Evaluation of the Effectiveness of a Psychodynamically Oriented Day Treatment Program for Children with Behaviour Problems: A Pilot Study* NATALIE GRIZENKO, M.D. I AND LILIANE SAYEGH, M.Ed. 2 Twenty-three consecutive admissions to a psychodynami- cally oriented day treatment program were assessed using a pre-/post-test design. Discharge scores revealed a signifi- cant improvement on all standardized scales for behaviour (p < .0001), academics (p <. 05), personality measures (p < .0001) andfamily measures (p < .05). Parents reported a significantly greater behavioural improvement than both teachers and primary therapists (p < .0001). Although all children showed improvement, parents reported significantly lower improvement rates (p < O. 05) for children with con- duct disorder compared with attention deficit disorder, oppositional defiant disorder and depression. Teachersfound that younger boys (aged six to nine) showed a significantly greater improvement (p <. 05) than older boys (aged ten to 12) in total behaviour score and externalizing subscores of the Revised Child Behavior Profile. At discharge 87% of chil- dren were reintegrated into regular school; only 17% were attending regular school at admission. D ay treatment for children began in 1943 with the ther- apeutic nursery school (1), but has been recognized as a significant innovation in mental health care only in the past 25 years (2). Between 1961 and 1981 there was a dramatic increase in the number of day treatment programs in the US, from ten to 353 (1,3). The recent appeal of day treatment programs stems from the need for more intensive therapeutic environments for children who do not respond to other out- patient settings. Unlike inpatient hospitalization, day treat- ment programs cost less, do not disrupt family, peer and community ties and do not encourage the child's dependency. Furthermore, they allow the child to be quickly reintegrated into a regular or specialized class, thus avoiding "institu- tionalization" of the child. In spite of the proven cost *Manuscript received December 1989. 'Assistant Professor, Department of Child Psychiatry, McGill University, Montreal, Quebec; Director, Lyall Preadolescent Day Treatment Program, Douglas Hospital, Verdun, Quebec. 2Researcher, Department of Child and Adolescent Psychiatry, Researcher, Lyall Preadolescent Day Treatment Program, Douglas Hospital, Verdun, Quebec. Address reprint requests to: Dr. Natalie Grizenko, Department of Child and Adolescent Psychiatry, Douglas Hospital, Lyall Pavillion, 6875 LaSalle Boulevard, Verdun, Quebec H4H IR3 Can. J. Psychiatry Vol. 35, August 1990 519 benefit of day treatment programs, they have decreased in number in 1981 and continue to be under-used (4). For day treatment to become widely accepted and used, it is manda- tory that we understand its present status and future benefits. Evaluation of day treatment outcome is crucial for its accep- tance by the medical community. Studies that evaluate the effectiveness of day treatment are scarce. Early studies were often descriptive (5-9). The most frequent outcome criterion used was the rate of reintegra- tion into a regular school after day treatment. It was found that 65 % to 70 % of severe cases and 80 % to 90 % of the less severe cases were able to be reintegrated into the normal school system, with approximately 70% of these (8,9) needing specialized education. It is simplistic, however, to use school reintegration as the sole measure of day treatment outcome, since reintegration may be influenced by other factors such as program policy and availability of school services. Futhermore, as Halpern states, maintaining a child in public school is a necessary but not sufficient condition for educating him (8). Recent studies (10-15) have broadened the definition of outcome to include the child's behavioural and academic improvements, in addition to school reintegration. Further- more, they have attempted to examine, through more exten- sive statistical analysis, demographic variables that may have positive or negative effects on outcome. The purpose of our study is to determine whether or not children with severe behavioural problems can be success- fully reintegrated into schools and whether or not their behavioural and academic problems can be significantly reduced. Secondly, we attempt to identify factors that may predict outcome. Findings from the study may have implications on public policy by helping to determine the importance of promoting day treatment for disturbed children and in selecting chil- dren who can benefit most from day treatment. Methods Population The study was carried out at the Lyall Preadolescent Day Treatment Program of the Douglas Hospital with 23 con- secutive children'admitted to a psychodynamically oriented day treatment program. The children and their families were first assessed by the team psychiatrist, who determined