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Zechmeister-Koss I, Goodyear M, Grössmann N, Wolf S. Integrating home treatment into the Austrian child and adolescent mental health care system: an implementation science perspective. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2022; 36:28-39. [PMID: 34699039 DOI: 10.1007/s40211-021-00404-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 09/22/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND In Austria, similar to other countries, health care planners have considered implementing home treatment (HT) programs for children and adolescents with mental health problems. However, introducing any new service innovation into the complex environment of the child and adolescent mental health care system requires context and implementation issues to be taken into account in advance. METHODS We identified implementation themes from international HT models and developed a questionnaire with open-ended implementation-related questions for Austrian professionals. We analysed the qualitative results alongside the domains in the Context and Implementation of Complex Interventions (CICI) framework to detect key implementation challenges for HT in Austria. RESULTS We found six implementation themes in international HT models, which formed the basis for development of the questionnaire. Within the qualitative data from ten Austrian professionals who responded to the questionnaire, we identified implementation challenges in all eight context and all four implementation domains of the CICI framework. CONCLUSIONS Key implementation challenges detected highlight the need to address the fit of HT within existing sociocultural norms and limited available human resources. Regional context-specific solutions need to be found on how to embed this new element best into the existing provider and financing structures. This calls for monitoring and evaluation alongside implementation to support decision-making.
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Affiliation(s)
- Ingrid Zechmeister-Koss
- Austrian Institute for Health Technology Assessment GmbH (AIHTA), Garnisongasse 7/20, 1090, Vienna, Austria.
| | | | - Nicole Grössmann
- Austrian Institute for Health Technology Assessment GmbH (AIHTA), Garnisongasse 7/20, 1090, Vienna, Austria
| | - Sarah Wolf
- Austrian Institute for Health Technology Assessment GmbH (AIHTA), Garnisongasse 7/20, 1090, Vienna, Austria
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Seleem MA, Amer RA. Demographic & clinical correlates of admission into a specialized psychiatric inpatient service for children and adolescents in Egypt: An observational retrospective study. J Psychiatr Ment Health Nurs 2021; 28:970-980. [PMID: 33432653 DOI: 10.1111/jpm.12730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 12/09/2020] [Accepted: 01/06/2021] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT Admitting children and adolescents in psychiatric inpatient units is a relatively new and still debatable practice in Egyptian society and in the entire Arab world. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE Egyptian young people diagnosed with complex behavioural problems, such as in other parts of the world, desperately need and do get benefit from inpatient psychiatric service. The demographic and clinical characteristics of children in need for such service are not clearly different from those reported in other parts of the world. WHAT ARE THE IMPLICATIONS FOR PRACTICE More should be done to spread awareness, remove obstacles, and develop more specialized inpatient units, with trained child psychiatrists and psychiatric nurses to provide best care for children and adolescents diagnosed with severe emotional and behavioural problems in Egypt, the Arab world and other developing countries in the world. ABSTRACT Background To our knowledge, this is the first study that aims to investigate the demographic and clinical correlates of admission into a specialized inpatient psychiatric unit for children and adolescents in Egypt and the Arab world. Methods The files of all service users who presented for care in the outpatient service for children and adolescents in Tanta University between July 2017 and December 2019 were reviewed. Of the 1,195 files reviewed, 100 patients were admitted to the inpatient unit for 133 admission episodes with an average duration of 18.5 days per episode. Results The most common diagnosis among admitted children and adolescents was disruptive behaviour disorder. Having a diagnosis of bipolar disorder, eating disorder, or trauma-related disorders powerfully predicted admission. Both physical and sexual abuse also predicted admission, readmission and longer duration of admission. Conclusions The need for admission into specialized psychiatric inpatient units for children and adolescents is comparable to that in other parts of the world. There is an urgent necessity to develop such therapeutic units across the entire Arab world with subsequent need to establish suitable training programs for mental health workers to deal with children and adolescents diagnosed with severe psychiatric disorders in inpatient setting.
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Affiliation(s)
- Mohammad A Seleem
- Faculty of Medicine, Department of Psychiatry and Neurology, Tanta University, Tanta, Egypt
| | - Reham A Amer
- Faculty of Medicine, Department of Psychiatry and Neurology, Tanta University, Tanta, Egypt
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Zechmeister-Koss I, Grössmann N, Wolf S. [Effectiveness and Safety of Home Treatment in Child and Adolescent Mental Health Care: A Systematic Literature Review]. PSYCHIATRISCHE PRAXIS 2021; 49:11-21. [PMID: 34416782 DOI: 10.1055/a-1517-6171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE In child and adolescent psychiatry, home treatment is becoming increasingly important due to limited inpatient care capacities and changing treatment philosophies. This paper examines its effectiveness and safety. METHODS We did a systematic literature search and summarized the home treatment model characteristics as well as the evidence on its benefits and harms narratively. RESULTS In the six identified studies, improvements in symptoms were found in both, home and institutionalized treatment. In the long-term, home treatment seems to be slightly superior and involves fewer hospital days. However, a best-practice model cannot be derived from the data available. CONCLUSION Home treatment can be considered as an alternative to inpatient treatment, but requires coordination with other mental health care elements and further evaluation.
