Supported discharge service versus inpatient care evaluation (SITE): a randomised controlled trial comparing effectivene
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ORIGINAL CONTRIBUTION
Supported discharge service versus inpatient care evaluation (SITE): a randomised controlled trial comparing effectiveness of an intensive community care service versus inpatient treatment as usual for adolescents with severe psychiatric disorders: self‑harm, functional impairment, and educational and clinical outcomes Dennis Ougrin1 · Richard Corrigall1 · Daniel Stahl1 · Jason Poole1 · Toby Zundel1 · Mandy Wait1 · Victoria Slater1 · Paula Reavey1 · Sarah Byford1 · John Ivens1 · Maarten Crommelin1 · Daniel Hayes1 · Kerry Middleton1 · Paul Young1 · Eric Taylor1 Received: 2 March 2020 / Accepted: 4 August 2020 © The Author(s) 2020
Abstract Clinical guidelines recommend intensive community care service treatment (ICCS) to reduce adolescent psychiatric inpatient care. We have previously reported that the addition of ICCS led to a substantial decrease in hospital use and improved school re-integration. The aim of this study is to undertake a randomised controlled trial (RCT) comparing an inpatient admission followed by an early discharge supported by ICCS with usual inpatient admission (treatment as usual; TAU). In this paper, we report the impact of ICCS on self-harm and other clinical and educational outcomes. 106 patients aged 12–18 admitted for psychiatric inpatient care were randomised (1:1) to either ICCS or TAU. Six months after randomisation, we compared the two treatment arms on the number and severity of self-harm episodes, the functional impairment, severity of psychiatric symptoms, clinical improvement, reading and mathematical ability, weight, height and the use of psychological therapy and medication. At six-month follow-up, there were no differences between the two groups on most measures. Patients receiving ICCS were significantly less likely to report multiple episodes (five or more) of self-harm (OR = 0.18, 95% CI: 0.05–0.64). Patients admitted to private inpatient units spent on average 118.4 (95% CI: 28.2–208.6) fewer days in hospitals if they were in the ICCS group compared to TAU. The addition of ICCS to TAU may lower the risk of multiple self-harm and may reduce the duration of inpatient stay, especially in those patients admitted for private care. Early discharge with ICCS appears to be a viable alternative to standard inpatient treatment. Keywords Randomised controlled trial · Intensive community care · Inpatient · Adolescent
Introduction Despite a considerable increase in the number of alternatives to inpatient admission, the absolute number of young people admitted for psychiatric inpatient care in England has remained relatively stable in the past three years. In 2018, 4703 youths were admitted (of which 1741 were admitted to private units, and the rest to National Health Service (NHS) units versus 4677 (1680 to private units) in 2017 and * Paul Young [email protected] 1
King’s College London, London, UK
4670 (1637 to private units) in 2016 [15]. However, there had been a twofold increase in the number of admissions in the preceding 15 years [26].All admi
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