Parent-child inpatient treatment for children with behavioural and emotional disorders: a multilevel analysis of within-subjects effects

Abstract

Background: The importance of parental involvement in child treatment is well-established. Several child psychiatric clinics have, therefore, set up inpatient family units where children and parents are both actively involved in the treatment. Unfortunately, evidence supporting the benefits of these units is sparse.

Methods: We evaluated the effectiveness of inpatient treatment for families with severe parent-child interaction problems in a child psychiatric setting. Consecutive admissions to the parent-child ward (N = 66) were studied. A within-subjects design was used with four assessment points (baseline, admission, discharge, four-week follow-up). Outcome measures were 1) parent and teacher ratings of child behaviour, and 2) parent self-ratings of parenting practices, parental strains and parental mental health. Data were analyzed using multilevel modelling for longitudinal data (piecewise growth curve models).

Results: All parent-rated measures improved significantly during the four-week treatment period (d = 0.4 - 1.3). These improvements were significantly greater than those observed during the four-week pre-admission period. In addition, benefits were maintained during the four-week follow-up period. Only parents' self-efficacy in managing their child's behaviour showed continued improvement during follow-up. Teacher ratings of children's disruptive behaviour at school were stable during the pre-admission period and showed significant improvements at follow-up (d = 0.3 - 0.4).

Conclusions: We conclude that parent-child inpatient treatment has positive effects on child and parent behaviour and mental health, and can therefore be recommended for children with behavioural and emotional disorders and severe parent-child interaction problems.

Fig. 1

Flow of participants through the study

Fig. 2

Trajectory of raw scores on the Child Behaviour Checklist (CBCL) Total scale and the Teacher Report Form (TRF) Total scale for a prototypical individual based on parameters estimated by piecewise linear growth modeling. *p < .05

Fig. 3

Trajectory of raw scores on the ADHD symptom rating scale for a prototypical individual based on parameters estimated by piecewise linear growth modeling. *p < .05

Fig. 4

Trajectory of raw scores on the ODD symptom rating scale for a prototypical individual based on parameters estimated by piecewise linear growth modeling. *p < .05