1
|
Eapen V, Gerstl B, Ahinkorah BO, John JR, Hawker P, Nguyen TP, Brice F, Winata T, Bowden M. Evidence-based brief interventions targeting acute mental health presentations for children and adolescents: systematic review. BJPsych Open 2024; 10:e78. [PMID: 38602192 PMCID: PMC11060074 DOI: 10.1192/bjo.2024.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 01/29/2024] [Accepted: 02/04/2024] [Indexed: 04/12/2024] Open
Abstract
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.
Collapse
Affiliation(s)
- Valsamma Eapen
- Academic Unit of Infant, Child, and Adolescent Psychiatry Services (AUCS), South Western Sydney Local Health District and Ingham Institute, Australia; and Discipline of Psychiatry and Mental Health, University of New South Wales, Australia
| | - Brigitte Gerstl
- Academic Unit of Infant, Child, and Adolescent Psychiatry Services (AUCS), South Western Sydney Local Health District and Ingham Institute, Australia; and Discipline of Psychiatry and Mental Health, University of New South Wales, Australia
| | - Bright Opoku Ahinkorah
- Academic Unit of Infant, Child, and Adolescent Psychiatry Services (AUCS), South Western Sydney Local Health District and Ingham Institute, Australia; Discipline of Psychiatry and Mental Health, University of New South Wales, Australia; and School of Public Health, University of Technology Sydney, Australia
| | - James Rufus John
- Academic Unit of Infant, Child, and Adolescent Psychiatry Services (AUCS), South Western Sydney Local Health District and Ingham Institute, Australia; and Discipline of Psychiatry and Mental Health, University of New South Wales, Australia
| | - Patrick Hawker
- Discipline of Psychiatry and Mental Health, University of New South Wales, Australia
| | - Thomas P. Nguyen
- Academic Unit of Infant, Child, and Adolescent Psychiatry Services (AUCS), South Western Sydney Local Health District and Ingham Institute, Australia; Discipline of Psychiatry and Mental Health, University of New South Wales, Australia; and Mental Health Team, School of Medicine, Western Sydney University, Australia
| | - Febe Brice
- Academic Unit of Infant, Child, and Adolescent Psychiatry Services (AUCS), South Western Sydney Local Health District and Ingham Institute, Australia
| | - Teresa Winata
- Academic Unit of Infant, Child, and Adolescent Psychiatry Services (AUCS), South Western Sydney Local Health District and Ingham Institute, Australia; Discipline of Psychiatry and Mental Health, University of New South Wales, Australia; and Infant, Child and Adolescent Mental Health Service (ICAMHS), South Western Sydney Local Health District, Australia
| | - Michael Bowden
- Child and Youth Mental Health, New South Wales Ministry of Health, Australia; Sydney Medical School, University of Sydney, Australia; and Department of Psychological Medicine, Sydney Children's Hospitals Network, Australia
| |
Collapse
|
2
|
Otis M, Barber S, Amet M, Nicholls D. Models of integrated care for young people experiencing medical emergencies related to mental illness: a realist systematic review. Eur Child Adolesc Psychiatry 2023; 32:2439-2452. [PMID: 36151355 PMCID: PMC9510153 DOI: 10.1007/s00787-022-02085-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 09/10/2022] [Indexed: 11/30/2022]
Abstract
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.
