Abstract
The study examines the effectiveness of home treatment in 70 children and adolescents (aged 6–17 years) with heterogeneous psychiatric disorders. Home treatment was offered to parents/children as an alternative to inpatient treatment (no randomized group assignment). Interventions were carried out by psychiatric nurses (n = 38) and medical students (n = 32) under the supervision of experienced child psychiatrists. Assessment of treatment effects was based on a structured parent interview and parents’, children’s and therapists’ ratings of various aspects of psychosocial functioning. Pre- or post-treatment comparisons indicate significant improvement of psychiatric symptoms, severity of the disorder, and psychosocial adjustment after three months of home-based interventions. Outcome of behavioral interventions carried out by experienced nurses was superior, compared to treatment effects achieved by advanced medical students. Post-treatment comparison of home-based (n = 70) and inpatient-based (n = 35) treatment effects suggests that inpatient treatment all in all was more effective. At one-year follow-up, however, the effects of home treatment were maintained in a higher number of patients, compared to the stability of effects seen after psychiatric hospitalization. Thus, home treatment appears to be an effective treatment setting. Motivation and compliance of patient and parents, and high skills of the therapists are key ingredients for the success of a home-based treatment program.
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Abbreviations
- HT::
-
Home-treated patients
- Comp::
-
Comparison group: inpatients
- MEI::
-
Mannheim Parent Interview (Mannheimer Eltern-Interview)
- SGKJ::
-
Global Assessment Scale for Children and Adolescents (Skala zur Gesamtbeurteilung von Kindern und Jugendlichen)
References
Blanz B, Schmidt MH (2000) Practitioner review: preconditions and outcome of inpatient treatment in child and adolescent psychiatry. J Child Psychol Psychiatry 41:703–712
Catty J, Burns T, Knapp M, Watt H, Wright C, Henderson J, Healey A (2002) Home treatment for mental health problems: a systematic review. Psychol Med 32:383–401
Esser G, Blanz B, Geisel B, Laucht M (1989) Mannheimer Eltern-Interview MEI [Mannheim Parent Interview MEI]. Beltz, Göttingen
Göpel C, Schmidt MH, Blanz B, Rettig B (1996) Behandlung hyperkinetischer Kinder im häuslichen Milieu [Home treatment of children with hyper-kinetic disorders]. Z Kinder Jugendpsychiatr 24:192–202
Henggeler SW, Rowland MD, Randall J, Ward DM, Pickrel SG, Cunningham PB, Miller SL, Edwards JE, Zealberg JJ, Hand LD, Santos AB (1999) Home-based multisystemic therapy as an alternative to the hospitalization of youths in psychiatric crisis: clinical outcomes. J Am Child Adolesc Psychiatry 38:1331–1339
Ihle W, Esser G, Schmidt MH (1995) Die Bedeutung seelischer Gesundheit für den Schulerfolg. Z Kinder Jugendpsychiatr 23(Supplement 1):37
Internationale Klassifikation psychischer Störungen ICD−10. Kapitel V (F) klinisch-diagnostische Leitlinien (1991) [Tenth Revision of the International Classification of Diseases, Chapter V (F): Mental and behavioural disorders]. Dilling H, Mombour W, Schmidt MH (eds). Huber, Bern
Kleining G, Moore H (1968) Soziale Selbsteinstufung (SSE). Ein Instrument zur Messung sozialer Schichten [Social self-rating (SSE): an instrument for the measurement of social classes]. Kölner Z Soziol Sozialpsychol 20:502–552
Lay B, Blanz B, Schmidt MH (2001) Effectiveness of home treatment in children and adolescents with externalizing psychiatric disorders. Eur Child Adolesc Psychiatry 10(Suppl. 1):80–90
Marcus A, Blanz B, Esser G, Niemeyer J, Schmidt MH (1993) Beurteilung des Funktionsniveaus bei Kindern und Jugendlichen mit psychischen Störungen [Assessment of the level of functioning in children and adolescents with psychiatric disorder]. Kindheit Entwicklung 2:166–172
Mattejat F, Hirsch O, Remschmidt H (2003) Die Nutzung von Telefoninter-views für die Qualitätssicherung und Therapieevaluation in der Kinder- und Jugendpsychiatrie: Literaturübersicht und empirische Ergebnisse zur Teilnahmequote und zu möglichen Stichprobenverzerrungen. Z Kinder Jugendpsychiatr psychother 31:17–34
Muellerpoths (2001) Kostenerfassung der Behandlung im häuslichen Rahmen in der Kinder- und Jugendpsychiatrie. Medizinische Dissertation, Universität Heidelberg
Remschmidt H, Schmidt MH (1986) Multiaxiales Klassifikationsschema für psychiatrische Erkrankungen im Kindes- und Jugendalter nach Rutter, Shaffer & Sturge [Multiaxial classification scheme for psychiatric diseases in children and adolescents according to Rutter, Shaffer & Sturge]. Huber, Bern
Remschmidt H, Schmidt MH (1988) Alternative Behandlungsformen in der Kinder- und Jugendpsychiatrie [Alternative treatments in child and adolescent psychiatry. A comparison of inpatient treatment, day care, and home treatment]. Enke, Stuttgart
Schoenwald SK, Ward DM, Henggeler SW, Rowland MD (2000) Multisystemic therapy versus hospitalization for crisis stabilization of youth: placement outcomes 4 months postreferral. Ment Health Serv Res 2:3–12
Shaffer D, Gould MS, Brasic J, Ambrosini P, Fisher P, Bird H, Aluwahlia S (1983) A children’s global assessment scale (CGAS). Arch Gen Psychiatry 40:1228–1231
Spinner K (2000) Indikationen für eine Behandlung im häuslichen Milieu. Medizinische Dissertation, Universität Heidelberg
Steinhausen HC (1985) Eine Skala zur Beurteilung psychisch gestörter Kinder und Jugendlicher [A scale for assessing psychiatric disorders in children and adolescents]. Z Kinder Jugendpsychiatr 13:230–240
Winsberg BG, Bialer I, Kupietz S, Botti E, Balka EB (1980) Home vs hospital care of children with behavior disorders. Arch Gen Psychiatry 37:413–418
Woolston JL, Berkowitz SJ, Schaefer MC, Adnopoz JA (1998) Intensive, integrated, inhome psychiatric services. Child Adolesc Psychiatr Clin N Am 7:615–633
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Schmidt, M.H., Lay, B., Göpel, C. et al. Home treatment for children and adolescents with psychiatric disorders. Eur Child Adolesc Psychiatry 15, 265–276 (2006). https://doi.org/10.1007/s00787-006-0531-x
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DOI: https://doi.org/10.1007/s00787-006-0531-x