Service evaluation and treatment pathways in an intensive community treatment service for adolescents in crisis services: What can we learn?

Abstract

Background: Intensive community treatment services are emerging as an alternative to admission and/or to support discharge from hospital. This service evaluation aims to assess treatment pathways and factors associated with treatment duration and general functioning. Methods: A service evaluation using routinely collected data from an intensive community treatment service between 2016 and 2023 was performed. Results: 141 adolescents aged 12 to 17 received intensive community treatment over 8 years. The average treatment duration was 29.2 weeks, significantly longer than the initial 12-week pathway proposed. Those treated for significantly longer seemed to present with more complex mental health needs. Lack of education provision, being part of an ethnic minority or having a higher number of services involved were significantly associated with higher treatment duration (p < .05). Conclusion: Results suggest that a longer treatment pathway might be necessary in intensive community care, so a 24-week treatment pathway was proposed. General functioning also improved over the course of treatment, and 89.4% were discharged back to their local community teams. The involvement of multiple specialist services and the presence of specific diagnoses (e.g., autism) deserve consideration. Future evaluations will clarify if more targeted treatment pathways are more effective and efficient.

Plain Language Summary

Intensive community treatment services are emerging as an alternative to admission to hospital, in order to support young people to remain at home close to their local communities. This paper aims to assess how does the treatment journey could look like and factors associated with treatment. We conducted a service evaluation using routinely collected data from an intensive community treatment service between 2016 and 2023. 141 adolescents aged 12 to 17 received intensive community treatment over 8 years. The average treatment duration was 29.3 weeks, significantly longer than the initial 12-week pathway proposed. Those who were treated for significantly longer seemed to have more complex mental health needs. Those who were not attending school, were part of an ethnic minority or were treated by more than one specialist service at the time, required longer time on treatment. The results suggest that a longer treatment pathway might be necessary in intensive community care, so a 24-week treatment pathway was proposed. General functioning also improved over the course of treatment, and 89.4% were discharged back to their local community teams, rather than being admitted to hospital. The involvement of multiple specialist services and the presence of specific diagnoses (e.g., autism) deserve consideration. Future evaluations will clarify if adapting treatment pathways to particular conditions (e.g., autism, trauma) would be beneficial.