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Predicting Time-to-Independent-Release from Current Level of Functioning for Psychiatric Inpatients: A “Survivor” Analysis

The Journal of Behavioral Health Services & Research volume 35, pages 315–333 (2008)Cite this article

Abstract

Non-optimal psychiatric discharges occur frequently and result in high costs. The Time-Sample Behavioral Checklist (TSBC) has been demonstrated to be the best method for determining successful independent discharge within 2 weeks of assessment for adult inpatients. This study examined the extent to which TSBC indexes and perceived dangerousness predict staff independent discharge-readiness judgments up to 6 months after initial assessment. Data from 22 acute and chronic/mixed units (N = 362) were analyzed using Cox proportional hazard regression. TSBC appropriate interpersonal interaction and appropriate behavior variability predicted shorter time-to-independent-release (TTIR). TSBC bizarre facial expressions and verbalizations predicted longer TTIR. Post hoc analyses suggest that acutely admitted inpatients perceived to be dangerous were discharged sooner than others—a finding that is likely attributable to differential psychotropic medication responsiveness. Implications are discussed for TSBC implementation for earlier identification of discharge-ready inpatients and for tailoring interventions to target behavior that predicts independent discharge success.

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Affiliations

  1. Department of Psychology, University of Houston, 126 Heyne Building, Houston, TX, 77204-5022, USA

    Justin R. Springer MA & Gordon L. Paul PhD

  2. Fulton State Hospital, 600 East Fifth Street, Fulton, MO, 65201, USA

    Justin R. Springer MA

Authors
  1. Justin R. Springer MA
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  2. Gordon L. Paul PhD
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Correspondence to Gordon L. Paul PhD.

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NOTE

Variables that were not normally distributed were transformed; however, the results did not significantly differ from non-transformed scores. Raw models were also statistically significant, such that inclusion of time-dependent covariates had minimal effect on prediction. Data were examined for possible non-independence because of clustering by unit through the inclusion of robust variance estimates.46 Model statistics with and without robust variance estimates exhibited miniscule differences (p value changes from 0.002 to 0.013) such that clustering by unit does not influence the validity of interpretations from the original analyses.

This investigation was the basis of a Masters thesis at the University of Houston by Mr. Springer under the direction of Dr. Paul. Appreciation for helpful comments is expressed to other members of the examining committee: Marco J. Mariotto, PhD, and Karla K. Stuebing, PhD. This study was partially supported by grants to Dr. Paul from the National Institute of Mental Health, Public Health Service (grants MH-15553 and MH-25464), the Illinois Department of Mental Health and Developmental Disabilities, the Joyce Foundation, the MacArthur Foundation, the Owsley Foundation, the Cullen Foundation, and the Center for Public Policy, University of Houston.

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Springer, J.R., Paul, G.L. Predicting Time-to-Independent-Release from Current Level of Functioning for Psychiatric Inpatients: A “Survivor” Analysis. J Behav Health Serv Res 35, 315–333 (2008). https://doi.org/10.1007/s11414-007-9096-9

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  • DOI: https://doi.org/10.1007/s11414-007-9096-9

Keywords

  • discharge readiness
  • psychiatric inpatient
  • behavioral assessment
  • dangerousness
  • survival analysis
  • time-to-release