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John S, Cohen D. Short Research Article: Opening a new CAMHS day hospital - does it affect inpatient admissions and does it help at all? Child Adolesc Ment Health 2024; 29:276-280. [PMID: 37881153 DOI: 10.1111/camh.12680] [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] [Accepted: 08/06/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Day hospitals in child and adolescent mental health services are held to be helpful entities in the psychiatric care of young people. However, limited research has been done to look into how day hospitals and similar settings affect referrals, inpatient stays and in which cohort of patients do they show the most impact. This study's primary aims were to examine the impact of a new Child and Adolescent Mental Health Service (CAMHS) day hospital on referrals and admissions to the associated CAMHS in-patient unit. A secondary aim of this study was to examine the demographics and clinical outcomes of the young people attending the day hospital. METHODS Information was gathered using retrospective reviews of clinical files and databases. RESULTS There was a reduction in admissions and in the total bed days from the study area following the opening of the day hospital. There was an improvement in clinical outcomes for young people attending the day hospital. CONCLUSION Day hospital in child and adolescent mental health services can prove to be a useful modality to provide support to young people with a moderate to severe mental illness leading to reduced inpatient admissions and improving lengths of inpatient stay. It also improves clinical outcomes for cohorts of young people where inpatient stay is not warranted but higher levels of support is needed.
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Affiliation(s)
| | - Dermot Cohen
- Galway CAMHS, HSE West, Galway, Ireland
- Department of Psychiatry, National University of Ireland Galway, Galway, Ireland
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Besse-Flütsch N, Bühlmann C, Fabijani N, Ruschetti GG, Smigielski L, Pauli D. Home treatment as an add-on to family-based treatment for adolescents with anorexia nervosa compared with standard family-based treatment and home-based stress reduction training: study protocol for a randomized clinical trial. J Eat Disord 2023; 11:135. [PMID: 37580810 PMCID: PMC10424408 DOI: 10.1186/s40337-023-00861-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 08/04/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Family-based treatment (FBT) is currently the most effective evidence-based treatment approach for adolescents with anorexia nervosa (AN). Home treatment (HT) as an add-on to FBT (FBT-HT) has been shown to be acceptable, feasible and effective. The described three-arm randomized clinical trial (RCT) is intended to investigate whether FBT-HT demonstrates higher efficacy compared to standard outpatient FBT with supplemental mindfulness-based stress reduction training (FBT-MBSR). METHODS This RCT compares FBT-HT to standard outpatient FBT and FBT-MBSR as a credible home-based control group in terms of efficacy and delivery. Adolescents with AN or atypical AN disorder (n = 90) and their parent(s)/caregiver(s) are to be randomly assigned to either FBT, FBT-HT or FBT-MBSR groups. Eating disorder diagnosis and symptomatology are to be assessed by eating disorder professionals using standardized questionnaires and diagnostic instruments (Eating Disorder Examination, Eating Disorder Inventory, Body Mass Index). In addition, parents and caregivers independently provide information on eating behavior, intrafamily communication, stress experience and weight. The therapeutic process of the three treatments is to be measured and assessed among both participants and care providers. The feasibility, acceptability and appropriateness can thus also be evaluated. DISCUSSION We hypothesize that FBT-HT will be an acceptable, appropriate and feasible intervention and, importantly, will outperform both established FBT and FBT-MBSR in improving adolescent weight and negative eating habits. Secondary outcome measures include the reduction in the stress experienced by caregivers, as well as the regulation of perceived expressed emotions within the family, while the intrafamily relationships are hypothesized to mediate/moderate the effectiveness of FBT. The proposed study has the potential to enhance the scientific and clinical understanding of the efficacy of FBT for AN, including whether the addition of HT to FBT versus another home-based adjunct intervention improves treatment outcomes. Furthermore, the study aligns with public health priorities to optimize the outcomes of evidence-based treatments and integrate the community setting. Trial registration This study is registered at ClinicalTrials.gov (NCT05418075).
