Innovations in Practice: pilot evaluation of the supported discharge service (<scp>SDS</scp>): clinical outcomes and service use

Ougrin, Dennis; Zundel, Toby; Corrigall, Richard; Padmore, Jane; Loh, Cheryl

doi:10.1111/camh.12038

Cited by 29 publications

(21 citation statements)

References 14 publications

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“…Symptom and functioning outcomes that favoured the SDS group were not significantly different from those with usual care. These treatment effects are in line with those noted in an RCT undertaken by an independent research group 30 who used the UK SDS model. 31 , 32 …”

Section: Discussionsupporting

confidence: 85%

Comparison of effectiveness and cost-effectiveness of an intensive community supported discharge service versus treatment as usual for adolescents with psychiatric emergencies: a randomised controlled trial

Ougrin

Corrigall

Poole

et al. 2018

The Lancet Psychiatry

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SummaryBackgroundIntensive community treatment to reduce dependency on adolescent psychiatric inpatient care is recommended in guidelines but has not been assessed in a randomised controlled trial in the UK. We designed a supported discharge service (SDS) provided by an intensive community treatment team and compared outcomes with usual care.MethodsEligible patients for this randomised controlled trial were younger than 18 years and had been admitted for psychiatric inpatient care in the South London and Maudsley NHS Foundation Trust. Patients were assigned 1:1 to either the SDS or to usual care by use of a computer-generated pseudorandom code with random permuted blocks of varying sizes. The primary outcome was number of inpatient bed-days, change in Strengths and Difficulties Questionnaire (SDQ) scores, and change in Children's Global Assessment Scale (CGAS) scores at 6 months, assessed by intention to treat. Cost-effectiveness was explored with acceptability curves based on CGAS scores and quality-adjusted life-years (QALYs) calculated from the three-level EuroQol measure of health-related quality of life (EQ-5D-3L), taking a health and social care perspective. This study is registered with the ISRCTN Registry, number ISRCTN82129964.FindingsHospital use at 6 months was significantly lower in the SDS group than in the usual care group (unadjusted median 34 IQR 17–63 vs 50 days, 19–125, p=0·04). The ratio of mean total inpatient days for usual care to SDS was 1·67 (95% CI 1·02–2·81, p=0·04), which decreased to 1·65 (0·99–2·77, p=0·057) when adjusted for differences in hospital use before randomisation. Scores for SDQ and CGAS did not differ between groups. The cost-effectiveness acceptability curve based on QALYs showed that the probability of SDS being cost-effective compared with usual care was around 60% with a willingness-to-pay threshold of £20 000–30 000 per QALY, and that based on CGAS showed at least 58% probability of SDS being cost-effective compared with usual care irrespective of willingness to pay. We recorded no adverse events attributable to SDS or usual care.InterpretationSDS provided by an intensive community treatment team reduced bed usage at 6 months' follow-up but had no effect on functional status and symptoms of mental health disorders compared with usual care. The possibility of preventing admissions, particularly through features such as reduced self-harm and improved reintegration into school, with intensive community treatment should be investigated in future studies.FundingSouth London and Maudsley NHS Trust.

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Section: Discussionsupporting

confidence: 85%

Comparison of effectiveness and cost-effectiveness of an intensive community supported discharge service versus treatment as usual for adolescents with psychiatric emergencies: a randomised controlled trial

Ougrin

Corrigall

Poole

et al. 2018

The Lancet Psychiatry

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“…Home treatment was better at providing improvement on all behavioural measures in patients with behavioural disorders only (Winsberg et al, 1980) and similar rate of improvement on emotional disorders and behavioural disorders (Mattejat et al, 2001). Despite significant improvements had been found with SDS in a pilot study (Ougrin, Zundel, Corrigall, Padmore, & Loh, 2014), there was no evidence that SDS was superior to inpatient care (Boege et al, 2015). MST in young people with psychiatric emergencies was at least as effective, and in some cases more effective, than psychiatric hospitalization (Henggeler et al, 1999).…”

Section: Clinical Outcomesmentioning

confidence: 99%

Review: Alternatives to inpatient care for children and adolescents with mental health disorders

Kwok

Yuan

Ougrin

2015

Child Adoles Ment Health

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Background Intensive community services may provide an alternative to inpatient care but there is little systematic evidence of their efficacy. This article provides a systematic review of randomized controlled trials (RCTs) reporting efficacy of intensive community services versus inpatient care in youth. Method Data sources were identified by searching Medline, PsychINFO and EMBASE databases as of December 2014. RCTs comparing intensive community services versus inpatient care in children and adolescents (through age 18) were included. Results Six unique RCTs including 569 youth were identified. The RCTs examined the efficacy of specialist outpatient treatment, multisystemic therapy, day patient treatment, intensive home treatment and supported discharge services versus inpatient care. Using intensive community services was associated with clinical improvements similar to inpatient care in most studies. Where differences in clinical outcomes existed, they tended to favour intensive community treatment. Using intensive community services was associated with shorter hospitalizations, lower costs and greater patient satisfaction. There were no independent replications of the results. Few studies investigated the use of intensive community treatment as an alternative to inpatient care in children and adolescents with severe immediate risk to self and others. Conclusions Intensive community services appear to be a viable alternative to inpatient care. Independent replication of results achieved by specific intensive community treatment models is a research priority.

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“…Two recent pilot studies assessed a new model of care conjoining inpatient and outpatient elements in a home-treatment setting for children and adolescents with complex mental health problems presenting for inpatient admission: Supported discharge service (SDS; Kent, UK, n = 30; [20]) and Home-treatment brings inpatient-treatment outside (Hot-BITs, German acronym: Behandelt Zu Hause Gesund werden [BeZuHG], Ravensburg, Germany; n = 100 [3]).…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness of intensive home treatment enhanced by inpatient treatment elements in child and adolescent psychiatry in Germany: A randomised trial

et al. 2015

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Innovations in Practice: pilot evaluation of the supported discharge service (SDS): clinical outcomes and service use

Cited by 29 publications

References 14 publications

Comparison of effectiveness and cost-effectiveness of an intensive community supported discharge service versus treatment as usual for adolescents with psychiatric emergencies: a randomised controlled trial

Comparison of effectiveness and cost-effectiveness of an intensive community supported discharge service versus treatment as usual for adolescents with psychiatric emergencies: a randomised controlled trial

Review: Alternatives to inpatient care for children and adolescents with mental health disorders

Cost-effectiveness of intensive home treatment enhanced by inpatient treatment elements in child and adolescent psychiatry in Germany: A randomised trial

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