Randomised comparison of the effectiveness and costs of community and hospital based mental health services for children with behavioural disorders
BMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7268.1047 (Published 28 October 2000) Cite this as: BMJ 2000;321:1047
- Richard Harrington, professor (R.C.Harrington{at}man.ac.uk)a,
- Sarah Peters, research associatea,
- Jonathan Green, senior lecturera,
- Sarah Byford, research fellowb,
- Jane Woods, research assistanta,
- Ruth McGowan, specialist registrara
- a Department of Child and Adolescent Psychiatry, University of Manchester, Manchester M27 4HA,
- b Centre for Health Economics, University of York, York YO1 5DD
- Correspondence to: R Harrington, University Department of Child and Adolescent Psychiatry, Royal Manchester Children's Hospital, Pendlebury, Manchester M27 4HA
- Accepted 1 August 2000
Abstract
Objective: To test the hypothesis that a community based intervention by secondary child and adolescent mental health services would be significantly more effective and less costly than a hospital based intervention.
Design: Open study with two randomised parallel groups.
Setting: Two health districts in the north of England.
Participants: Parents of 3 to 10 year old children with behavioural disorder who had been referred to child and adolescent mental health services.
Intervention: Parental education groups.
Main outcome measures: Parents' and teachers' reports of the child's behaviour, parental depression, parental criticism of the child, impact of the child's behaviour on the family.
Results: 141 subjects were randomised to community (n=72) or hospital (n=69) treatment. Primary outcome data were obtained on 115 (82%) cases a year later. Intention to treat analyses showed no significant differences between the community and hospital based groups on any of the outcome measures, or on costs. Parental depression was common and predicted the child's outcome.
Conclusions: Location of child mental health services may be less important than the range of services that they provide, which should include effective treatment for parents' mental health problems.
Footnotes
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Funding Research grant from the NHS Executive's Motherhood and Child Health initiative. Clinical costs were provided by Manchester Children's Hospital NHS Trust (funding for two of the therapists to train in the Webster-Stratton programme in Seattle, United States) and by Salford social services.
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Competing interests None declared.
- Accepted 1 August 2000