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Affiliation(s)
- Nicole Besse-Flütsch
- Department of Child and Adolescent Psychiatry, Psychiatric University Hospital Zürich, University of Zürich, Neumünsterallee 3, 8032, Zurich, Switzerland.
| | - Claudia Bühlmann
- Department of Child and Adolescent Psychiatry, Psychiatric University Hospital Zürich, University of Zürich, Neumünsterallee 3, 8032, Zurich, Switzerland
| | - Natalie Fabijani
- Department of Child and Adolescent Psychiatry, Psychiatric University Hospital Zürich, University of Zürich, Neumünsterallee 3, 8032, Zurich, Switzerland
| | - Gian Giacomo Ruschetti
- Department of Child and Adolescent Psychiatry, Psychiatric University Hospital Zürich, University of Zürich, Neumünsterallee 3, 8032, Zurich, Switzerland
| | - Lukasz Smigielski
- Department of Child and Adolescent Psychiatry, Psychiatric University Hospital Zürich, University of Zürich, Neumünsterallee 3, 8032, Zurich, Switzerland
| | - Dagmar Pauli
- Department of Child and Adolescent Psychiatry, Psychiatric University Hospital Zürich, University of Zürich, Neumünsterallee 3, 8032, Zurich, Switzerland
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Goldschmidt AB, Tortolani CC, Accurso EC, Dunbar EMP, Egbert AH, Donaldson D, Donaldson AA. Adapting family-based treatment for adolescent anorexia nervosa delivered in the home: A novel approach for improving access to care and generalizability of skill acquisition. J Eat Disord 2023; 11:130. [PMID: 37543601 PMCID: PMC10403819 DOI: 10.1186/s40337-023-00850-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 07/26/2023] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND Anorexia nervosa (AN) is a serious mental illness associated with high rates of morbidity and mortality. Family-based treatment (FBT) is a well-established treatment for adolescent AN, yet it is underutilized in community settings and is unavailable to many families, particularly those from lower income and racial and ethnic minority backgrounds. Furthermore, some families do not respond optimally to FBT, possibly because of challenges translating skills acquired in office-based treatment settings to naturalistic settings. Home-based treatment could reduce barriers to access and enhance generalization of newly learned treatment skills. Home-based models demonstrate initial feasibility, acceptability, and efficacy for adolescent AN, however, FBT principles have yet to be applied as a stand-alone intervention in a home-based level of care. This paper describes the rationale for and process of adapting FBT principles/interventions to improve fit within a home-based model delivered in the context of community mental health, and discusses potential strengths and opportunities associated with this approach. RESULTS Adaptations were made through consultation with collaborating community agencies and were guided by the complex interventions framework. The primary modifications included: (1) altered dose; (2) multiple family meals; (3) additional support for meal preparation and supervision; (4) clinician attendance at medical appointments; (5) cultural adaptation; and (6) introduction of distress tolerance and emotion regulation skills. CONCLUSIONS Implementing FBT in the home may present one promising and novel approach to enhance engagement and treatment outcomes for adolescents with restrictive eating disorders, particularly those who are underserved, but evaluation of efficacy/effectiveness is needed.
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Affiliation(s)
- Andrea B Goldschmidt
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Christina C Tortolani
- Department of Counseling, Educational Leadership, and School Psychology, Rhode Island College, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University/The Miriam Hospital, Providence, RI, USA
| | - Erin C Accurso
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | | | - Amy H Egbert
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University/The Miriam Hospital, Providence, RI, USA
- Department of Psychological Sciences, University of Connecticut, Connecticut, Storz, USA
| | - Deidre Donaldson
- Department of Family Medicine, Warren Alpert Medical School of Brown University/Gateway Healthcare, Providence, RI, USA
| | - Abigail A Donaldson
- Department of Pediatrics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA
