Comparison of Outcomes of Acute Care in Short-Term Residential and Psychiatric Hospital Settings
William B. Hawthorne, PhD; Elizabeth E. Green, PhD; James B. Lohr, MD; Richard Hough, PhD; Peggy G. Smith, PhD

Objective: The study compared the demographic and diagnostic characteristics

of clients and the outcomes of treatment in five short-term

acute residential treatment programs and two acute hospital-based

psychiatric programs. Methods: A total of 368 clients in the short-term

acute residential treatment programs and 186 clients in the psychiatric

hospital programs participated in an observational study. The

study used a repeated-measures design and assessed participants on

multiple standardized measures of symptoms and functioning at admission,

discharge, and four-month follow-up. Comparisons between

the two groups were conducted separately by diagnostic category.

Measures included the Brief Symptom Inventory, the Behavior and

Symptom Identification Scale-32, the Medical Outcomes Short-Form-

36, and the Client Satisfaction Questionnaire-8. Results: The two types

of programs admit persons with similar levels of acute distress who

have comparable levels of improvement at discharge and an equivalent

degree of short-term stability of treatment gains. Costs of treatment

episodes were considerably lower for the short-term residential

programs, and client satisfaction with the two types of programs was

comparable. Conclusions: Short-term acute residential treatment is a

less costly yet similarly effective alternative to psychiatric hospitalization

for many voluntary adult patients. (Psychiatric Services 50:401–

406, 1999)


Dr. Hawthorne is executive director of the Community Research Foundation, 444

Camino del Rio South, Suite 219, San Diego, California 92108 (e-mail, hobie@ He is also associate clinical professor in the department of psychiatry at the

University of California, San Diego. Dr. Green is research coordinator at Community

Research Foundation and in private practice in San Diego. Dr. Lohr is chief of the

psychiatry service at the Veterans Affairs Medical Center in San Diego. Dr. Hough is

codirector for research on child and adolescent mental health services at Children’s

Hospital and Health Center in San Diego. Dr. Smith is chief of program review and

development at San Diego County Mental Health Services. Earlier versions of this paper

were presented at poster sessions of the annual meeting of the American Public

Health Association held November 9–13, 1997, in Indianapolis, at the Institute on Psychiatric

Services held October 18–22, 1996, in Chicago, and at the annual convention

of the American Psychological Association held August 8–12, 1996, in Toronto, Ontario.