Collapse
Affiliation(s)
- Michaela Otis
- Imperial College London, South Kensington, London, SW7 2BX UK
- NIHR Applied Research Collaboration (ARC) Northwest London, London, UK
- Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Susan Barber
- Imperial College London, South Kensington, London, SW7 2BX UK
- NIHR Applied Research Collaboration (ARC) Northwest London, London, UK
- Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Mona Amet
- Imperial College London, South Kensington, London, SW7 2BX UK
| | - Dasha Nicholls
- Imperial College London, South Kensington, London, SW7 2BX UK
- NIHR Applied Research Collaboration (ARC) Northwest London, London, UK
- Chelsea and Westminster NHS Foundation Trust, London, UK
| |
Collapse
|
3
|
Anderson KE, Han SC, Kavlich SG, Brown S, Ho J, Everhart SA. Adaptation of family-based treatment within an inpatient medical stabilization program for children with eating disorders. Int J Eat Disord 2023; 56:1511-1519. [PMID: 37129459 DOI: 10.1002/eat.23979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 04/21/2023] [Accepted: 04/22/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVE Eating disorders are serious psychiatric conditions predominantly affecting children, adolescents, and young adults. While family-based treatment (FBT) is the gold standard outpatient treatment approach for adolescents with restrictive eating disorders, there is not a universally recognized best practice within higher levels of care. There is a particular dearth of literature detailing recommended psychological and behavioral interventions in the inpatient medical setting. METHOD The present article provides an account of how FBT principles have been incorporated in Children's Hospital of Orange County at Mission's inpatient medical stabilization program for children and adolescents with restrictive eating disorders. Practical examples illustrate how key FBT tenets are successfully translated into the inpatient multidisciplinary setting. RESULTS The use of FBT can encourage a unified approach among medical and psychosocial providers and serves to destigmatize patients with eating disorders and associated behaviors. The successes and challenges of FBT implementation are discussed. DISCUSSION Though anecdotal evidence and preliminary findings support positive outcomes from the implementation of FBT within a pediatric medical stabilization program for patients, families, and staff, research is needed to understand best practices within higher levels of care. Additional research efforts will also help elucidate whether adapted FBT can become a standard of care for patients with restrictive eating disorders in inpatient settings. PUBLIC SIGNIFICANCE This article describes how a children's hospital has adopted family-based treatment (FBT) for youth who are hospitalized due to an eating disorder. FBT is the most efficacious treatment for youth with eating disorders. This article describes specific examples of how FBT can be implemented within a medical setting. This article will support a greater understanding of FBT principles and guide providers to translate FBT into higher level of care settings.
Collapse
Affiliation(s)
| | - Sohyun C Han
- Children's Hospital of Orange County, Mission Viejo, California, USA
| | - Sarah G Kavlich
- Children's Hospital of Orange County, Mission Viejo, California, USA
| | - Shonda Brown
- Children's Hospital of Orange County, Mission Viejo, California, USA
| | - Jennifer Ho
- Children's Hospital of Orange County, Mission Viejo, California, USA
| | | |
Collapse
|
4
|
Li LP, Rao DF, Chen XX, Qi XY, Chen XX, Wang XQ, Li J. The impact of hospital-family integrated continuation nursing based on information technology on patients unhealthy mood, family function and sexual function after cervical cancer surgery. Medicine (Baltimore) 2023; 102:e33504. [PMID: 37083787 PMCID: PMC10118314 DOI: 10.1097/md.0000000000033504] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/21/2023] [Indexed: 04/22/2023] Open
Abstract
The objective of this study was to explore the impact on hospital-family integrated continuation care based on information technology on the negative emotions, family function, and sexual function of patients after cervical cancer surgery. The clinical case data onto 114 postoperative cervical cancer patients who were nursing in our hospital from July 2019 to July 2021 were selected and were divided into a control group and an observation group. The control group used routine nursing care, and on this basis, the observation group used information technology as the basis for hospital-family integrated continuation care, and we observed and compared the differences in the 2 groups of patients bad mood, family function, and sexual function. The score of anxiety (P = .017), depression (P = .009), fatigue rating (P = .012), and anger (P < .001) in the observation group after care were significantly lower than those in the control group. Problem solving, role, emotional response, emotional involvement, and family function total score in the observation group after care was significantly lower than those in the control group (P < .05). Sexual desire score, sexual arousal score, vaginal lubrication score, orgasm score, sexual satisfaction score, dyspareunia score, and Female Sexual Function Inventory total scores in the observation and control groups after care were significantly higher than those before care (P < .05). The sexual function scores in the observation group after care was significantly higher than those in the control group (P < .05). The hospital-family integrated continuation care based on information technology is more effective than conventional nursing care for patients after cervical cancer surgery.
