Preliminary Assessment of a Novel Continuum-of-Care Model for Young People With Autism Spectrum Disorders

Cummings, Michael R.; Dubovsky, Steven; Ehrlich, Isaac; Kandefer, Sevie; Cleve, Janell Van; Yin, Yong; Cranwell, Victoria; Gordon, Joshua A.; Youngs, Margaret

doi:10.1176/appi.ps.201900574

Cited by 3 publications

(15 citation statements)

References 12 publications

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“…Introducing a multidisciplinary telephone follow-up service from the emergency department for patients and caregivers of MHR emergencies, consisting mainly of suicide-related emergencies, reduced admissions by 16% (OR = 0.45, 95% CI 0.33–0.60, P < 0.001) [ 28 ]. For LOS, another telephone follow-up study reported a monthly total LOS reduction from 315 to 298 h [ 43 ]. All psychological innovations required psychiatric staff for assessment and treatment.…”

Section: Resultsmentioning

confidence: 99%

“…Thus, all samples were complete in representing the population of young people using those services. Six studies were rated as good quality [ 25 – 30 ], 12 were fair quality [ 31 – 42 ], and 4 were poor quality [ 43 – 46 ]. There was considerable variability between study methodologies, particularly the post-intervention time frame to capture the intervention effects.…”

Section: Methodsmentioning

confidence: 99%

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Models of integrated care for young people experiencing medical emergencies related to mental illness: a realist systematic review

Otis

Barber

Amet

et al. 2022

Eur Child Adolesc Psychiatry

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Mental illness heightens risk of medical emergencies, emergency hospitalisation, and readmissions. Innovations for integrated medical–psychiatric care within paediatric emergency settings may help adolescents with acute mental disorders to get well quicker and stay well enough to remain out of hospital. We assessed models of integrated acute care for adolescents experiencing medical emergencies related to mental illness (MHR). We conducted a systematic review by searching MEDLINE, PsychINFO, Embase, and Web of Science for quantitative studies within paediatric emergency medicine, internationally. We included populations aged 8–25 years. Our outcomes were length of hospital stay (LOS), emergency hospital admissions, and rehospitalisation. Limits were imposed on dates: 1990 to June 2021. We present a narrative synthesis. This study is registered on PROSPERO: 254,359. 1667 studies were screened, 22 met eligibility, comprising 39,346 patients. Emergency triage innovations reduced admissions between 4 and 16%, including multidisciplinary staffing and training for psychiatric assessment (F(3,42) = 4.6, P < 0.05, N = 682), and telepsychiatry consultations (aOR = 0.41, 95% CI 0.28–0.58; P < 0.001, N = 597). Psychological therapies delivered in emergency departments reduced admissions 8–40%, including psychoeducation (aOR = 0.35, 95% CI 0.17–0.71, P < 0.01, N = 212), risk-reduction counselling for suicide prevention (OR = 2.78, 95% CI 0.55–14.10, N = 348), and telephone follow-up (OR = 0.45, 95% CI 0.33–0.60, P < 0.001, N = 980). Innovations on acute wards reduced readmissions, including guided meal supervision for eating disorders (P = 0.27), therapeutic skills for anxiety disorders, and a dedicated psychiatric crisis unit (22.2 vs 8.5% (P = 0.008). Integrated pathway innovations reduced readmissions between 8 and 37% including family-based therapy (FBT) for eating disorders (X2(1,326) = 8.40, P = 0.004, N = 326), and risk-targeted telephone follow-up or outpatients for all mental disorders (29.5 vs. 5%, P = 0.03, N = 1316). Studies occurred in the USA, Canada, or Australia. Integrated care pathways to psychiatric consultations, psychological therapies, and multidisciplinary follow-up within emergency paediatric services prevented lengthy and repeat hospitalisation for MHR emergencies. Only six of 22 studies adjusted for illness severity and clinical history between before- and after-intervention cohorts and only one reported socio-demographic intervention effects.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Models of integrated care for young people experiencing medical emergencies related to mental illness: a realist systematic review

Otis

Barber

Amet

et al. 2022

Eur Child Adolesc Psychiatry

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Section: Published Time Type and Conducted Countries Of The Extracted...mentioning

confidence: 99%

“…The studies included in this scoping review were published within the last ten years (2010 to 2021). Twenty studies were observational (non-interventional) [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] and the rest were interventional studies [45][46][47][48][49][50]. There were twenty-three studies conducted in North America (88.5%) [25,26,[28][29][30][31][32][33][34][35][36][39][40][41][42][43][44][45][46][47][48][49], while two were conducted in Europe [27,…”

