Service Evaluation of a Central and North West London Adolescent Home Treatment Team: A Five-Year Review

Abstract

This service evaluation reviews the first five years of the Adolescent Community Treatment Service (ACTS), an intensive community treatment team developed by Central and North West London (CNWL) NHS Foundation Trust to support children and young people (CYP) aged 13–17 in mental health crisis. Between July 2019 and July 2024, ACTS worked with 163 CYP. The service aimed to prevent psychiatric admissions and facilitate early discharge from inpatient units. ACTS avoided psychiatric inpatient admission for 58.2% of referrals to inpatient hospitals and supported 43 discharges of CYP from inpatient settings. Post-intervention, significant clinical improvements were observed, including reduced symptom severity, improved functioning, and enhanced educational engagement. Although primary diagnosis did not significantly relate to discharge destination, CYP presenting with greater symptom severity tended to require inpatient care. Findings support ACTS as a flexible, least-restrictive model for crisis intervention to inpatient care. This is consistent with NHS Long Term Plan priorities, but also underscores the ongoing need for inpatient services for those whose safety cannot be managed in the community. Further research is needed to explore long-term outcomes, economic impact, and tailored pathways for neurodivergent and minoritised groups.

Plain Language Summary

This report looks at the first five years of the Adolescent Community Treatment Service (ACTS), a team set up by the NHS in Central and North West London to support young people aged 13–17 going through a mental health crisis. The team works in the community to help avoid hospital admissions where possible, and to support young people leaving hospital so they can return home safely. Between July 2019 and July 2024, ACTS worked with 163 young people. Of those who were being considered for admission to hospital, ACTS helped 58% stay in the community instead. The team also supported 43 young people to leave hospital earlier and continue their recovery at home. Young people who worked with ACTS showed improvements after treatment, including fewer symptoms, better day-to-day functioning, and greater involvement in education. While a young person’s diagnosis alone did not determine whether they needed hospital care, those with more severe difficulties were more likely to need admission. Overall, the findings suggest ACTS is a flexible and effective way of providing intensive support in the community, in line with NHS priorities to use the least restrictive care possible. At the same time, there is still a need for hospital services for those whose risks are too high to be managed outside of inpatient care. More research is needed to understand the long-term benefits of ACTS, its cost-effectiveness, and how best to support young people with additional needs, such as neurodivergent or minoritised groups.