during the hospitalization were examined as potential predictors of service use. Information about outpatient mental health specialty services after hospitalization was assessed repeatedly and verified with treatment records. RESULTS: Seventy-three percent of adolescents received aftercare within the first month after discharge, and 92% eventually received outpatient services. Fifty-seven percent of adolescents remained in treatment 6 months after initiation of services. Psychiatric comorbidity, prior service use, and presence of a biological parent or grandparent in the home were related to initial service use. Psychiatric comorbidity and history of repeated suicide attempts were related to longer duration, and older age and minority group status were related to shorter duration of aftercare service use. CONCLUSIONS: Most adolescents receive aftercare services, but there are certain groups that are relatively less likely to access or remain in services. Interventions to decrease the barriers to care in such groups may be beneficial.