Adolescent residential treatment: a one to three year follow-up

A systematic review of mental health outcome measures for young people aged 12 to 25 years

BACKGROUND

Mental health outcome measures are used to monitor the quality and effectiveness of mental health services. There is also a growing expectation for implementation of routine measurement and measures being used by clinicians as a feedback monitoring system to improve client outcomes. The recent focus in Australia and elsewhere targeting mental health services to young people aged 12-25 years has meant that outcome measures relevant to this age range are now needed. This is a shift from the traditional divide of child and adolescent services versus adult services with a transitioning age at 18 years. This systematic review is the first to examine mental health outcome measures that are appropriate for the 12 to 25 year age range.

METHODS

MEDLINE and PsychINFO databases were systematically searched to identify studies using mental health outcome measures with young people aged 12 to 25 years. The search strategy complied with the relevant sections of the PRISMA statement.

RESULTS

A total of 184 published articles were identified, covering 29 different outcome measures. The measures were organised into domains that consisted of eight measures of cognition and emotion, nine functioning measures, six quality of life measures, and six multidimensional mental health measures. No measures were designed specifically for young people aged 12 to 25 years and only two had been used by clinicians as a feedback monitoring system. Five measures had been used across the whole 12 to 25 year age range, in a range of mental health settings and were deemed most appropriate for this age group.

CONCLUSIONS

With changes to mental health service systems that increasingly focus on early intervention in adolescence and young adulthood, there is a need for outcome measures designed specifically for those aged 12 to 25 years. In particular, multidimensional measures that are clinically meaningful need to be developed to ensure quality and effectiveness in youth mental health. Additionally, outcome measures can be clinically useful when designed to be used within routine feedback monitoring systems.

Alternatives to admission for children and adolescents: providing intensive mental healthcare services at home and in communities: what works?

PURPOSE OF REVIEW

To review the evidence on alternatives to inpatient mental healthcare for children and adolescents requiring intensive treatment for severe and complex mental health problems.

RECENT FINDINGS

Systematic reviews of intensive case management in adult mental healthcare conclude that intensive treatment models such as assertive community treatment and crisis resolution teams improve patient satisfaction and reduce hospital use in some circumstances. The relatively few studies on children suggest that intensive community-based services can be as effective as inpatient care for certain groups. However, the mental health needs of the young people involved in the studies, their social and family circumstances and the context of local mental health provision varied greatly.

SUMMARY

There is little high-quality research into the effectiveness of alternatives to inpatient care for young people requiring intensive treatment for complex, severe mental health problems. Studies support the use of alternatives to inpatient admission for particular groups of young people and suggest a need for a combination of complementary models of specialist intensive provision. There is insufficient evidence on which to base decisions on which model is best for which group of young people and randomized control studies are urgently needed.

Global assessment of psychosocial functioning in child and adolescent psychiatry. A review of three unidimensional scales (CGAS, GAF, GAPD)

Global assessment of functioning represents an important aspect of assessment in clinical practice and research. It can help identify persons in need of psychiatric treatment, have predictive value and measure change over time, including treatment effects. This review examines publications concerning development, psychometric properties and usefulness of three scales for children: Axis-VI in ICD-10 Global Assessment of Psychosocial Disability (GAPD), Children's Global Assessment Scale (CGAS) and Axis-V in DSM-IV Global Assessment of Functioning Scale (GAF). It is based on literature searches in PubMed and PsycInfo (1977-2003), and screening of Scandinavian and English textbooks on child psychiatry. The three scales differ in theoretical guidelines, descriptions of codes/anchor points and psychometric aspects. CGAS has been evaluated in 69 papers and 33 have been published on GAF used for children. The one paper comparing GAPD and CGAS found both scales sufficiently reliable for clinical practice. Reliability of CGAS and GAF has been found to vary from fair to substantial, depending on raters, training and diagnostic groups. International consensus for the use of one scale for global assessment of functioning for children 4-18 years would improve reliability in clinical practice and ease comparisons of studies across countries. A training programme would assist in this.

