The Pilot Study "Home Treatment in Child and Adolescent Psychiatry" Aims to Evaluate the Effectiveness of a 3-month Home-based Intervention as an Alternative to an Inpatient Stay at a Psychiatric Clinic. Participants Are Children and Adolescents With Current Psychiatric Conditions.

N/AActive Not RecruitingNCT07559838

Medical University Innsbruck43 enrolled

Overview

This study investigates the effectiveness of an intervention for children and adolescents with psychiatric disorders. The core concept is the provision of treatment in the patient's home environment as an alternative to, and substitute for, inpatient psychiatric care. Patients receive between 3 and 7 treatment sessions per week over a period of 3 months. A multidisciplinary team-comprising a physician, psychologist, social worker, occupational therapist, dietitian, and educational specialist-delivers assessments and interventions on site. Participation in the program is offered as a voluntary alternative to hospitalization. The study is designed as a single-arm pragmatic trial. The primary outcome is the change in clinical symptom severity and psychosocial functioning, as assessed by the study physician. A follow-up assessment will be conducted after 6 months to evaluate long-term effectiveness. In addition to the primary outcome, both patients and their legal guardians provide self-reports on psychosocial functional impairment. Changes in functional impairment constitute the secondary outcome. For comparative purposes, outcomes will be contrasted with a historical control group consisting of inpatient participants.

Study Type

INTERVENTIONAL

Allocation

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Psychiatric Disorder

Interventions

Home treatment interventionBEHAVIORAL

Participants receive an intensive home-based psychiatric treatment program as an alternative to inpatient hospitalization. The intervention is delivered in the participants' home environment over a period of 3 months and consists of 3 to 7 treatment sessions per week. A multidisciplinary team composed of a physician, psychologist, social worker, occupational therapist, dietitian, and educational specialist provides integrated on-site assessment and treatment. The intervention includes clinical evaluation, psychotherapeutic and psychosocial interventions, medication management, functional support, and family involvement as needed.

Eligibility

Sex: ALLMin age: 6 YearsMax age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Sufficient proficiency in the German language * Age between 6 and 18 years * Residence within approximately a 30-minute driving distance from the hospital * Willingness and ability of patient and caregivers to comply with treatment appointments * Clinical indication for psychiatric treatment Exclusion Criteria: * Immediate threats to the child's safety or well-being in the home environment * Current risk of harm to self or others * Current violent behavior * Inability of patient or caregivers to adhere to treatment appointments * Lack of motivation or insufficient engagement leading to inability to participate in treatment * No exclusion based on specific psychiatric diagnoses

Outcomes

Primary Outcomes

Change in biopsychosocial symptom severity

The Health of the Nation Outcome Scale for Children (HoNOSCA) (Gowers et al., 1999) is a clinician-rated scale used to assess the biopsychosocial severity of mental health problems in children and adolescents. The scale is composed of two sections and 15 items. Section one, comprising items 1-13, relates to different types of well-being issues, such as behavioral difficulties, clinical symptoms, social difficulties, and impairment. Section two, comprising items 14-15, relates to difficulties in understanding the nature of the underlying issues as well as knowledge of available resources. Symptoms are rated on a 5-point Likert scale, ranging from 0 (no problem at all) to 4 (severe problem); thus, higher scores imply greater severity of difficulties with a score range of 0-60. A sum score is calculated to represent the overall psychopathological state. Initial psychometric testing showed satisfactory reliability and validity, and the scale is sensitive to change.

Time frame: From enrollment to the end of treatment at 12 weeks as well as 6 months after treatment has ended.

Secondary Outcomes

Change in Self- and Caregiver-Reported Functional Impairment

The Columbia Impairment Scale (CIS) (Bird et al., 1993) is an instrument used to measure psychological functional impairment. Functional impairment refers to the extent to which presenting symptoms affect an individual's capacity to function adaptively across multiple contexts, such as at home, at school, at work, or in relationships with others, including parents, siblings, or friends. The scale is composed of 13 items, with responses given on a 4-point Likert scale ranging from zero (no problem at all) to four (very severe problem). These items are divided into four domains: interpersonal relations, broad psychopathological domains, use of leisure time, and functioning in school or at work. Sum scores are reported as an overall indicator of impairment; higher scores imply greater impairment with a score range of 0-52

Time frame: From enrollment to the end of treatment at 12 weeks as well as 6 months after treatment has ended