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Behandelt zu Hause Gesund werden

Hometreatment in Verzahnung mit Klinikelementen, Chancen und Herausforderungen

Published Online:https://doi.org/10.1024/1422-4917/a000267

Fragestellung: Evaluation zweier Behandlungsformen für psychisch erkrankte Kinder und Jugendliche mit Indikation zur stationären Behandlung: (1) verkürzter stationärer Aufenthalt mit sich anschließender Hometreatmentbehandlung verzahnt mit Klinikelementen aus dem stationären Spektrum (BeZuHG = Behandelt zu Hause gesund werden) (2) stationäre Regelbehandlung (TAU). Methodik: 100 konsekutiv stationär aufgenommene Kinder und Jugendliche wurden in die Studie eingeschlossen und in die Interventionsgruppe (BeZuHG) oder die Kontrollgruppe (stationäre Behandlung) randomisiert. Soziodemographische Daten, ICD-10 und DSM-IV Diagnose, Fragebögen zum psychosozialen Funktionsniveau, Schwere der Symptomatik und Ausmaß der Beeinträchtigung vor und nach der Behandlung wurden erhoben und in Bezug auf Machbarkeit, Outcome, Kontaktfrequenz und Akzeptanz der Familien für beide Behandlungsformen evaluiert. Ergebnisse: Patienten der BeZuHG-Behandlung zeigten gleich gute Behandlungs-Ergebnisse wie stationär behandelte Patienten bei gleichzeitig signifikanter Reduktion der stationären Verweildauer in der BeZuHG-Gruppe. Eine Akzeptanz des BeZuHG-Settings war von den Familien gegeben, eine bessere Einbindung der Eltern in die Behandlung war möglich. Schlussfolgerungen: Sektorenübergreifende Konzepte sollten regelhaft in das Spektrum kinder- und jugendpsychiatrischer Behandlungen integriert werden. Weitere Evaluation ist erforderlich, die Stabilität des Behandlungsergebnisses muss in einem 1-Jahres-Follow-up überprüft werden.


Effectiveness of hometreatment in light of clinical elements, chances, and limitations

Objective: The main objective was to evaluate two models of care for children and adolescents requiring hospitalization due to severe mental illness. Model 1: early discharge followed by a newly established home treatment service enhanced by clinical elements according to need (BeZuHG); Model 2: admission to an inpatient unit (TAU). Methods: 100 children and adolescents admitted to inpatient care were randomized to either a control group (regular inpatient stay) or an intervention group (BeZuHG group). Sociodemographic data, ICD-10 and DSM-IV diagnoses, health and social functioning, psychopathology, clinical impairment, and service use were assessed pre- and posttreatment regarding effectiveness, outcome, contact time, and acceptance within the families. Results: Clinical outcome in BeZuHG treatment was as effective as inpatient care. There was a good acceptance within the families, family resources enhanced treatment outcome, and a significant reduction in length of inpatient stay could be shown. Conclusions: The BeZuHG model should be a regular option in child and adolescent psychiatric care. Further rigorous evaluation of the model is required: A 1-year follow-up investigating the stability of the shown effects is planned.

Literatur

  • Baier, V. , Favrod, J. , Ferrari, P. , Koch, N. , Holzer, L. (2013). Early tailored assertive community case management for hard-to-engage adolescents suffering from psychiatric disorders. Early Intervention in Psychiatry, 7, 94–99. First citation in articleCrossrefGoogle Scholar

  • Barkmann, C. , Marutt, K. , Forouher, N. , Schulte-Markwort, M. (2003). Planning and implementation of evaluation studies in child and adolescent psychiatry. Praxis Kinderpsychologie Kinderpsychiatrie, 52, 517–33. First citation in articleMedlineGoogle Scholar

  • Bird, H. R. , Shaffer, D. , Fisher, P. , Gould, M. S. , Staghezza, B. , Chen, J. Y. et al. (1993). The Columbia Impairment Scale (CIS): Pilot findings on a measure of global impairment for children and adolescents. International Journal of Methods in Psychiatric Research, 3, 167–176. First citation in articleGoogle Scholar

  • Bird, H. R. , Andrews, H. , Schwab-Stone, M. , Goodman, S. , Dulcan, M. , Richters, J. et al. (1996). Global measure of impairment for epidemiologic and clinical use with children and adolescents. Journal of Methods in Psychiatric Research, 6, 295–307. First citation in articleCrossrefGoogle Scholar

  • Bjorklund, R. W. , Monroe-DeVita, M. M. , Reed, D. , Toulon, A. , Morse, G. (2009). Washington state’s initiative to disseminate and implement high-fidelity ACT teams. Psychiatric Services, 60, 24–28. First citation in articleCrossref MedlineGoogle Scholar