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Affiliation(s)
| | - Nicole Grössmann
- Austrian Institute for Health Technology Assessment GmbH (AIHTA)
| | - Sarah Wolf
- Austrian Institute for Health Technology Assessment GmbH (AIHTA)
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Sprengeler MK, Mattheß J, Eckert M, Richter K, Koch G, Reinhold T, Vienhues P, Berghöfer A, Fricke J, Roll S, Keil T, Ludwig-Körner C, Kuchinke L, von Klitzing K, Schlensog-Schuster F. Efficacy of parent-infant psychotherapy compared to care as usual in children with regulatory disorders in clinical and outpatient settings: study protocol of a randomised controlled trial as part of the SKKIPPI project. BMC Psychiatry 2021; 21:118. [PMID: 33639894 PMCID: PMC7913440 DOI: 10.1186/s12888-021-03112-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/09/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The first years of life are a significant period for child development, when children are particularly sensitive and prone to crises. This early phase lays the foundation for healthy growth. Clinical assessment of psychological symptoms in early infancy and adequate treatment are both important in improving the diagnostic outcome and preventing later long-term developmental consequences. The most common psychological problems in the first 3 years of life are regulatory disorders. The aim of this trial is to investigate the efficacy of Parent-Infant Psychotherapy (PIP) for infants and young children (aged 0-36 months, diagnosed with at least one regulatory disorder) and their mothers, compared to care as usual (CAU). METHODS In this open multicentre randomised controlled trial, 160 mother-infant dyads are randomised to receive PIP or CAU for 6 weeks of intervention in clinical or outpatient (including home treatment) settings. The primary outcome is the maternal sensitivity (sensitivity scale of the Emotional Availability Scales (EAS)) after 6 weeks. Secondary outcomes include assessment of interaction, mental health problems, attachment, development, psychological factors, treatment adherence, health care system utilisation, and costs, after 6 weeks and 12 months. DISCUSSION This study will evaluate whether a manualised focus-based short-term psychodynamic psychotherapeutic intervention in mother-child dyads improves the care situation for families of children diagnosed with regulatory disorders, and helps prevent long-term psychopathologies. Assessment of the intervention in different settings will support the development of more tailored interventions for affected infants and their mothers. TRIAL REGISTRATION German Clinical Trial Register, ID: DRKS00017008 . Registered 03/20/2019.
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Affiliation(s)
- Mona Katharina Sprengeler
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Leipzig, Liebigstrasse 20a, 04103, Leipzig, Germany.
| | - Janna Mattheß
- International Psychoanalytic University Berlin, Berlin, Germany
| | - Melanie Eckert
- International Psychoanalytic University Berlin, Berlin, Germany
| | - Katharina Richter
- International Psychoanalytic University Berlin, Berlin, Germany
- Institute of Social Medicine, Epidemiology, and Health Economics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Gabriele Koch
- International Psychoanalytic University Berlin, Berlin, Germany
| | - Thomas Reinhold
- Institute of Social Medicine, Epidemiology, and Health Economics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Petra Vienhues
- Fachklinik für Psychiatrie, Psychosomatik und Psychotherapie, DIAKO Nordfriesland, Flensburg, Germany
| | - Anne Berghöfer
- Institute of Social Medicine, Epidemiology, and Health Economics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Julia Fricke
- Institute of Social Medicine, Epidemiology, and Health Economics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Stephanie Roll
- Institute of Social Medicine, Epidemiology, and Health Economics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Thomas Keil
- Institute of Social Medicine, Epidemiology, and Health Economics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Institute for Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
- State Institute of Health, Bavarian Health and Food Safety Authority, Bad Kissingen, Germany
| | | | - Lars Kuchinke
- Psychological Methods and Evaluation, International Psychoanalytic University Berlin, Berlin, Germany
| | - Kai von Klitzing
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Leipzig, Liebigstrasse 20a, 04103, Leipzig, Germany
| | - Franziska Schlensog-Schuster
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Leipzig, Liebigstrasse 20a, 04103, Leipzig, Germany
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Eckert M, Richter KM, Mattheß J, Koch G, Reinhold T, Vienhues P, Berghöfer A, Roll S, Keil T, Schlensog-Schuster F, von Klitzing K, Ludwig-Körner C, Kuchinke L. [Postpartum mental health problems: healthcare service situation and effectiveness of parent-infant psychotherapy. Presentation of the SKKIPPI project funded by the German Innovationsfonds]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:1538-1547. [PMID: 33146761 DOI: 10.1007/s00103-020-03242-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 10/13/2020] [Indexed: 01/30/2023]
