Effectiveness and safety analysis of home-treatment models in child and adolescent psychiatric care

Abstract

Abstract Background The Austrian child and adolescent psychiatric care landscape is characterised by substantial deficits on the intramural and extramural level. To overcome these supply shortfalls alternative outreach approaches, such as home-treatment (HT) can be introduced, which shall facilitate the reduction of hospitalisations. Thus, we aimed to systematically characterise international HT models considering their efficacy and safety in the area of child and adolescent psychiatry. Methods A systematic literature search in six databases, as well as an extended hand search, was conducted. Taking into account the predefined inclusion criteria, six HT studies were eligible for the qualitative synthesis; comprising two randomised controlled trials (RCTs), two non-randomised controlled trials (NRCTs) and two observational studies. Results The following four effectiveness measures were investigated: change in symptoms, hospitalisation, treatment satisfaction and need for further treatment. A benefit of HT models compared to stationary care could be identified considering patient symptoms, espeicially psychopathological symptoms; however, solely in the longer-term treatment. Studies have also shown that HT is associated with fewer days of hospitalisation, but with a higher need for further treatments. Inconclusive evidence was identified considering treatment satisfaction. Safety endpoints were not evaluated by any included study. Conclusions The results are limited by a moderate to high risk of bias due to several factors (e.g. small sample sizes, various assessment instruments). However, the evidence indicates that in long-term, HT can lead to an improvement in psychopathological symptoms and supports the transition from inpatient to outpatient care. Therefore, HT may be considered as an alternative or supplement to the stationary child and adolescent psychiatric care. However, further evidence is needed considering safety outcomes. Key messages In the long-term, home-treatment can lead to a bigger improvement in psychopathological symptoms for the children and adolescent compared to stationary care. Further evidence is needed especially regarding possible adverse events of home-treatment in the field of child and adolescent psychiatry.