Measuring patient dependency in child and adolescent mental health Abstract Within the context of child and adolescent mental health inpatient services, a literature review was undertaken to understand the concept of inpatient dependency and how it can be measured. Articles and books relating to patient dependency and its measurement in various contexts were retrieved, and other published measures were identified. It was found that dependency has been defined in many different ways, and various techniques have aimed to quantify or categorize patients’ dependencies. This article focuses particularly on measures used in adult psychiatry and paediatric services. At present, there is no available established measure of patient dependency in child and adolescent inpatients. This article identifies the need to develop a measure of inpatient dependency that is specifically designed for these services, and outlines a tool that the authors have recently designed. Key words: Dependency n Inpatient CAMHS n Mental health nursing n Patient dependency n Psychometric tools n Unit resources C hild and adolescent mental health (CAMHS) inpatient units provide services for young people who are experiencing complex and severe mental health problems. An inpatient unit has a fixed capacity, which is determined by both the number of beds on the ward and the amount of available nursing time that can be devoted to each patient. CAMHS inpatients all have different dependency levels, which vary widely across presentation such that admitting a highly dependent young person to a unit close to full capacity is likely to overstretch unit resources. In this article, the authors review the concept of patient dependency and how it has been measured in various contexts. They then justify the need for the development of a specific measure of dependency in inpatient CAMHS. Literature review The search was restricted to English language sources from January 1953 to December 2005. Electronic databases used Paul Abeles, Adam Danquah, Malli Wadge, Peter Hodgkinson, Eleri Holmes were MEDLINE, The British Nursing Index, CINAHL, and PsycINFO. In addition, the websites of the Institute of Health Sciences and Public Health Research, the British Library Integrated Catalogue the Royal College of Psychiatrists and the Department of Health were searched. Key words used were: ‘patient dependency’, ‘inpatient dependency’, ‘dependency measure’, ‘dependency tool’ and ‘dependency needs’. The search included any medical- or nursing-related setting and excluded articles which did not appear to describe a system for quantifying or categorizing the dependency of patients.These online searches were augmented by reviewing the reference list of the articles obtained. Articles describing measures of patient dependency were observed to fall into general adult health care, paediatrics, mental health (adult and older people) and just one measure was identified in child and adolescent mental health services (which is the authors’ area of specific interest). Introduction to dependency measures Patient dependency as a concept is referred to and measured across a range of medical disciplines. The Audit Commission (1992) defines patient dependency as ‘... an assessment of a patient’s ability to care for him or herself, for instance, with regard to feeding, personal hygiene and mobility’ (also see MacGuire, 1988). There is no one, overarching definition of patient dependency. For example, in the context of community nursing, patient dependency has been defined as ‘... the extent to which the patient’s level of functional capacity dictates the time required for personal, technical, supportive and educative (district) nursing care’ (Hopkins and Durand, 1987). Dependency as a function of the amount of nursing that a patient requires is a consistent theme in the literature, but, as Barr et al (1973) have noted, amount of nursing can relate to a number of factors, including time spent by the bedside, severity of condition or the need for specialized treatment. Dependency classification systems need to distinguish between the actual ‘clinical’ dependency of a patient, and the demands made upon nursing time. Systems that measure patient dependency are defined by James (1991) as those that ‘allocate patients into a number of groups on the basis of their demand for nursing care’. This means that in practice, even where the measure of patient dependency is based on severity of clinical status (Gibson et al, 1986), the different levels ultimately correspond to intensity of observation and staff time required. Patient dependency can be seen as a base measure from which many aspects of care and progress can be investigated and on which managerial decisions can be made (Goldstone et al, 1983). In a review of the literature, Escolme and James (2004) 1064 British Journal of Nursing, 2007,Vol 16, No 17 Paul Abeles is Clinical Psychologist and Eleri Holmes is Assistant Psychologist, Department of Clinical Psychology, Booth Hall Children’s Hospital, Blackley, Manchester; Adam Danquah is Trainee Clinical Psychologist, University of Manchester; Malli Wadge is Senior Clinical Sister and Peter Hodgkinson is Ward Manager, Ward 3, Birmingham Children’s Hospital, Birmingham Accepted for publication: August 2007