Abstract
After the birth of a child, parents may experience episodes of stress and psychological strain. Some infants show psychological or somatic stress in the form of early regulatory disorders. While the close connection between parental psychological stress, early regulatory disorders, and the development of the parent-child relationship is well documented, current data on effective treatment options are lacking. Previous care services mostly operate on a preventive basis; evidence-based psychotherapeutic services with a special focus on the parent-child relationship are rare.SKKIPPI is a multicenter research project (Berlin, Flensburg, Hamburg, Leipzig) and consists of several study parts with a mixed methods approach: an epidemiological cohort study, two randomized controlled intervention studies (RCTs), and a qualitative study. A population-based cohort study records the occurrence and determinants of psychosocial stress and mental health disorders, as well as the use of health and social services by parents and their children within the first two years of life, using online questionnaires and telephone interviews. The aim of the two RCTs is to evaluate the efficacy of a focused, dyadic parent-infant psychotherapy (Eltern-Säugling-Kleinkind-Psychotherapie, ESKP) compared to routine treatment in inpatient and outpatient settings. The focus of these RCTs is on the improvement of maternal sensitivity and on mother-child attachment, as well as child development and the reduction of mother-child psychopathological symptoms. The qualitative study intends to reconstruct the perspectives of parents on the assistance system and to explore reasons for underuse. The results are expected to help develop preventive as well as therapeutic strategies in the German health system.
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Affiliation(s)
- Melanie Eckert
- Psychosoziale Intervention, International Psychoanalytic University, Berlin, Deutschland
| | - Katharina M Richter
- Psychosoziale Intervention, International Psychoanalytic University, Berlin, Deutschland
- Fachklinik für Psychiatrie, Psychosomatik und Psychotherapie, DIAKO Nordfriesland, Flensburg, Deutschland
| | - Janna Mattheß
- Psychosoziale Intervention, International Psychoanalytic University, Berlin, Deutschland
| | - Gabriele Koch
- Psychosoziale Intervention, International Psychoanalytic University, Berlin, Deutschland
| | - Thomas Reinhold
- Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Petra Vienhues
- Fachklinik für Psychiatrie, Psychosomatik und Psychotherapie, DIAKO Nordfriesland, Flensburg, Deutschland
| | - Anne Berghöfer
- Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Stephanie Roll
- Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Thomas Keil
- Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
- Institut für Klinische Epidemiologie und Biometrie, Universität Würzburg, Würzburg, Deutschland
- Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Bad Kissingen, Deutschland
| | - Franziska Schlensog-Schuster
- Klinik und Poliklinik für Psychiatrie, Psychotherapie und Psychosomatik des Kindes- und Jugendalters, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Kai von Klitzing
- Klinik und Poliklinik für Psychiatrie, Psychotherapie und Psychosomatik des Kindes- und Jugendalters, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | | | - Lars Kuchinke
- Methodenlehre und Evaluation, International Psychoanalytic University, Stromstr 3b, 10555, Berlin, Deutschland.
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Böge I, DeKeijzer D, Fegert JM, Schulze U. Schnittstellenkoordination von systemübergreifenden Hilfen für Kinder und Jugendliche mit psychischen Beeinträchtigungen. KINDHEIT UND ENTWICKLUNG 2020. [DOI: 10.1026/0942-5403/a000311] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Schnittstellen zwischen psychosozialen Hilfesystemen stellen Sollbruchstellen einer gelingenden systemübergreifenden Behandlung psychisch erkrankter Kinder/Jugendlicher dar. Daten zu Schnittstellenmanagement in Deutschland liegen bisher nicht vor. Ziel der Studie ASpeKT war es, zu vier Zeitpunkten (T1 Aufnahme, T2 Entlassung, T3 6 Mo und T4 12 Mo nach Entlassung) den Ist-Stand von installierten Hilfen bei psychisch erkrankten Kindern und Jugendlichen ( n=191) zu erheben, Patientenzufriedenheit zu evaluieren sowie dies an zwei, strukturell unterschiedlichen Standorten (Klinik A/Klinik B) zu vergleichen. Zu T2 erhielten 13 % der Patienten keine Hilfen. 43,6 % (A) bzw. 70,4 % (B) erhielten Psychotherapie (PT), 67,3 % (A) bzw. 80,3 % (B) Jugendhilfemaßnahmen (JH), 37,6 % (A) bzw. 16.9 % (B) schulische Unterstützung. Gute Schnittstellenkoordination ist prognostisch essentiell, um den meist noch komplexen Hilfebedarf psychisch erkrankter Kinder/Jugendlicher nach stationärer Behandlung abzubilden.