Collapse
Affiliation(s)
- Li-Ping Li
- Department of Gynaecology, Wuhan NO.1 Hospital, Wuhan, Hubei, China
| | - Dan-Feng Rao
- Department of Gynaecology, Wuhan NO.1 Hospital, Wuhan, Hubei, China
| | - Xiang-Xiang Chen
- Department of Gynaecology, Wuhan NO.1 Hospital, Wuhan, Hubei, China
| | - Xiu-Yun Qi
- Department of Rehabilitation Medicine, Wuhan NO.4 Hospital, Wuhan, Hubei, China
| | - Xiao-Xue Chen
- Department of Gynaecology, Wuhan NO.1 Hospital, Wuhan, Hubei, China
| | - Xiao-Qing Wang
- Department of Gynaecology, Wuhan NO.1 Hospital, Wuhan, Hubei, China
| | - Jing Li
- Department of Gynaecology, Taikang Tongji (Wuhan) Hospital, Wuhan, Hubei, China
| |
Collapse
|
5
|
Berry KR, Gliske K, Schmidt C, Ballard J, Killian M, Fenkel C. The Impact of Family Therapy Participation on Youth and Young Adult Engagement and Retention in a Telehealth Intensive Outpatient Program: Quality Improvement Analysis (Preprint). JMIR Form Res 2022; 7:e45305. [PMID: 37079372 PMCID: PMC10160927 DOI: 10.2196/45305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/17/2023] [Accepted: 03/27/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Early treatment dropout among youths and young adults (28%-75%) puts them at risk for poorer outcomes. Family engagement in treatment is linked to lower dropout and better attendance in outpatient, in-person treatment. However, this has not been studied in intensive or telehealth settings. OBJECTIVE We aimed to examine whether family members' participation in telehealth intensive outpatient (IOP) therapy for mental health disorders in youths and young adults is associated with patient's treatment engagement. A secondary aim was to assess demographic factors associated with family engagement in treatment. METHODS Data were collected from intake surveys, discharge outcome surveys, and administrative data for patients who attended a remote IOP for youths and young adults, nationwide. Data included 1487 patients who completed both intake and discharge surveys and either completed or disengaged from treatment between December 2020 and September 2022. Descriptive statistics were used to characterize the sample's baseline differences in demographics, engagement, and participation in family therapy. Mann-Whitney U and chi-square tests were used to explore differences in engagement and treatment completion between patients with and those without family therapy. Binomial regression was used to explore significant demographic predictors of family therapy participation and treatment completion. RESULTS Patients with family therapy had significantly better engagement and treatment completion outcomes than clients with no family therapy. Youths and young adults with ≥1 family therapy session were significantly more likely to stay in treatment an average of 2 weeks longer (median 11 weeks vs 9 weeks) and to attend a higher percentage of IOP sessions (median 84.38% vs 75.00%). Patients with family therapy were more likely to complete treatment than clients with no family therapy (608/731, 83.2% vs 445/752, 59.2%; P<.001). Different demographic variables were associated with an increased likelihood of participating in family therapy, including younger age (odds ratio 1.3) and identifying as heterosexual (odds ratio 1.4). After controlling for demographic factors, family therapy remained a significant predictor of treatment completion, such that each family therapy session attended was associated with a 1.4-fold increase in the odds of completing treatment (95% CI 1.3-1.4). CONCLUSIONS Youths and young adults whose families participate in any family therapy have lower dropout, greater length of stay, and higher treatment completion than those whose families do not participate in services in a remote IOP program. The findings of this quality improvement analysis are the first to establish a relationship between participation in family therapy and an increased engagement and retention in remote treatment for youths and young patients in IOP programing. Given the established importance of obtaining an adequate dosage of treatment, bolstering family therapy offerings is another tool that could contribute to the provision of care that better meets the needs of youths, young adults, and their families.
Collapse
Affiliation(s)
| | - Kate Gliske
- Charlie Health, Inc, Bozeman, MT, United States
| | | | - Jaime Ballard
- University of Minnesota, St. Paul, MN, United States
| | - Michael Killian
- College of Social Work, Florida State University, Tallahassee, FL, United States
| | | |
Collapse
|
6
|
Balkchyan AA, Nakamura T, Murray SB. Updates in the treatment of eating disorders in 2021: a year in review in Eating Disorders: The Journal of Treatment & Prevention. Eat Disord 2022; 30:144-153. [PMID: 35442858 DOI: 10.1080/10640266.2022.2064109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
An array of novel and important studies advancing the treatment of eating disorders (EDs) were published in Eating Disorders: The Journal of Treatment & Prevention in 2021. In an unprecedented year of challenges to the delivery of ED treatment, and the volume of patients requiring it, this review summarizes the recent contributions to the literature on the treatment of EDs. Notably, an emphasis on assessing and addressing barriers to collaborative care offers much promise in augmenting treatment delivery and patient outcomes. In keeping with recent data illustrating an elevated risk for increased symptom severity during the COVID-19 pandemic, a focus on further disseminating treatments to higher level of care settings will be critical as the field meets the challenge presented by COVID-19. In addition, we review recent findings relating to the broader assessment and treatment of comorbidities which exacerbate ED symptom severity-which offer critical insights into the development of novel treatments. These recent contributions pave the way for more nuanced approaches to treating EDs across the diagnostic spectrum.
