The benefits of an adolescent psychiatric day service: the Harrow experience – a pilot study

Abstract

PurposeThe purpose of this study is to describe the characteristics of severely psychiatrically impaired adolescents requiring day hospital management and the effectiveness of the service using standardised outcome measures.Design/methodology/approachThe data was collected on adolescents aged 13‐17 years in two London boroughs, attending the day service over a period of one year. Outcome measures were HoNOSCA, CGAS, SDQ and qualitative data from feedback forms from adolescents and parents.FindingsThe adolescents (n=22) had varied disorders, but mainly depression, (n=9) and psychosis (n=4). HoNOSCA score on admission was mean 18.14 (SD 3.78) but by discharge it had reduced to mean 15.39 (SD 7.31) (p=0.07), and CGAS reduced from initial mean score of 43.83 (SD 9.90) to 53.17 (SD 12.04) (p=0.003). Attendance for 19 (86 per cent) adolescents was for less than six months. Following discharge 14 (64 per cent) returned to education or employment. Adolescents and their carers reported high levels of satisfaction. The findings indicate substantial improvement and satisfaction with the service. The size of the improvement in outcome scores and the consistency across the HoNOSCA and CGAS associated with high service satisfaction also suggest that the data is reliable.Research limitations/implicationsThe small size of the sample and loss of data made it difficult to extrapolate from the results to other groups of impaired adolescents. There was no control group in the study and therefore it was not possible to demonstrate whether the improvement was due to spontaneous changes over time, Tier 3 CAMHS input or the attendance at the day service. It is difficult to demonstrate what proportion of adolescents who were admitted to the day service would have required a Tier 4 in patient admission had the service not been available. A larger study using a more robust design involving randomisation to the day‐service or in‐patient service would provide important comparative data regarding the service benefits.Originality/valueCurrently there is little provision for severely psychiatrically impaired adolescents who require a day treatment programme. Day patient programmes appear to offer a useful and accessible treatment method. The service is much cheaper than an in‐patient service, and may also reduce the demands for or duration of inpatient admission. Unfortunately the service did not obtain continuation funding in view of NHS funding cuts, rather than dissatisfaction by local commissioners, and so needed to close. The data presented here can hopefully be used to support the case for child and adolescent psychiatric day programmes.

The systemic value of integrating an adolescent day service into an inpatient service: A qualitative case study

“…They run as a standalone service or in collaboration with inpatient services (IPSs) (Thapar et al, 2017). They are distinct from other alternative Tier 4 Child and Adolescent Mental Health Services (CAMHS) as they provide the highest level of direct therapeutic support outside of IPSs at a fraction of the cost (Tovey et al, 2012).…”

“…For instance, some DSs are disorder specific (Chinnery, 2015), whilst others treat a variety of mental health disorders (Thatte et al, 2013). Some DSs are open five days per week (Thatte et al, 2013), whilst others are only open for three (Tovey et al, 2012). In addition, some DSs have a rolling intake (McCrossan et al, 2017), whilst others have a fixed cohort of patients who must start at the same time (Kennair et al, 2011).…”

“…This study provides the first analysed qualitative investigation into the value of adolescent DSs. Previous evidence is grounded in descriptive (McDougall et al, 2008;Thapar et al, 2017) and verbatim evidence (Durbin et al, 2017;Tovey et al, 2012). Thus, the sound methodological rigour used to carry out the research (Braun & Clarke, 2006), combined with the safeguards put in place to mitigate for bias (Creswell & Miller, 2000;Krefting, 1991;Lincoln & Guba, 1985) ensure that the study's findings are credible.…”

“…The variety of outcome measurements used to assess the effectiveness of DSs also poses a significant issue for the accurate cross comparison of studies. For example, one study used the Health of the National Outcome Scales for Children and Adolescents (hoNOSCA) (Tovey et al, 2012), whilst another used the Child and Adolescent Functional Assessment Scale (CAFAS) (Thatte et al, 2013). Given that each outcome measure records slightly different parameters relating to young people (e.g.…”

“…Its findings provided limited insight into the benefits or effectiveness of DSs. Two other studies have sought the qualitative perspectives of young people, parents and carers through DS surveys (Durbin et al, 2017; Tovey et al, 2012); however, these did not provide qualitative analysis. Overall, survey feedback highlighted positive experiences of the DSs in both studies.…”