BMJ 2000;321:1047-1050 ( 28 October )

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Randomised comparison of the effectiveness and costs of community and hospital based mental health services for children with behavioural disorders

Richard Harrington, professor, ^a Sarah Peters, research associate, ^a Jonathan Green, senior lecturer, ^a Sarah Byford, research fellow, ^b Jane Woods, research assistant, ^a Ruth McGowan, specialist registrar. ^a

^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 R.C.Harrington{at}man.ac.uk

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.

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