Collapse
Affiliation(s)
- Ane A Balkchyan
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, California, USA
| | - Tiffany Nakamura
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, California, USA
| | - Stuart B Murray
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, California, USA
| |
Collapse
|
7
|
Forsberg S, Gorrell S, Accurso EC, Trainor C, Garber A, Buckelew S, Le Grange D. Family-based treatment for pediatric eating disorders: Evidence and guidance for delivering integrated interdisciplinary care. CHILDRENS HEALTH CARE 2021; 52:7-22. [PMID: 36619528 PMCID: PMC9817879 DOI: 10.1080/02739615.2021.1984240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Eating disorders (EDs) are complex psychiatric diagnoses requiring specialized care. Family-based treatment (FBT) is the first-line treatment for adolescent anorexia nervosa and is also efficacious for other EDs. This study describes practice changes due to the implementation of an integrated interdisciplinary FBT-aligned treatment program for EDs at a large tertiary care hospital in the United States. We examined the feasibility and acceptability of implementation, barriers to implementation, and impact on providers' roles over a one-year period. Practice changes came with shifts in roles, and were largely experienced as acceptable with good suitability. Barriers identified may inform future interdisciplinary implementation efforts.
Collapse
Affiliation(s)
- Sarah Forsberg
- Department of Psychiatry and Behavioral Sciences, UCSF
Weill Institute for Neurosciences, University of California, San Francisco, San
Francisco, CA, USA
| | - Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, UCSF
Weill Institute for Neurosciences, University of California, San Francisco, San
Francisco, CA, USA
| | - Erin C. Accurso
- Department of Psychiatry and Behavioral Sciences, UCSF
Weill Institute for Neurosciences, University of California, San Francisco, San
Francisco, CA, USA
| | - Claire Trainor
- Department of Psychology, Drexel University, Philadelphia,
PA, USA
- Center for Weight Eating and Lifestyle Science (WELL
Center), Drexel University, Philadelphia, PA, USA
| | - Andrea Garber
- Department of Pediatrics, Division of Adolescent Medicine,
University of California, San Francisco, San Francisco, CA, USA
| | - Sara Buckelew
- Department of Pediatrics, Division of Adolescent Medicine,
University of California, San Francisco, San Francisco, CA, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, UCSF
Weill Institute for Neurosciences, University of California, San Francisco, San
Francisco, CA, USA
- Department of Psychiatry & Behavioral Neuroscience, The
University of Chicago, Chicago, IL, USA (Emeritus)
| |
Collapse
|
8
|
Accurso EC, Mu KJ, Landsverk J, Guydish J. Adaptation to family-based treatment for Medicaid-insured youth with anorexia nervosa in publicly-funded settings: Protocol for a mixed methods implementation scale-out pilot study. J Eat Disord 2021; 9:99. [PMID: 34389052 PMCID: PMC8360814 DOI: 10.1186/s40337-021-00454-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/04/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Family-based treatment (FBT) for anorexia nervosa is an evidence-based treatment, but its effectiveness is untested among socioeconomically disadvantaged and racially diverse youth. Adapting FBT may facilitate "scale-out" for Medicaid-insured youth served in publicly-funded settings and potentially improve outcomes for more diverse populations. METHODS This mixed methods effectiveness-implementation Hybrid Type 3 pilot study protocol included a planning period in collaboration with the San Francisco Department of Public Health, culminating in a two-day in-person FBT training for 25 therapists in the county, followed by the opportunity to engage in one year of weekly supervision. The training incorporated FBT adaptations intended to improve fit for low-income families within community-based settings. Treatment appropriateness and acceptability will be measured immediately post-training. Following the training, cases referred for FBT will only be assigned to the trained clinicians who voluntarily opted into long-term group supervision. Clinicians treating at least one FBT case during the supervision period will report on implementation, adaptations, and patient weight gain. Finally, semi-structured interviews with clinician participants will be conducted, focused on implementation challenges and facilitators, local treatment adaptations, and overall satisfaction with FBT. DISCUSSION Learning about clinician adaptations will advance knowledge about treatment of eating disorders in publicly-funded community clinics, which serve a racially/ethnically and socioeconomically diverse group of youth. This project is designed to accelerate FBT implementation in publicly-funded mental health systems, and inform service improvements for underserved youth with eating disorders.