  • Borduin, C. M. , Schaeffer, C. M. , Heiblum, N. (2009). A randomized clinical trial of multisystemic therapy with juvenile sexual offenders: effects on youth social ecology and criminal activity. Journal of Consulting and Clinical Psychology, 77, 26–37. First citation in articleCrossref MedlineGoogle Scholar

  • Brann, P. , Coleman, G. , Luk, E. (2001). Routine outcome measurement in a child and adolescent mental health service: An evaluation of HoNOSCA. Australian and New Zealand Journal of Psychiatry, 35, 370–376. First citation in articleCrossref MedlineGoogle Scholar

  • Burns, T. , Catty, J. , Dash, M. , Roberts, C. , Lockwood, A. , Marshal, M. (2007). Use of intensive case management to reduce time in hospital in people with severe mental illness: Systematic review and meta-regression. British Medical Journal, 335, 336–340. First citation in articleCrossref MedlineGoogle Scholar

  • Delmo, C. , Weiffenbach, O. , Gabriel, M. , Stadler, C. , Poustka, F. (2001). Diagnostisches Interview. Kiddie-Sads-Present- and Lifetime Version (K-SADS-PL). 5. Auflage der deutschen Forschungsversion, erweitert um ICD-10-Diagnostik 2001. Frankfurt a. M.: Klinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters. First citation in articleGoogle Scholar

  • Fam, J. , Lee, C. , Lim, B. L. , Lee, K. K. (2007). ACT in Singapore: A 1-year follow-up study. Annals of the Academy of Medicine (Singapore), 36, 409–412. First citation in articleMedlineGoogle Scholar

  • George, L. , Durbin, J. , Koegl, C. J. (2009). System-wide implementation of ACT in Ontario: An ongoing improvement effort. The Journal of Behavioral Health Services and Research, 36, 309–319. First citation in articleCrossref MedlineGoogle Scholar

  • Gowers, S. G. , Harrington, R. C. , Whitton, A. , Lelliott, P. , Beevor, A. , Wing, J. et al. (1999). Brief scale for measuring the outcomes of emotional and behavioural disorders in children: Health of the Nation Outcome Scales for children and Adolescents (HoNOSCA). British Journal of Psychiatry, 174, 413–416. First citation in articleCrossref MedlineGoogle Scholar

  • Henggeler, S. W. , Rowland, M. D. , Randall, J. , Ward, D. M. , Pickrel, S. G. , Cunningham, P. B. et al. (1999). Home-based multisystemic therapy as an alternative to the hospitalization of youths in psychiatric crisis: Clinical outcomes. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1331–1339. First citation in articleCrossref MedlineGoogle Scholar

  • Ihle, W. , Esser, G. (2002). Epidemiologie psychischer Störungen im Kindes- und Jugendalter: Prävalenz, Verlauf, Komorbidität und Geschlechtsunterschiede. Psychologische Rundschau, 53, 159–169. First citation in articleLinkGoogle Scholar

  • Ito, J. (2009). Realization of Assertive Community Treatment in Japan. Seishin Shinkeigaku Zasshi – Psychiatria et Neurologia Japonica, 111, 313–318. First citation in articleMedlineGoogle Scholar

  • Jenner, J. A. (2008). Assertive community treatment in the Netherlands. Acta Psychiatrica Scandinavica, 117, 76–77. First citation in articleMedlineGoogle Scholar

  • Joy, C. B. , Adams, C. E. , Rice, K. (2006). Crisis intervention for people with severe mental illnesses. Cochrane Database of Systematic Reviews, CD001087. First citation in articleGoogle Scholar

  • Killaspy, H. , Kingett, S. , Bebbington, P. , Blizard, R. , Johnson, S. , Nolan, F. et al. (2009). Randomised evaluation of ACT:3-year outcomes. British Journal of Psychiatry,195, 81–82. First citation in articleCrossrefGoogle Scholar

  • Klasen, H. , Woerner, W. , Rothenberger, A. , Goodman, R. (2003). Die deutsche Fassung des Strengths and Difficulties Questionnaire (SDQ-Deu) – Übersicht und Bewertung erster Validierungs- und Normierungsbefunde. Praxis der Kinderpsychologie und Kinderpsychiatrie, 52, 491–502. First citation in articleMedlineGoogle Scholar

  • Lamb, C. E. (2009). Alternatives to admission for children and adolescents: providing intensive mental healthcare services at home & in communities: What works? Current Opinion in Psychiatry, 22, 345–350. First citation in articleCrossref MedlineGoogle Scholar