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Affiliation(s)
- Isabel Böge
- ZfP Südwürttemberg, Abteilung für Psychiatrie und Psychotherapie des Kindes- und Jugendalters, Weissenau
- Universität Ulm, Klinik für Kinder und Jugendpsychiatrie/Psychotherapie, Ulm
| | - Deborah DeKeijzer
- ZfP Calw, Klinik für Kinder- & Jugendpsychiatrie & -Psychotherapie, Böblingen
| | - Jörg M. Fegert
- Universität Ulm, Klinik für Kinder und Jugendpsychiatrie/Psychotherapie, Ulm
| | - Ulrike Schulze
- Universität Ulm, Klinik für Kinder und Jugendpsychiatrie/Psychotherapie, Ulm
- ZfP Calw, Klinik für Kinder- & Jugendpsychiatrie & -Psychotherapie, Böblingen
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Mattheß J, Eckert M, Richter K, Koch G, Reinhold T, Vienhues P, Berghöfer A, Roll S, Keil T, Schlensog-Schuster F, von Klitzing K, Ludwig-Körner C, Kuchinke L. Efficacy of Parent-Infant-Psychotherapy with mothers with postpartum mental disorder: study protocol of the randomized controlled trial as part of the SKKIPPI project. Trials 2020; 21:490. [PMID: 32503611 PMCID: PMC7275538 DOI: 10.1186/s13063-020-04443-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/23/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND After the birth of a child, many mothers and fathers experience postpartum mental disorders like depression, anxiety, obsessive-compulsive disorder, stress or other illnesses. This endangers the establishment of a secure attachment between the children and their primary caregivers. Early problems in parent-child interaction can have adverse long-term effects on the family and the child's well-being. In order to prevent a transgenerational transmission of mental disorders, it is necessary to evaluate psychotherapeutic interventions that target psychologically burdened parents of infants or toddlers. The aim of this trial is to investigate the efficacy of Parent-Infant-Psychotherapy (PIP) for mothers with postpartum mental disorder and their infants (0-12 months). METHODS/DESIGN In this open, randomized controlled intervention trial 180 mother-infant-dyads will be included and randomly allocated to 12 sessions of PIP or care as usual. The interventions take place either in inpatient adult psychiatric departments or in outpatient settings with home visits. The primary outcome is the change in maternal sensitivity assessed by the Sensitivity subscale of the Emotional Availability Scale (EAS) through videotaped dyadic play-interactions after 6 weeks. Secondary outcomes are maternal psychopathology, stress, parental reflective functioning, infant development and attachment after 6 weeks and 12 months. In addition, maternal attachment (AAI) and reflective functioning (AAI) will be analyzed as potential moderators, and resource usage in the German health system as well as associated costs will be evaluated. DISCUSSION There is increasing demand for well-controlled studies on psychotherapeutic interventions in the postpartum period that do not only focus on particular risk groups. This randomized controlled trial (RCT) represents one of the first studies to investigate the efficacy of PIP in inpatient psychiatric departments and outpatient care centers in Germany. The results will fill knowledge gaps on the factors contributing to symptom reduction in postpartum mental disorders and improvements in mother-child relationships and help in developing preventive and therapeutic strategies for the fragmented German health care system. TRIAL REGISTRATION German Register for Clinical Trials, ID: DRKS00016353.
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Affiliation(s)
- J Mattheß
- International Psychoanalytic University, Stromstr. 3b, 10555, Berlin, Germany.
| | - M Eckert
- International Psychoanalytic University, Stromstr. 3b, 10555, Berlin, Germany
| | - K Richter
- Department of Psychiatry, Psychosomatics and Psychotherapy, Diakonissenkrankenhaus Flensburg, Flensburg, Germany
| | - G Koch
- International Psychoanalytic University, Stromstr. 3b, 10555, Berlin, Germany
| | - T Reinhold
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin, Berlin, Germany
| | - P Vienhues
- Department of Psychiatry, Psychosomatics and Psychotherapy, Diakonissenkrankenhaus Flensburg, Flensburg, Germany
| | - A Berghöfer
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin, Berlin, Germany
| | - S Roll
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin, Berlin, Germany
| | - T Keil
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin, Berlin, Germany
- Institute of Clinical Epidemiology and Biometry, University of Wuerzburg, Wuerzburg, Germany
- State Institute of Health, Bavarian Health and Food Safety Authority, Bad Kissingen, Germany
| | - F Schlensog-Schuster
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Leipzig, Leipzig, Germany
| | - K von Klitzing
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Leipzig, Leipzig, Germany
| | - C Ludwig-Körner
- Department of Psychiatry, Psychosomatics and Psychotherapy, Diakonissenkrankenhaus Flensburg, Flensburg, Germany
| | - L Kuchinke
- Department of Psychiatry, Psychosomatics and Psychotherapy, Diakonissenkrankenhaus Flensburg, Flensburg, Germany
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