Collapse
Affiliation(s)
- Erin C Accurso
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA.
| | - Karen J Mu
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA.,San Francisco Department of Public, Health Behavioral Health Services, San Francisco, CA, USA
| | | | - Joseph Guydish
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| |
Collapse
|
9
|
Herpertz-Dahlmann B. Intensive Treatments in Adolescent Anorexia Nervosa. Nutrients 2021; 13:1265. [PMID: 33924294 PMCID: PMC8068891 DOI: 10.3390/nu13041265] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/30/2021] [Accepted: 04/04/2021] [Indexed: 12/26/2022] Open
Abstract
Approximately one-fifth to one-third of patients with adolescent anorexia nervosa (AN) need intensive care in the course of their illness. This article provides an update and discussion on different levels of intensive care (inpatient treatment (IP), day patient treatment (DP) and home treatment (HoT)) in different health care systems based on recently published literature. Important issues discussed in this article are new recommendations for the refeeding process and the definition of target weight as well as principles of medical stabilization and psychotherapeutic approaches. The pros and cons of longer or shorter hospitalization times are discussed, and the advantages of stepped care and day patient treatment are described. A new promising intensive treatment method involving the patient, their caregivers and the direct home environment is introduced. Parents and caregivers should be included in treatment research to foster collaborative work with the attending clinicians. There is an urgent need to evaluate the mid- to long-term outcomes of various intensive treatment programs to compare their effectiveness and costs across different health care systems. This could help policy makers and other stakeholders, such as public and private insurances, to enhance the quality of eating disorder care.
Collapse
Affiliation(s)
- Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, RWTH, Neuenhofer Weg 21, D-52074 Aachen, Germany
| |
Collapse
|
10
|
Baudinet J, Simic M. Adolescent Eating Disorder Day Programme Treatment Models and Outcomes: A Systematic Scoping Review. Front Psychiatry 2021; 12:652604. [PMID: 33995149 PMCID: PMC8116630 DOI: 10.3389/fpsyt.2021.652604] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/29/2021] [Indexed: 12/14/2022] Open
Abstract
Background: Adolescent eating disorder day programmes (DP), or partial hospitalization programs, are becoming increasingly widespread worldwide. They typically function as an alternative to inpatient care and/or a step up or down in treatment intensity. There has been an increase in the number of publications within the last 5 years investigating DP outcomes. While there are now numerous programmes operating internationally, there is large variability in the content, structure and theoretical underpinnings of each programme. This makes it difficult to compare programme outcomes, and the impact the therapeutic model may have. Aims: To review existing literature on adolescent eating disorder DP treatment models and outcomes. Methods: A systematic scoping review was conducted. Four databases (PsychInfo, EMBASE, Medline, CENTRAL) were searched for relevant peer-reviewed journal articles and book chapters investigating adolescent eating disorder DPs that function as alternatives to inpatient treatment. No restrictions on study methodology were imposed. Studies were first mapped by location, study characteristics and day programme treatment characteristics, then narratively synthesized. Results: Forty nine studies were included in this review. All used a quantitative methodology. One study also included qualitative methods. The majority of studies included describe DPs in the USA (69%). Seventy-six percent of the studies described DPs that operate 5-days per week and most (57%) either only admit or only report on outcomes for restrictive eating disorders. Two-thirds (69%) reported on DPs that had a family focused treatment model, the remainder had a more integrated treatment model informed mostly by individual psychotherapeutic models. Generally, DP treatment is associated with weight gain and improvements in eating disorder and comorbid psychopathology. The studies that include follow-up data (27%) reveal improvements are usually maintained from 3 months to 2 years post-treatment. Early weight gain, early psychological change and early therapeutic alliance are associated with improved end of treatment outcomes. Findings regarding other potential predictors of outcome are mixed. Conclusions: Current evidence suggests day programmes are an effective alternative to inpatient treatment that lead to sustained improvements. DPs tend to either be young-person-only with a family-focused treatment model or all age with a more integrative model. Controlled, empirical investigations into the impact of the therapeutic model on outcomes are needed, as are investigations into treatment mechanisms and the individual and parent experience of day programme treatment.
Collapse
Affiliation(s)
- Julian Baudinet
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, London, United Kingdom.,Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), London, United Kingdom
| | - Mima Simic
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, London, United Kingdom
| |
Collapse
|