A New Acute-At-Home Child and Adolescent Clinical Service: Evaluation of Impact
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Objective An Acute at Home (AAH) clinical service was implemented to reduce emergency and inpatient admissions to the regional tertiary child and adolescent mental health system. This paper examines describes the served the population and impact on emergency and inpatient admissions.Methods Analysis of re-admission rates for those enrolled before and after the May 2019 implementation of the AAH service in comparison over the same time period to an unexposed comparison group. In addition the groups were compared on clinical and demographic variables comparing those exposed and those not exposed to the AAH service.Results The results indicated that the AAH group experienced reduced rates of readmission and lengths of stay post-exposure. Family composition, sex, seven Adverse Childhood Experience survey items, and nine Western Canada Waitlist Child Mental Health Priority Criteria Score items distinguished those exposed to AAH compared to those who were not. Thirteen of 19 independent variables indicated greater pathology in the AAH group with less likelihood of potential of danger to self.Conclusion The present results indicate a substantial benefit of the AAH service via reducing readmissions and lengths of stay. The quantitative measures warrant a careful qualitative examination of the AAH processes along with ongoing monitoring of the program’s effect.
Abstract
Objective An Acute at Home (AAH) clinical service was implemented to reduce emergency and inpatient admissions to the regional tertiary child and adolescent mental health system. This paper examines describes the served the population and impact on emergency and inpatient admissions.Methods Analysis of re-admission rates for those enrolled before and after the May 2019 implementation of the AAH service in comparison over the same time period to an unexposed comparison group. In addition the groups were compared on clinical and demographic variables comparing those exposed and those not exposed to the AAH service.Results The results indicated that the AAH group experienced reduced rates of readmission and lengths of stay post-exposure. Family composition, sex, seven Adverse Childhood Experience survey items, and nine Western Canada Waitlist Child Mental Health Priority Criteria Score items distinguished those exposed to AAH compared to those who were not. Thirteen of 19 independent variables indicated greater pathology in the AAH group with less likelihood of potential of danger to self.Conclusion The present results indicate a substantial benefit of the AAH service via reducing readmissions and lengths of stay. The quantitative measures warrant a careful qualitative examination of the AAH processes along with ongoing monitoring of the program’s effect.
참고문헌 (24)
- Holmes D, "The mentally ill and social exclusion:a critical examination of the use of seclusion from the patient’s perspective", Issues Ment Health Nurs, 25, pp.559~578 (2004)
- van Wijk CM, "Seclusion: a medical and political problem", Ned Tijdschr Geneeskd, 153, pp.A962~ (2009)
- Strout TD, "Perspectives on the experience of being physically restrained:an integrative review of the qualitative literature", Int J Ment Health Nurs, 19, pp.416~427 (2010)
- Ociskova M, "Psychological factors and treatment effectiveness in resistant anxiety disorders in highly comorbid inpatients", Neuropsychiatr Dis Treat, 2, pp.1539~1551 (2016)
- Yao H, "Patients with mental health disorders in the COVID-19 epidemic", Lancet Psychiatry, 7, pp.e21~ (2020)
- Wallström R, "‘Don’t abandon me’: young people’s experiences of child and adolescent psychiatric inpatient care supporting recovery described in blogs", Int J Ment Health Nurs, 30, pp.117~125 (2020)
- Stanton J, "Referral to an acute child and adolescent inpatient unit: the experiences and views of community mental health referrers", Qual Health Res, 27, pp.1664~1674 (2017)
- Stanton J, "Self-determination theory in acute child and adolescent mental health inpatient care. A qualitative exploratory study", PLoS One, 15, pp.e0239815~ (2020)
- Boege I, "Cost-effectiveness of intensive home treatment enhanced by inpatient treatment elements in child and adolescent psychiatry in Germany: a randomised trial", Eur Psychiatry, 30, pp.583~589 (2015)
- Boege I, "Hometreatment-an effective alternative to inpatient treatment in child and adolescent psychiatry?", Z Kinder Jugendpsychiatr Psychother, 43, pp.411~421 (2015)
- Göpel C, "Clinical and medico-legal aspects of home-based care by nurses as an alternative for inpatient treatment in child and adolescent psychiatry", Med Law, 19, pp.327~334 (2000)
- Cawthorpe D, "Priority-setting for children’s mental health: clinical usefulness and validity of the priority criteria score", J Can Acad Child Adolesc Psychiatry, 16, pp.18~26 (2007)
- McCaffrey ES, "Mental health literacy in primary care: Canadian Research and Education for the Advancement of Child Health (CanREACH)", Evid Based Med, 22, pp.124~131 (2017)
- Novick J, "The validation of the Western Canada Waiting List Children’s Mental Health-Priority Criteria Score Instrument: 2002-2015 results", J Hosp Adm, 5, pp.1~8 (2016)
- Novick J, "A measurable treatment plan:using the Children’s Global Assessment and the Problem Severity scales as outcomes of clinical treatment", J Hosp Adm, 6, pp.9~15 (2016)
- Rahman A, "ERRATUM TO: on becoming trauma-informed: role of the adverse childhood experiences survey in tertiary child and adolescent mental health services and the association with standard measures of impairment and severity", Perm J, 22, pp.17-054~ (2018)
- Cawthorpe D, "Relationship between adverse childhood experience survey items and psychiatric disorders", Perm J, 22, pp.18-001~ (2018)
- Melathopolous K, "Central intake development and system change impact on per capita child and adolescent mental health discharges from 2002 to 2017: implications for optimizing system design based on shaping demand", Permanente, 23, pp.18.215~ (2019)
- Lamb CE, "Alternatives to admission for children and adolescents: providing intensive mental healthcare services at home and in communities:what works?", Curr Opin Psychiatry, 22, pp.345~350 (2009)
- Shepperd S, "Alternatives to inpatient mental health care for children and young people", Cochrane Database Syst Rev, (2), pp.CD006410~ (2009)
- Hanson KE, "Familybased recovery: an innovative in-home substance abuse treatment model for families with young children", Child Welfare, 94, pp.161~183 (2015)
- Sjølie H, "Crisis resolution and home treatment:structure, process, and outcome - a literature review", J Psychiatr Ment Health Nurs, 17, pp.881~892 (2010)
- Vusio F, "Experiences and satisfaction of children, young people and their parents with alternative mental health models to inpatient settings: a systematic review", Eur Child Adolesc Psychiatry, 29, pp.1621~1633 (2020)
- Garcia Gonzalez De Ara C, "Housing first: at home recovery of severe mental disorder", Rev Med Suisse, 13, pp.1605~1609 (2017)