Defense Date


Document Type


Degree Name

Doctor of Philosophy


Health Administration

First Advisor

Dr. Robert E. Hurley


General acute care hospitals play a particularly important role in the delivery of children's mental health given the extant lack of alternatives to long term hospitals for patients requiring a restrictive treatment environment (Glied and Cuellar, 2003). This cross-sectional study identifies environmental and organizational factors associated with general acute care and children's hospitals in the United States that provide hospital-based child/adolescent psychiatric services and the number of services. Two macro-level theories, Resource Dependence Theory and Institutional Theory were used to identify environmental and organizational factors. A nationwide sample of hospitals was drawn from the 2003 AHA annual survey. Data from the 2002 AHA annual survey, Area Resource File and American College of Graduate Medical Education was used for the independent variables. There were three analyses, correlation, descriptive and logistic regression. Results demonstrate that hospitals in markets with a low percentage of non-white children, higher family median income, high hospital community orientation, and high percentage of not for profit hospitals are more likely to offer child psychiatric services. Organizational factors associated with an increased likelihood to providing child psychiatric services include hospitals identified as Catholic, public or children's and those with a child psychiatric residency program. Three factors were associated with hospitals providing a high number of child psychiatric services and include hospitals in metropolitan statistical areas, system affiliation, and general acute care hospitals. This study demonstrated that 1. large hospitals are more likely to offer child psychiatric services and a high number of services, 2. children's hospitals provide child psychiatric services, but not a high number of them, and 3. hospitals with a high number of service offerings are mainly located in MSA's and more likely to offer outpatient substance abuse services. Significant results were obtained in the analysis of hospital characteristics and the provision of child psychiatric services, but weaker results were observed when analyzing the number of services. Further research is needed to identify factors with stronger associations to the level of service offerings.


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