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Goldschmidt AB, Tortolani CC, Egbert AH, Brick LA, Elwy AR, Donaldson D, Le Grange D. Implementation and outcomes of home-based treatments for adolescents with anorexia nervosa: Study protocol for a pilot effectiveness-implementation trial. Int J Eat Disord 2022; 55:1627-1634. [PMID: 36324297 PMCID: PMC10018372 DOI: 10.1002/eat.23796] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/28/2022] [Accepted: 07/28/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Although family-based treatment (FBT) is considered a first-line treatment for adolescent anorexia nervosa (AN), it is underutilized in community settings and is unavailable to many families for a multitude of practical reasons (e.g., costs of treatment, transportation constraints). Adapting FBT interventions for delivery in home-based and community-based settings may reduce pragmatic barriers to treatment uptake and engagement. METHODS This pilot effectiveness-implementation trial will assess outcomes, implementation, and mechanisms of FBT adapted for the home setting (FBT-HB), delivered in the context of community-based behavioral health agencies. Adolescents with AN-spectrum disorders (n = 50) and their caregivers will be randomly assigned to either FBT-HB or home-based treatment as usual (TAU; integrated family therapy approach). Caregivers and adolescents will provide data on weight, eating, and putative treatment mechanisms, including caregiver self-efficacy and adolescent eating-related and weight-related distress. Implementation constructs of feasibility, acceptability, and appropriateness will be measured among providers and participating families. HYPOTHESES We expect that FBT-HB will be feasible, acceptable, and appropriate, and will outperform TAU in terms of improvements in adolescent weight and eating-related psychopathology. We further expect that caregiver self-efficacy and adolescent eating-related and weight-related distress, but not general distress, will show greater improvements in FBT-HB relative to TAU and will be associated with better adolescent weight and eating outcomes in FBT-HB. POTENTIAL IMPLICATIONS The proposed study has clear potential to advance scientific and clinical understanding of the real-world effectiveness of FBT for AN, including whether adapting it for the home setting improves its accessibility and effects on treatment outcome.
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Affiliation(s)
| | - Christina C. Tortolani
- Department of Counseling, Educational Leadership, and School Psychology, Rhode Island College, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University/The Miriam Hospital, Providence, RI, USA
| | - Amy H. Egbert
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University/The Miriam Hospital, Providence, RI, USA
| | - Leslie A. Brick
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University/The Miriam Hospital, Providence, RI, USA
| | - A. Rani Elwy
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University/The Miriam Hospital, Providence, RI, USA
| | - Deidre Donaldson
- Department of Family Medicine, Warren Alpert Medical School of Brown University/Gateway Healthcare, Providence, RI, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
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Pauli D, Flütsch N, Hilti N, Schräer C, Soumana M, Häberling I, Berger G. Home treatment as an add-on to family-based treatment in adolescents with anorexia nervosa: A pilot study. EUROPEAN EATING DISORDERS REVIEW 2022; 30:168-177. [PMID: 35001459 PMCID: PMC9303788 DOI: 10.1002/erv.2882] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 11/25/2021] [Accepted: 12/24/2021] [Indexed: 11/10/2022]
Abstract
Objective This pilot study examines the feasibility and the effectiveness of add‐on home treatment (HT) to family‐based treatment (FBT) in adolescents with anorexia nervosa (AN). The HT intervention is delivered by specialised nurses and aims at supporting patients and parents to re‐establish family meals in the home environment. Method We performed a 3‐month study in AN patients with a waiting‐list control design comparing 45 (43 females, 2 males) adolescents receiving FBT augmented with HT compared to 22 (21 females, 1 male) participants receiving FBT alone on the waiting list for additional HT. Eating disorder diagnosis, psychopathology and severity of clinical symptoms were assessed using the Eating Disorder Examination (EDE) interview, the Eating Disorders Inventory (EDI‐2) and clinical parameters (BMI, menstrual status, level of over‐exercising) at baseline and after 3 months. Results After 3 months of treatment, both treatment groups showed a significant early weight gain, a reduction in the rate of AN diagnoses assessed with the EDE interview and a reduction in EDI‐2 total scores. The combined HT/FBT group showed a significantly greater increase in BMI than the FBT‐only group. In the combined HT/FBT group, none of the patients had to be admitted to hospital, while three (13.6%) of the FBT‐only group had to be referred to inpatient treatment. Discussion Our results suggest that HT augmented FBT might be useful compared to FBT alone in terms of early weight gain and might reduce the risk of hospital admission in adolescent AN. Home treatment as an add‐on to family‐based treatment seems to be a well‐accepted and very effective method for the treatment of eating disorders in adolescence. Combining family‐based treatment with home treatment thus seems to even enhance the therapy effectiveness of FBT in terms of initial weight gain as well as psychopathology
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Affiliation(s)
- Dagmar Pauli
- Department of Child and Adolescent Psychiatry, University of Zurich, Zurich, Switzerland
| | - Nicole Flütsch
- Department of Child and Adolescent Psychiatry, University of Zurich, Zurich, Switzerland
