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

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Abstract
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.