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.

Journal article


Ougrin, D., Corrigall, R., Stahl, D., Poole, J., Zundel, T., Wait, M., Slater, V., Reavey, P., Byford, S., Ivens, J., Crommelin, M., Hayes, D., Middleton, K., Young, P. and Taylor, E. (2020). 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. European Child & Adolescent Psychiatry. https://doi.org/10.1007/s00787-020-01617-1
AuthorsOugrin, D., Corrigall, R., Stahl, D., Poole, J., Zundel, T., Wait, M., Slater, V., Reavey, P., Byford, S., Ivens, J., Crommelin, M., Hayes, D., Middleton, K., Young, P. and Taylor, E.
Abstract

Background: 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. Aim: 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. Method: 106 patients aged 12-18 admitted for psychiatric inpatient care were randomised (1:1) to either ICCS or TAU. Six months after randomization, 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.
Results: 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 (5 or more) of self-harm (OR=0·18, 95% CI: 0·05 to 0·64). Patients admitted to private inpatient units spent on average 118.4 (95% CI: 28·2 to 208.6) fewer days in hospitals if they were in the ICCS group compared to TAU.
Conclusion: 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.

Year2020
JournalEuropean Child & Adolescent Psychiatry
PublisherSpringer
Digital Object Identifier (DOI)https://doi.org/10.1007/s00787-020-01617-1
Publication dates
Print04 Aug 2020
Publication process dates
Accepted02 Mar 2020
Deposited10 Sep 2020
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