| | - Nadine Hilti
- Department of Child and Adolescent Psychiatry, University of Zurich, Zurich, Switzerland
| | - Christiane Schräer
- Department of Child and Adolescent Psychiatry, University of Zurich, Zurich, Switzerland
| | - Mariama Soumana
- Department of Child and Adolescent Psychiatry, University of Zurich, Zurich, Switzerland
| | - Isabelle Häberling
- Department of Child and Adolescent Psychiatry, University of Zurich, Zurich, Switzerland
| | - Gregor Berger
- Department of Child and Adolescent Psychiatry, University of Zurich, Zurich, Switzerland
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Clisu DA, Layther I, Dover D, Viner RM, Read T, Cheesman D, Hodges S, Hudson LD. Alternatives to mental health admissions for children and adolescents experiencing mental health crises: A systematic review of the literature. Clin Child Psychol Psychiatry 2022; 27:35-60. [PMID: 34836461 PMCID: PMC8811329 DOI: 10.1177/13591045211044743] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Many children and young people (CYP) presenting with mental health crises are admitted to hospital due to concerns around illness severity and risk. Whilst inpatient admissions have an important role for such children, there are a number of burdens associated with them, and safe avoidance of admissions is favourable. We systematically reviewed the literature for studies of interventions reported as alternatives to a hospital admission in CYP presenting with mental health crises, in any inpatient setting. Methods: Three databases (PsychInfo, PubMed and Web of Science) were searched for peer-reviewed papers in October 2020, with an updated search in May 2021. Results: We identified 19 papers of interventions delivered in the emergency department, the home, outside of home but outside of clinics and in hospital clinics. The quality of most included studies was low, with less than half being randomised controlled trials and only half of these at low risk of bias. The best quality studies and greatest evidence for efficacy came from in-home interventions, in particular multisystemic therapy, which improved psychological outcomes, and though a large number of CYP still ended up being admitted, there appeared to be decreased length of stay. Conclusions: Overall, we could not recommend a particular intervention as an alternative to inpatient admission; however, our review describes benefits across a range of types of interventions that might be considered in multi-modal treatments. We also provide recommendations for future research, in particular the evaluation of new interventions as they emerge.
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Affiliation(s)
- Denisa A Clisu
- 573582UCL GOS Institute of Child Health, London, UK.,3221Barnet Enfield and Haringey Mental Health Trust, London, UK
| | | | - Deborah Dover
- 3221Barnet Enfield and Haringey Mental Health Trust, London, UK
| | | | - Tina Read
- 3221Barnet Enfield and Haringey Mental Health Trust, London, UK
| | - David Cheesman
- 3221Barnet Enfield and Haringey Mental Health Trust, London, UK
| | - Sally Hodges
- 9705The Tavistock and Portman NHS Trust, London, UK
| | - Lee D Hudson
- 573582UCL GOS Institute of Child Health, London, UK.,4956Great Ormond Street Hospital, London, UK
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7
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Flütsch N, Hilti N, Schräer C, Soumana M, Probst F, Häberling I, Berger G, Pauli D. Feasibility and acceptability of home treatment as an add-on to family based therapy for adolescents with anorexia nervosa. A case series. Int J Eat Disord 2021; 54:1707-1710. [PMID: 34227130 PMCID: PMC8457051 DOI: 10.1002/eat.23567] [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: 12/22/2020] [Revised: 06/08/2021] [Accepted: 06/08/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study examines the feasibility, acceptability, and preliminary effect sizes on outcome measures of home treatment (HT) as an add-on to family-based therapy (FBT) in adolescents with anorexia nervosa (AN). The HT intervention is delivered by specialized nurses and aims at supporting patients and parents to re-establish family meals in the home environment. METHOD Forty-five (43 female, 2 male) adolescents meeting ICD 10 criteria for anorexia nervosa or atypical anorexia nervosa received FBT augmented with HT over 12 weeks. Eating disorder (ED) diagnosis, psychopathology and severity of clinical symptoms were assessed using the Eating Disorder Examination (EDE) interview, the Eating Disorders Inventory (EDI-2) at baseline (BL) and after 3-months RESULTS: All participants and parents were retained and found HT acceptable. At the end of Treatment (EOT) participants showed a significant early weight gain, a reduction in the AN psychopathology assessed with the EDE interview and a reduction in EDI-2 total scores. None of the patients had to be admitted to hospital. Treatment satisfaction was high in both patients and parents. DISCUSSION Findings provide preliminary evidence that HT is feasible, acceptable and produces clinically significant improvements in targeted outcome.