Section: Published Time Type and Conducted Countries Of The Extracted...mentioning

confidence: 99%

“…In total, 16 of the studies addressed interventions targeting all mental health conditions [25,26,28,30,31,[33][34][35][36]39,40,42,44,45,48,50]. Other interventions targeting mental health disorders included substance use disorders [32,38,41,43], schizophrenia [27], anxiety and depression [37,47], suicidal ideation and self-harm [49], or other mental health issues [29,46] (Figure 3). Among the 26 studies under review, n = 6, 23.07% discussed interventions involving multidisciplinary coordinated care, including HAP [26], PCMH [25], PBHCI [44], FHMC [28], MCC [30], and the Floresco's model [50]; In a total of 7 studies, 26.92% of the studies focused on interventions using various health services resources and seeking government assistance, including HEARTSMAP [45], QI [40], PAO [35], ACA [36], BHH [46], the model of Having Trained Psychiatric Professionals [31], and the rapid-access ambulatory psychiatric care [33]; n = 2, 7.69% of the studies addressed pharmacy-related methods, which are TOC [39] and PMEGs [42]...…”

Section: Target Conditions and Intervention Typementioning

confidence: 99%

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Interventions to Reduce Repeat Presentations to Hospital Emergency Departments for Mental Health Concerns: A Scoping Review of the Literature

2023

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Background: The number of readmissions to the emergency department (ED) for mental health services each year is significant, which increases healthcare costs and negatively affects the morale and quality of life of patients and their families. Object: This scoping review aimed to establish a better understanding of interventions that have been implemented to reduce psychiatric patient readmission and ED use within the ED, to identify areas for improvement, and therefore to assist in the development of more effective actions in the future. Method: The scoping review was conducted on several bibliographic databases to identify relevant studies. Two researchers independently screened and reviewed titles, abstracts, and full-text articles that met the inclusion criteria. Using Covidence software, 26 out of 6951 studies were eligible for inclusion in this scoping review based on the PRISMA checklist. Data were extracted, collated, summarized, presented, and discussed. Result: This review identified 26 studies which examined interventions aimed to reduce ED visits, such as the High Alert Program (HAP), the Patient-Centered Medical Home (PCMH), the Primary Behavioral Health Care Integration (PBHCI), and the Collaborative Care (CC) Program, etc. Twenty-three of the studies were conducted in North America, while the rest were conducted in Europe and Australia. A total of 16 studies examined interventions directed to any mental health conditions, while the rest addressed specific health conditions, such as substance use disorders, schizophrenia, anxiety, depression. Interventions involved comprehensive and multidisciplinary services, incorporation of evidence-based behavioral and pharmacological strategies, and emphasized the case management that was found to be effective. Additionally, there was a marked consideration for diverse mental health groups, such as those with substance use disorder and of young age. Most interventions showed a positive effect on reducing psychiatric ED visits. Conclusion: Various initiatives have been implemented worldwide to reduce the number of emergency department visits and the associated burden on healthcare systems. This review highlights the greater need for developing more accessible interventions, as well as setting up a comprehensive community health care system aiming to reduce frequent ED presentations.

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Evidence-based brief interventions targeting acute mental health presentations for children and adolescents: systematic review

Eapen,

Gerstl,

Ahinkorah

et al. 2024

BJPsych open

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Background Brief intervention services provide rapid, mobile and flexible short-term delivery of interventions to resolve mental health crises. These interventions may provide an alternative pathway to the emergency department or in-patient psychiatric services for children and young people (CYP), presenting with an acute mental health condition. Aims To synthesise evidence on the effectiveness of brief interventions in improving mental health outcomes for CYP (0–17 years) presenting with an acute mental health condition. Method A systematic literature search was conducted, and the studies’ methodological quality was assessed. Five databases were searched for peer-reviewed articles between January 2000 and September 2022. Results We synthesised 30 articles on the effectiveness of brief interventions in the form of (a) crisis intervention, (b) integrated services, (c) group therapies, (d) individualised therapy, (e) parent–child dyadic therapy, (f) general services, (g) pharmacotherapy, (h) assessment services, (i) safety and risk planning and (j) in-hospital treatment, to improve outcomes for CYP with an acute mental health condition. Among included studies, one study was rated as providing a high level of evidence based on the National Health and Medical Research Council levels of evidence hierarchy scale, which was a crisis intervention showing a reduction in length of stay and return emergency department visits. Other studies, of moderate-quality evidence, described multimodal brief interventions that suggested beneficial effects. Conclusions This review provides evidence to substantiate the benefits of brief interventions, in different settings, to reduce the burden of in-patient hospital and readmission rates to the emergency department.

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Preliminary Assessment of a Novel Continuum-of-Care Model for Young People With Autism Spectrum Disorders

Cited by 3 publications

References 12 publications

Models of integrated care for young people experiencing medical emergencies related to mental illness: a realist systematic review

Models of integrated care for young people experiencing medical emergencies related to mental illness: a realist systematic review

Interventions to Reduce Repeat Presentations to Hospital Emergency Departments for Mental Health Concerns: A Scoping Review of the Literature

Evidence-based brief interventions targeting acute mental health presentations for children and adolescents: systematic review

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