[Value of telephone interview for quality assurance and therapy evaluation in child and adolescent psychiatry. Review of the literature and empirical results of participation quota and possible sampling bias]

OBJECTIVE

The incurred costs of telephone interviews are lower than those of other methods. Thus the question arises whether this method affords the necessary quality for therapy evaluation in child and adolescent psychiatry and psychopathology. A review of the literature shows higher rates of participation for telephone and personal interviews as opposed to those for questionnaires sent by mail. Results of investigations within the social sciences are inconsistent with regard to the quality of the data collected in telephone interviews. The few results available from samples from psychiatry permit no clear-cut conclusions as to the quality of such data.

METHOD

The results of two follow-up studies of former inpatients of a hospital for child and adolescent psychiatry are presented with regard to the rate of participation and the sample bias.

RESULTS

The empirical data show a higher rate of participation for telephone interviews (85%) than for either personal interviews or questionnaires sent by mail. Sample bias in telephone interviews is smaller than in the other assessment approaches.

CONCLUSIONS

Since the advantages of telephone interviews outweigh those of other methods, this method of interviewing should be used as a matter of routine for quality assurance and therapy evaluation.

Effectiveness of intensive short-term residential treatment with severely disturbed adolescents

Analysis of follow-up data on 123 adolescents treated over a four-year period indicates that intensive short-term residential treatment that includes emphasis on work with families, involvement in community activities, and discharge planning can be an effective means of helping youngsters with severe psychiatric disorders who have not responded to briefer or less intensive forms of psychiatric treatment.

Effective treatment for mental disorders in children and adolescents

As pressure increases for the demonstration of effective treatment for children with mental disorders, it is essential that the field has an understanding of the evidence base. To address this aim, the authors searched the published literature for effective interventions for children and adolescents and organized this review as follows: (1) prevention; (2) traditional forms of treatment, namely outpatient therapy, partial hospitalization, inpatient treatment, and psychopharmacology; (3) intensive comprehensive community-based interventions including case management, home-based treatment, therapeutic foster care, and therapeutic group homes; (4) crisis and support services; and (5) treatment for two prevalent disorders, major depressive disorder and attention-deficit hyperactivity disorder. Strong evidence was found for the treatment of attention-deficit hyperactivity disorder, depression, anxiety, and disruptive behavior disorders. Guidance from the field relevant to moving the evidence-based interventions into real-world clinical practice and further strengthening the research base will also need to address change in policy and clinical training.

A profile of children and adolescents in a psychiatric unit: multidomain impairment and research implications

OBJECTIVE

The scientific literature has not kept pace with the evolution of child and adolescent psychiatric inpatient units, including their nature, patient profile, philosophical orientation and efficacy. This study aims to establish a comprehensive, multimodal description of the population served by an inpatient psychiatric treatment facility for children and adolescents.

METHOD

A multidisciplinary assessment regime including psychiatric, medical, speech and language examination, observer rating and patient self-report of psychopathology was used to assess 58 consecutive patients over a 20-month period.

RESULTS

In addition to a prevalence of disruptive behaviour disorders of 67% and a high rate of comorbidity with other psychiatric conditions, a breadth of impairment was demonstrated in many areas. Significantly decreased measures of socialisation, communication, daily living skills, self-esteem, intelligence and physical health are reported. Moderate to severe language handicap was found in 40% of patients.

CONCLUSIONS

The inpatient population of children and adolescents exhibited not only a high rate of disruptive behaviour disorders, frequently comorbid with other psychiatric conditions, but also high levels of physical, speech, language and living skills impairment. This finding supports the need for multimodal, multidisciplinary evaluation and treatment in this population. Outcome research evaluating treatment effectiveness must also account for the wide-ranging disabilities of these children and adolescents.

Continuity of care for conduct disordered youth

The objectives of this study were to determine which risk factors associated with chronicity had been displayed by youths who had been treated for conduct disorder in a tertiary level mental health centre and also to count the number of interventions and the number of agencies involved during their many years in treatment. The files of 25 youths with conduct disorder were examined to extract all relevant data. The youths averaged nine years between first intervention and last discharge. Common risk factors were the early onset and the variety of antisocial behaviours and the multiple settings in which behaviours occurred. The youths experienced an average of 19 interventions by 15 agencies. Interventions lasted on average seven months with little occurrence of follow-up. The severity of antisocial behaviours increased from first to last intervention. The apparent ineffectiveness of treatment may be related to the short duration of treatments and the lack of follow-up which resulted in the involvement of many agencies.