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Affiliation(s)
- Nicole Flütsch
- Department of Child and Adolescent PsychiatryUniversity of ZurichZürichSwitzerland
| | - Nadine Hilti
- Department of Child and Adolescent PsychiatryUniversity of ZurichZürichSwitzerland
| | - Christiane Schräer
- Department of Child and Adolescent PsychiatryUniversity of ZurichZürichSwitzerland
| | - Mariama Soumana
- Department of Child and Adolescent PsychiatryUniversity of ZurichZürichSwitzerland
| | - Fabian Probst
- Department of Child and Adolescent PsychiatryUniversity of ZurichZürichSwitzerland
| | - Isabelle Häberling
- Department of Child and Adolescent PsychiatryUniversity of ZurichZürichSwitzerland
| | - Gregor Berger
- Department of Child and Adolescent PsychiatryUniversity of ZurichZürichSwitzerland
| | - Dagmar Pauli
- Department of Child and Adolescent PsychiatryUniversity of ZurichZürichSwitzerland
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Woody C, Baxter A, Wright E, Gossip K, Leitch E, Whiteford H, Scott JG. Review of services to inform clinical frameworks for adolescents and young adults with severe, persistent and complex mental illness. Clin Child Psychol Psychiatry 2019; 24:503-528. [PMID: 30818969 DOI: 10.1177/1359104519827631] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Severe, persistent and complex mental illness (SPCMI) affects a small proportion of young people but is associated with severe disability and a large burden on families and health services. This article identifies and describes service models for adolescents and young adults with SPCMI. METHODS A systematic search was conducted for services for young people aged 12-25 years with SPCMI. The review sought service models providing extended care and/or multidisciplinary services to meet the complex and long-term needs of this population. RESULTS A total of 43 sources were identified. Evidence of effectiveness was found for both community- and bed-based services. Specific components suggested as important in service delivery included care provided by multidisciplinary teams, consumer and family involvement in care planning, intensive case management and service integration through the continuum of care. CONCLUSION Clinical frameworks for this population must incorporate effective community care integrated with inpatient treatment of short duration. Frameworks require consumer and family-centred care with flexibility to support progression through developmental stages and tasks while addressing issues related to risk management, fluctuation in illness severity and stages of recovery. A continuum of care is necessary to meet the needs that arise from SPCMI in adolescents and young adults.
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Affiliation(s)
- Charlotte Woody
- 1 School of Public Health, Faculty of Medicine, The University of Queensland, Australia.,2 Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Australia
| | - Amanda Baxter
- 1 School of Public Health, Faculty of Medicine, The University of Queensland, Australia.,2 Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Australia
| | - Eryn Wright
- 1 School of Public Health, Faculty of Medicine, The University of Queensland, Australia.,2 Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Australia
| | - Kate Gossip
- 1 School of Public Health, Faculty of Medicine, The University of Queensland, Australia.,2 Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Australia
| | - Elizabeth Leitch
- 1 School of Public Health, Faculty of Medicine, The University of Queensland, Australia.,2 Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Australia
| | - Harvey Whiteford
- 1 School of Public Health, Faculty of Medicine, The University of Queensland, Australia.,2 Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Australia
| | - James G Scott
- 1 School of Public Health, Faculty of Medicine, The University of Queensland, Australia.,2 Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Australia.,3 Metro North Mental Health, Royal Brisbane and Women's Hospital, Australia
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Abstract
Systemic Treatment of Eating Disorders Abstract. Eating disorders (EDs) are deleterious illnesses that are associated with significant psychiatric and medical morbidity and mortality, considerable distress and impairment, marked caregiver burden, and high treatment costs. Because EDs commonly onset in adolescence and young adulthood, and with consistent evidence that early intervention results in the most promising treatment outcomes, an increasing amount of research has been devoted to the treatment of adolescent EDs. Although still less researched in adult presentations of EDs, the historical record of research on adolescent ED treatment over the last half-century principally supports family therapy. Current published clinical guidelines recommend an ED-specific family therapy as the first-line treatment of adolescents with anorexia nervosa (AN) and as a recommended treatment of adolescents with bulimia nervosa (BN). The number of treatment trials for adolescent AN has slowly grown over the last few decades and, more recently, family interventions include protocols extending to new populations and diagnoses, including BN. This narrative review summarizes existing family-based approaches to the treatment of adolescent EDs, integrating recent research findings. This article also includes discussion of methods, both current and proposed, that expand and adapt current family-based approaches in efforts to improve the breadth and scope of ED treatment in adolescence and young adulthood.
