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Wolf, S. and Grössmann, N. (2020): Home-Treatment in Child and Adolescent Psychiatry: An Analysis of the Effectiveness and Possible Implementation in Austria. HTA-Projektbericht 129.

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The Austrian child and adolescent psychiatric care landscape is characterised by substantial deficits on the intramural as well as on the extramural level. To overcome these supply shortfalls, alternative outreach approaches, such as home-treatment (HT), can be introduced to facilitate the reduction of hospitalisations. The present report aimed to systematically characterise international HT-models considering their effectiveness and safety in the area of child and adolescent psychiatry. Additionally, essential healthcare infrastructures necessary for introducing HT-programmes in Austria were examined.

A systematic literature search in six databases, as well as an extended hand search was conducted. Taking into account the predefined inclusion and exclusion criteria, eleven publications on 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. In addition, semistructured consultations with Austrian multidisciplinary experts were conducted.

The evidence on effectiveness included four endpoints: change in symptoms, hospitalisation, treatment satisfaction and need for further treatment. A benefit of HT-models compared to stationary care could be identified considering psychosocial symptoms; however, solely in the long-term follow-up. Studies have also shown that HT is associated with fewer days of hospitalisation, but with a high proportion of patients needing further treatment after HT. Inconclusive evidence was identified considering treatment satisfaction. Safety endpoints were not evaluated by any of the included studies.

Before implementing an HT-programme, the professional groups, the types of therapies and the target patient population should be defined. Moreover, functions and responsibilities for the coordination between HT-teams and other healthcare providers, as well as a financing strategy and a legal basis should be elaborated, preferably on the federal state level. Therefore, existing capacities of the intramural and extramural child and adolescent psychiatric sector, including personnel and coordinating resources, should be sufficiently established. In any case, an accompanying evaluation of an HT-programme is recommended to promote future evidence-based developments in the field of child and adolescent psychiatry.

Item Type:Project Report
Keywords:Home treatment, child and adolescent psychiatry, effectiveness and safety, implementation criteria
Subjects:WM Psychiatry
WS Pediatrics
WS Pediatrics > WS 200-463 Diseases of Children and Adolescents
Series Name:HTA-Projektbericht 129
Deposited on:13 Nov 2020 13:01
Last Modified:13 Nov 2020 13:01

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