The Effectiveness of a Community Intensive Therapy Team on Young People’s Mental Health Outcomes

Abstract

Background: UK‐wide concerns about availability, cost, efficacy and inappropriate use of psychiatric inpatient provision for adolescents have led to the development of new models of intensive community based care. Method: This paper describes the Fife Intensive Therapy Team (FITT) model and provides an analysis of HoNOSCA (Health of the Nation Outcomes Scale for Children and Adolescents) data for 57 patients to evaluate the effectiveness of the service. Results: Following intervention by the FITT, a substantial and significant reduction in HoNOSCA scores was recorded. Conclusions: The apparent success of the model has implications for the future development of acute mental health services for young people.

A CAMHS Intensive Treatment Service: Clinical outcomes in the first year

“…When service users who were admitted to the IPU during ITS involvement were excluded, the mean CGAS rating of 44.28 is still within reported IPU admission ranges (Green et al, 2000; mean CGAS: 44.0). The mean HoNOSCA Clinical Score at admission (22.94) is comparable with that reported by another Scottish ITS (Simpson et al, 2010; mean: 19.12). Self-report measures indicate significant difficulties across range of clinical areas at the point of admission.…”

“…HoNOSCA and CGAS change was associated with initial case severity, a finding which has been replicated in other studies (Garralda et al, 2000; Simpson et al, 2010). Finally, although length of intervention was not significantly correlated with changes in HoNOSCA or CGAS, number of appointments offered was, where more ITS appointments was associated with greater clinical and functional improvements, highlighting the importance of intensive community treatment as a component of overall CAMHS care.…”

“…This is greater than HoNOSCA change found following community outpatient treatment, where a 3.61 point decrease was noted at 6 months (Garralda et al, 2000) and is roughly equivalent to change following an average inpatient admission (mean HoNOSCA Clinical Score change: 5.76; Green et al, 2001). These results cannot be attributed wholly to ITS intervention; however, a similar CAMHS ITS reported mean HoNOSCA Clinical Score changes of 10.95, from an average of 19.12 at admission to 8.17 at discharge (Simpson et al, 2010), although median length of intervention appeared to be longer at 20 weeks in comparison with the CAMHS ITS described here.…”

“…Statistical analysis of admission and discharge data are reported in Table 2 where, following a Shapiro–Wilk test, parametric Paired Sample t -tests or non parametric Wilcoxon Signed Ranks tests were used. Mean HoNOSCA Clinical Scores decreased by an average of 6.94 points following intervention ( Z =-4.725, p< 0.001) and 65% of young people ( n =32) showed a clinically relevant change of four or more points (Sharma, Wilkinson, & Fear, 1999; Simpson, Cowie, Wilkinson, Lock, & Monteith, 2010). Mean CGAS scores increased by an average of 16.42 points, indicating significant improvements in service users functioning following intervention ( Z =-5.521, p <0.001) and clinical improvements from ‘obvious’ to ‘some noticeable problems’ (Shaffer et al, 1983).…”

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

“…Two other reported psychiatric community services in the UK are the Community Intensive Therapy Team in South Wales (Darwish, Salmon, Ahuja, & Steed, ) and the Fife Intensive Therapy team (Simpson, Cowie, Wilkinson, & Lock, ). However, these are examples of intensive psychiatric support in the community in areas with less inpatient psychiatric services for young people (step‐up care) and thus differ from this current study in goals and the clinical population served.…”