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Affiliation(s)
- Patrick Pasi
- Klinik für Konsiliarpsychiatrie und Psychosomatik, Universitätsspital Zürich
| | - Dagmar Pauli
- Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie, PUK Zürich
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10
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Kwok KHR, Yuan SNV, Ougrin D. Review: Alternatives to inpatient care for children and adolescents with mental health disorders. Child Adolesc Ment Health 2016; 21:3-10. [PMID: 32680359 DOI: 10.1111/camh.12123] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/13/2015] [Indexed: 11/29/2022]
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.
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Affiliation(s)
- Ka Ho Robin Kwok
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, King's College London, PO 85, De Crespigny Park, London SE5 8AF, UK
| | - Sze Ngar Vanessa Yuan
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, King's College London, PO 85, De Crespigny Park, London SE5 8AF, UK
| | - Dennis Ougrin
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, King's College London, PO 85, De Crespigny Park, London SE5 8AF, UK
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11
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Adrian N, Smith JG. Occupied bed days a redundant currency? An evaluation of the first 10 years of an integrated model of care for mentally ill adolescents. Clin Child Psychol Psychiatry 2015; 20:458-71. [PMID: 24694901 DOI: 10.1177/1359104514527298] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We report on clinical outcomes from the first 10 years of operation of an Adolescent Assertive Outreach Team (AAOT) which forms part of an integrated Tier 4 service offering inpatient, day-patient and intensive community treatment. METHOD Prospective data were recorded at pre- and post-treatment for patients accepted for treatment by the AAOT over a 10-year period. RESULTS A total of 393 adolescents were treated by the AAOT, and 135 received some hospital care as part of their treatment. Contact periods with the team were significantly shorter for those treated wholly in the community. Outcome measures indicated severe pathology at onset with substantial improvement in function regardless of whether treatment involved hospital care or community support only. CONCLUSIONS Adolescent Outreach is a viable and sustainable alternative to inpatient care for some young people referred for admission, reducing but not eliminating the need for acute beds.
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Affiliation(s)
- Nicolette Adrian
- Springfield University Hospital, South West London and St George's Mental Health NHS Trust, UK
| | - Jared G Smith
- Division of Population Health Sciences and Education, St George's, University of London, UK
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12
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Ougrin D, Zundel T, Corrigall R, Padmore J, Loh C. Innovations in Practice: pilot evaluation of the supported discharge service (SDS): clinical outcomes and service use. Child Adolesc Ment Health 2014; 19:265-269. [PMID: 32878355 DOI: 10.1111/camh.12038] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/24/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND The Supported Discharge Service (SDS) is a model of enhanced care in the community for adolescents after inpatient discharge. METHODS This study comprised the first 20 patients referred to SDS, largely those with delayed discharges. Service use and clinical outcomes were collected and predictors of total contact time were investigated. RESULTS Significant improvements had been made with SDS. Higher baseline Strengths and Difficulties Questionnaire (SDQ) conduct scores were associated with less contact time. CONCLUSIONS SDS is a feasible model of care. Adolescents with conduct problems may benefit from engagement strategies. Further rigorous evaluation of the model is required.
