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

Abstract

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.

Intensive Home Treatment for adolescents in psychiatric crisis

“…The HoNOSCA has shown to be a valid questionnaire, to require minimum time to be filled out and to have no physical or mental burden for subjects since it is filled out by their medical practitioners [25,26] are debated [24,27,28] we used a total score of scales 1-13, which makes a maximal total score of 52 points (higher score indicates more severe problems). Scales 1-13 are categorized in four categories, including behavioural problems (question 1-4), impairment (question 5-6), symptoms (question [7][8][9] and social problems (question 10-13). We divided scores by category, because focusing on individual items -rather than total scores-appears more useful in evaluating the impact of inpatient psychiatric treatment on adolescents [25].…”

“…In children and adolescents both intensive community services and inpatient care have been found to be associated with clinical improvements in most studies [9]. Thereby, intensive community services were associated with shorter hospitalizations, greater patient satisfaction and lower costs [9]. Homebased multisystem therapy (MST) showed to be effective at decreasing externalizing symptoms, improving family functioning and school attendance, together with higher satisfaction scores randomly assigned to inpatient hospitalization [10,11].…”

“…However, while developing new treatment models for youth in psychiatric crisis and moving from inpatient to outpatient treatment, inpatient treatment can be warranted in individual cases [6]. As such, short term studies show promising results, whereas results of long-term follow-up and independent replication of the results of intensive community treatment in youth are urgency [9,13,14].…”

Editorial: The job of an editor—one year on

“…We look at an innovative intensive crisis cognitive behaviour, family-centred intervention which appears to be promising in young people admitted for inpatient care (McBee-Strayer et al, 2019). It is aimed at shortening inpatient treatment, part of a larger body of knowledge that is rapidly developing in the field of alternatives to inpatient admissions (Kwok et al, 2016;Ougrin et al, 2018;Ougrin et al, 2014). Staying with the inpatient care theme, we publish the first evaluation of the Recovery Questionnaire for Young People (ReQuest-YP), a novel outcome measure for personal recovery in hospitalised young people (Bentley, Bucci, & Hartley, 2019).…”

Editorial: The future of crisis mental health services for children and young people

“…Take an example from another part of the crisis pathway. In the United Kingdom, which has relatively few inpatient beds per head of population compared to many other developed countries, we are still admitting young people who could be treated as well, if not better, in the community with intensive crisis intervention or home treatment (Kwok, Yuan, & Ougrin, ). For some, we admit there is evidence that we may be doing more harm than good (Dubicka et al., ; Hannigan et al., ; Ougrin et al., ).…”