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. 2022 Apr;67(4):268-279.
doi: 10.1177/07067437211000627. Epub 2021 Mar 15.

Effectiveness and Predictors of Outcomes in a Psychiatric Day Treatment Program for Elementary-Age

Sahar Balvardi  1 , Noriyeh Rahbari  2 , Alexia Jolicoeur-Martineau  2   3 , Lauren Rudy  4 , Mitchell Arnovitz  5 , David P Laplante  2 , Maria Brown  6 , Paola Habib  1   2 , Phyllis Zelkowitz  1   2 , Jaswant Guzder  1   2 , Ashley D Wazana  1   2
Affiliations

Effectiveness and Predictors of Outcomes in a Psychiatric Day Treatment Program for Elementary-Age

Sahar Balvardi et al. Can J Psychiatry. 2022 Apr.

Abstract
in English, French

Objective: In this study, we aimed to (1) assess the effectiveness of an intensive multimodal day treatment program in improving externalizing problems and function in elementary-age children and (2) examine 3 predictors of the treatment outcome (i.e., family functioning, baseline severity, and comorbid disorders).

Methods: The sample included 261 children (80.9% boys) between ages of 5 and 12. A retrospective chart review, from 2013 to 2018, and a prospective chart review, from 2018 to 2019, were conducted to extract all relevant data for the present study. Parents and teachers provided reports on children's externalizing problems (i.e., aggressive behavior, attention problems, and rule-breaking behavior) and their level of function across different domains. The level of family functioning was also reported by parents, while clinicians assessed children's severity of disturbance and their diagnoses at intake.

Results: Based on both parents' and teachers' reports, children showed significant improvement in their externalizing problems. Moreover, children showed functional improvement at home, at school, with peers, and in hobbies by the end of the program. Based on teacher's reports, children with lower level of severity showed less improvement in their attention problems, and those with comorbid developmental problems showed less improvement in their aggressive and rule-breaking behaviors. Family functioning did not predict any treatment outcome.

Conclusion: An intensive multimodal day treatment program was effective in reducing the symptoms of externalizing problems in elementary-age children. However, children with less severe difficulties and comorbid developmental problems showed less improvement in their externalizing problems.

Objectif:: Nous visions par la présente étude à 1) évaluer l’efficacité d’un programme multimodal intensif de traitement de jour à améliorer les problèmes et la fonction d’externalisation chez les enfants d’âge primaire, et à 2) examiner trois prédicteurs du résultat du traitement (c.-à-d., le fonctionnement familial, la gravité au départ, et les troubles comorbides).

Méthode:: L’échantillon comprenait 261 enfants (80,9% des garçons) âgés entre 5 et 12 ans. Un examen rétrospectif des dossiers, de 2013 à 2018, et un autre examen prospectif des dossiers, de 2018 à 2019, ont été menés afin d’extraire toutes les données pertinentes pour la présente étude. Les parents et les enseignants ont fourni des rapports sur les problèmes d’externalisation des enfants (c.-à-d., le comportement agressif, les problèmes d’attention et le comportement de non-respect des règles) et sur leur niveau de fonctionnement dans différents domaines. Le niveau de fonctionnement familial était aussi rapporté par les parents, tandis que les cliniciens évaluaient la gravité de la perturbation chez les enfants et leur diagnostic à l’entrée dans le programme.

Résultats:: Selon les rapports tant des parents que des enseignants, les enfants manifestaient une amélioration significative de leurs problèmes d’externalisation. En outre, les enfants démontraient une amélioration fonctionnelle à la maison, à l’école, avec les camarades et dans les loisirs à la fin du programme. D’après les rapports des enseignants, les enfants dont le niveau de gravité était plus faible avaient moins d’amélioration de leurs problèmes d’attention, et ceux dont les problèmes développementaux étaient comorbides avaient moins d’amélioration de leurs comportements agressifs et de non-respect des règles. Le fonctionnement familial ne prédisait aucun résultat du traitement.

Conclusion:: Un programme multimodal intensif de traitement de jour a été efficace pour réduire les symptômes des problèmes d’externalisation chez des enfants d’âge primaire. Cependant, les enfants ayant des difficultés moins graves et des problèmes développementaux comorbides ont manifesté moins d’amélioration de leurs problèmes d’externalisation.

Keywords: comorbidity; day treatment program; externalizing problems; family functioning; severity.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
CGI-I reported by parents, CCW, and community school teacher. Note. The results regarding community teacher’s report of children’s improvement at home (N = 3) and in hobbies (N = 14) were not included in this study given the small sample size for these 2 domains. CCW = childcare worker; CGI-I = Clinical Global Impression of Improvement.
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