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Affiliation(s)
- Dennis Ougrin
- Child and Adolescent Psychiatry, King's College London, London, UK
| | - Toby Zundel
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Jane Padmore
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Cheryl Loh
- Department of Psychological Medicine, Changi General Hospital, 2 Simei Street 3, 529889, Singapore
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13
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Munro C, Thomson V, Corr J, Randell L, Davies JE, Gittoes C, Honeyman V, Freeman CP. A new service model for the treatment of severe anorexia nervosa in the community: the Anorexia Nervosa Intensive Treatment Team. PSYCHIATRIC BULLETIN 2014; 38:220-5. [PMID: 25285220 PMCID: PMC4180986 DOI: 10.1192/pb.bp.113.044818] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 10/30/2013] [Accepted: 11/18/2013] [Indexed: 11/23/2022]
Abstract
Aims and method A community intensive treatment service for severe anorexia nervosa is described. The service is multidisciplinary but driven by a focus on psychological formulation. Psychological and dietetic interventions are grounded in a process of active risk management. Evaluations of safety, cost and acceptability of the service are described. Results Patients are highly satisfied with their care. A relatively low mortality rate for such a high-risk population was observed. In-patient bed use and costs were substantially reduced. Clinical implications There is a case for greater use of intensive community care for patients with severe anorexia nervosa, as it can be acceptable to patients, relatively safe and cost less than admission.
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Affiliation(s)
- Calum Munro
- Anorexia Nervosa Intensive Treatment Team (ANITT), NHS Lothian, Edinburgh, UK ; Department of Psychiatry, University of Edinburgh, UK
| | - Victoria Thomson
- Anorexia Nervosa Intensive Treatment Team (ANITT), NHS Lothian, Edinburgh, UK
| | - Jean Corr
- Anorexia Nervosa Intensive Treatment Team (ANITT), NHS Lothian, Edinburgh, UK
| | - Louise Randell
- Anorexia Nervosa Intensive Treatment Team (ANITT), NHS Lothian, Edinburgh, UK
| | - Jennie E Davies
- Anorexia Nervosa Intensive Treatment Team (ANITT), NHS Lothian, Edinburgh, UK
| | - Claire Gittoes
- Anorexia Nervosa Intensive Treatment Team (ANITT), NHS Lothian, Edinburgh, UK
| | - Vicky Honeyman
- Anorexia Nervosa Intensive Treatment Team (ANITT), NHS Lothian, Edinburgh, UK
| | - Chris P Freeman
- Anorexia Nervosa Intensive Treatment Team (ANITT), NHS Lothian, Edinburgh, UK ; Queen Margaret University, Edinburgh, UK
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14
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Bezance J, Holliday J. Mothers' experiences of home treatment for adolescents with anorexia nervosa: an interpretative phenomenological analysis. Eat Disord 2014; 22:386-404. [PMID: 25024015 DOI: 10.1080/10640266.2014.925760] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Home treatment (HT) is emerging as an alternative to admission for adolescents with anorexia nervosa. It relies heavily on parental (often maternal) input to be effective. Given the high levels of carer stress reported by mothers, the current study aimed to explore mothers' experience of HT. A qualitative study using purposeful sampling was conducted. Nine interviews were analyzed using interpretative phenomenological analysis. Two contextual themes described the mother-daughter relationship and maternal stress and distress prior to HT. The third theme, "experience of help," included sub-themes of when help is needed, the need for containment, gaining strength and skills, and how HT met families' philosophy and values. The results support previous research on the stress that mothers particularly are under when their adolescent daughters have anorexia nervosa, and provides rich data on their experiences. HT is perceived as having both helpful and unhelpful aspects. Further research on its effectiveness is needed.
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Affiliation(s)
- Jessica Bezance
- a Oxford Institute of Clinical Psychology Training, Isis Education Centre, Warneford Hospital , Headington , Oxford , UK
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15
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Kaplan T, Racussen L. A crisis recovery model for adolescents with severe mental health problems. Clin Child Psychol Psychiatry 2013; 18:246-59. [PMID: 23060601 DOI: 10.1177/1359104512449320] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A model of intervention at the interface and for the in-patient phase for adolescents with severe mental health crises was developed to reduce length of stay while maintaining quality of service consonant with the 'recovery model'. The model is described, and discussed in the context of the limited literature on both crisis intervention with adolescents and families, and 'recovery' in this age-group. The model may be suitable also for use by community teams dealing with adolescents in crisis.