  • Marshall, M. , Lockwood, A. (2000). Assertive community treatment for people with severe mental disorders. Cochrane Database of Systematic Reviews, CD001089. First citation in articleGoogle Scholar

  • Mattejat, F. , Hirt, B. R. , Wilken, J. , Schmidt, M. H. , Remschmidt, H. (2001). Efficacy of inpatient and home treatment in psychiatrically disturbed children and adolescents. Follow-up assessment of the results of a controlled treatment study. European Child and Adolescent Psychiatry, 10(Suppl. 1), I71–I79. First citation in articleGoogle Scholar

  • McCrone, P. , Killaspy, H. , Bebbington, P. , Johnson, S. , Nolan, F. , Pilling, S. et al. (2009). The REACT study: Cost effectiveness analysis of assertive community treatment in North London. Psychiatric Services, 60, 908–913. First citation in articleCrossref MedlineGoogle Scholar

  • Petermann, F. (2005). Zur Epidemiologie psychischer Störungen im Kindes- und Jugendalter – eine Bestandsaufnahme. Kindheit und Entwicklung, 14, 48–57. First citation in articleLinkGoogle Scholar

  • Ougrin, D. , Zundel, T. , Corrigal, R. , Padmore, J. , Loh, C. (2013). Pilot evaluation of the supported discharge service (SDS): Clinical outcomes and use. Child and Adolescent Mental Health, online Aug. 2013. doi 10.1111/camh.12038 First citation in articleGoogle Scholar

  • Ravens-Sieberer, U. , Wille, N. , Erhard, M. , Bettge, S. , Wittchen, H. U., Rothenberger, A. et al. (2008). Prevalence of mental health problems among children and adolescents in Germany: Results of the BELLA study within the National Health Interview and Examination Survey. European Child and Adolescent Psychiatry, 17(Suppl 1), 22–33. First citation in articleCrossref MedlineGoogle Scholar

  • Rhiner, B. , Graf, T. , Dammann, G. , Furstenau, U. (2011). Multisystemic therapy for adolescents in Switzerland – Implementation and first results. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 39, 33–9. First citation in articleLinkGoogle Scholar

  • Schmidt, M. H. , Lay, B. , Göpel, C. , Naab, S. , Blanz, B. (2006). Home treatment for children and adolescents with psychiatric disorders. European Child & Adolescent Psychiatry, 15, 265–76. First citation in articleCrossref MedlineGoogle Scholar

  • Shaffer, D. , Gould, M. S. , Brasic, J. , Ambrosini, P. , Fisher, P. , Bird, H. et al. (1983). A children’s global assessment scale. Archives of General Psychiatry, 40, 1228–1231. First citation in articleCrossref MedlineGoogle Scholar

  • Shepperd, S. , Gowers, G. , James, T. (2008). Systematic review and mapping study of alternatives to inpatient care for children and adolescents with complex mental health needs. Report for the National Institute for Health Research Service Delivery and Organisation Programme. London: NCCSDO. First citation in articleGoogle Scholar

  • Sytema, S. , Wunderink, L. , Bloemers, W. , Roorda, L. , Wiersma, D. (2007). ACT in the Netherlands: A randomised controlled trial. Acta Psychiatrica Scandinavica, 116, 105–112. First citation in articleCrossref MedlineGoogle Scholar

  • Tyrer, P. , Balod, A. , Germanavicius, A. , McDonald, A. , Varadan, M. , Thomas, J. (2007). Perceptions of assertive community treatment in the UK and Lithuania. International Journal of Social Psychiatry, 53, 498–506. First citation in articleCrossref MedlineGoogle Scholar

  • Verhaegh, M. J. M. , Bongers, I. M. B. , Kroon, H. , Garretsen, H. F. L. (2007). Assertive community treatment for patients with a first episode psychosis: Model fidelity and specific adaptations for particular target groups. Tijdschrift voor Psychiatrie, 49, 789–798. First citation in articleMedlineGoogle Scholar

  • Walter, R. , Kampert, K. , Remschmidt, H. (1988). Evaluation der kinder- und jugendpsychiatrischen Versorgung in drei hessischen Landkreisen. Praxis Kinderpsychologie Kinderpsychiatrie, 37, 2–11. First citation in articleMedlineGoogle Scholar

  • Woolston, J. L. , Adnopoz, J. A. , Berkowitz, S. J. (2007). IICAPS – A home-based psychiatric treatment for children and adolescents. New Haven, CT: Yale University Press. First citation in articleGoogle Scholar

  • Yates, P. , Garralda, M. E. , Higginson, I. (1999). Paddington Complexity Scale and Health of the Nation Outcome Scales for Children and Adolescents. British Journal of Psychiatry, 174, 417–423. First citation in articleCrossref MedlineGoogle Scholar