Young people in Out of Home Care (OoHC) have complex mental health and psychosocial needs due to a range of individual, systemic and intergenerational factors that may limit the effectiveness of usual clinic-based services. To address this, in 2017 an assertive-integrated service (AIS) model of care was adopted by the Child and Adolescent Mental Health Service (CAMHS) in South Western Sydney Local Health District (SWSLHD), Australia, through outreach to the young person in the community. This paper outlines the study protocol comparing AIS with clinic-based CAMHS usual care to meet the physical, mental health and wellbeing needs of young people in OoHC. Using routinely collected outcome data, the AIS model will be compared to clinic-based CAMHS treatment as usual care. Measures of overall functioning (e.g. Global Assessment Scale [CGAS]), psychological functioning (e.g. Strength and Difficulties Questionnaire [SDQ]), general health and social functioning (e.g. Health of the Nation Outcome Scales for Children and Adolescents [HoNOSCA]) and other relevant socio-demographic and clinical variables will be collected at intake and at 3-month intervals until discharge from the respective services. Semi-structured interviews will also be conducted with young people, their carers, and service providers, to examine qualitative themes about the suitability of service provision. It is expected that a better understanding of the key indicators of functioning for young people accessing AIS and clinic-based services will help inform what works for these young people so that they can receive targeted and tailored support from the start of service engagement.
Young people in OOHC have complex mental health concerns, therefore the South Western Sydney Local Health District (SWSLHD) has trialled a tiered model of mental health care. Under this model the OOHC mental health team (OOHC-MHT) provides specialist tier four service delivery for those with the most severe, intense mental health needs. OOHC consumers with a reduced level of severity access services at a tier three centre-based iCAMHS. This study aims to understand the characteristics of young people in OOHC accessing different service provision options in Sydney, Australia. Sixty-six OOHC consumers 8–17 years accessing mental health services across SWSLHD from January 2020–December 2021 participated in the study. Group differences in OOHC-MHT and iCAMHS outcome measures were compared. HoNOSCA scores were significantly worse for OOHC-MHT than iCAMHS, indicating more severe psychopathology for OOHC-MHT at baseline. In OOHC-MHT, HoNOSCA decreased significantly from admission to discharge and scores on the CGAS increased significantly, indicating significant improvements in psychopathology and functioning. In the iCAMHS group scores on the HoNOSCA significantly decreased indicating improved psychopathology over this period. These findings support a tiered model of service delivery for OOHC consumers, with this tailored level of care resulting in significantly improved outcomes across a range of complexity.
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