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Affiliation(s)
- Tony Kaplan
- New Beginning Young People's Crisis Recovery Unit, BEHMHT, UK.
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16
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Wharff EA, Ginnis KM, Ross AM. Family-based crisis intervention with suicidal adolescents in the emergency room: a pilot study. SOCIAL WORK 2012; 57:133-43. [PMID: 23038875 DOI: 10.1093/sw/sws017] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The prevailing model of care for psychiatric patients in the emergency room (ER) is evaluation and disposition, with little or no treatment provided. This article describes the results of a pilot study of a family-based crisis intervention (FBCI) for suicidal adolescents and their families in a large, urban pediatric ER. FBCI is an intervention designed to sufficiently stabilize patients within a single ER visit so that they can return home safely with their families. Of the 100 suicidal adolescents and their families in the sample, 67 met eligibility criteria for FBCI. Demographic and clinical characteristics and disposition outcomes from the sample were compared with those obtained retrospectively from a matched comparison group (N = 150). Statistical analyses compared group inpatient admission rates and disposition outcomes. Patients in the pilot cohort were significantly less likely to be hospitalized than were those in the comparison group (36 percent versus 55 percent). Only two of the patients in the FBCI cohort were hospitalized immediately after receiving the intervention during their ER visit. FBCI with suicidal adolescents and their families during a single ER visit is feasible and safely limits the need for inpatient psychiatric hospitalization, thereby avoiding disruption of family, academic, and social activities and increasing use of less intrusive and more cost-effective psychiatric treatment.
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17
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Simpson W, Cowie L, Wilkinson L, Lock N, Monteith G. The Effectiveness of a Community Intensive Therapy Team on Young People's Mental Health Outcomes. Child Adolesc Ment Health 2010; 15:217-223. [PMID: 32847201 DOI: 10.1111/j.1475-3588.2009.00546.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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.
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Affiliation(s)
- Wendy Simpson
- Playfield Institute for Children and Young People's Mental Health, Stratheden Hospital, Cupar, Fife, Scotland. E-mail:
| | - Lee Cowie
- Fife Child and Adolescent Mental Health Service, Stratheden Hospital, Cupar, Fife, Scotland
| | - Lucy Wilkinson
- Bute Medical School, University of St. Andrews, Fife, Scotland
| | - Naomi Lock
- Bute Medical School, University of St. Andrews, Fife, Scotland
| | - Graham Monteith
- Fife Child and Adolescent Mental Health Service, Stratheden Hospital, Cupar, Fife, Scotland
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18
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Rani J, Prosser A, Worrall-Davies A, Kiernan K, Hewson L. User and carer views of CAMHS intensive home treatment service in Bradford. ACTA ACUST UNITED AC 2009. [DOI: 10.1002/pdh.292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Alternatives to admission for children and adolescents: providing intensive mental healthcare services at home and in communities: what works? Curr Opin Psychiatry 2009; 22:345-50. [PMID: 19461516 DOI: 10.1097/yco.0b013e32832c9082] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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.
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McDougall T, Worrall-Davies A, Hewson L, Richardson G, Cotgrove A. Tier 4 Child and Adolescent Mental Health Services (CAMHS) - Inpatient Care, Day Services and Alternatives: An Overview of Tier 4 CAMHS Provision in the UK. Child Adolesc Ment Health 2008; 13:173-180. [PMID: 32847182 DOI: 10.1111/j.1475-3588.2007.00481.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This paper addresses Tier 4 services for children and young people whose needs require highly specialised services, and describes the range of provision which is currently available for this group. Although the evidence base is in its infancy, what is known about clinical outcomes, cost effectiveness and the views of users is summarised. The current shortfalls in tier 4 provision are highlighted, the drivers for change are identified and recommendations are made for future service improvements.
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Affiliation(s)
- Tim McDougall
- Pine Lodge Young People's Centre, Cheshire & Wirral Partnership NHS Foundation Trust, UK. E-mail:
| | | | - Lesley Hewson
- Children and Young People's Service, Bradford District Primary Care Trust, UK
| | | | - Andrew Cotgrove
- Pine Lodge Young People's Centre, Cheshire & Wirral Partnership NHS Foundation Trust, UK. E-mail:
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