Effectiveness of home treatment in children and adolescents with psychiatric disorders-systematic review and meta-analysis.

BACKGROUND: Home treatment in child and adolescent psychiatry offers an alternative to conventional inpatient treatment by involving the patient's family, school, and peers more directly in therapy. Although several reviews have summarised existing home treatment programmes, evidence of their effectiveness remains limited and data synthesis is lacking. METHODS: We conducted a meta-analysis on the effectiveness of home treatment compared with inpatient treatment in child and adolescent psychiatry, based on a systematic search of four databases (PubMed, CINAHL, PsychINFO, Embase). Primary outcomes were psychosocial functioning and psychopathology. Additional outcomes included treatment satisfaction, duration, costs, and readmission rates. Group differences were expressed as standardised mean differences (SMD) in change scores. We used three-level random-effects meta-analysis and meta-regression and conducted both superiority and non-inferiority testing. RESULTS: We included 30 studies from 13 non-overlapping samples, providing data from 1795 individuals (mean age: 11.95 ± 2.33 years; 42.5% female). We found no significant differences between home and inpatient treatment for postline psychosocial functioning (SMD = 0.05 [- 0.18; 0.30], p = 0.68, I2 = 98.0%) and psychopathology (SMD = 0.10 [- 0.17; 0.37], p = 0.44, I2 = 98.3%). Similar results were observed from follow-up data and non-inferiority testing. Meta-regression showed better outcomes for patient groups with higher levels of psychopathology at baseline and favoured home treatment over inpatient treatment when only randomised controlled trials were considered. CONCLUSIONS: This meta-analysis found no evidence that home treatment is less effective than conventional inpatient treatment, highlighting its potential as an effective alternative in child and adolescent psychiatry. The generalisability of these findings is reduced by limitations in the existing literature, and further research is needed to better understand which patients benefit most from home treatment. TRIAL REGISTRATION: Registered at PROSPERO (CRD42020177558), July 5, 2020.

Intensive community care services for children and young people in psychiatric crisis: an expert opinion.

BACKGROUND: Children and young people's (CYP) mental health is worsening, and an increasing number are seeking psychiatric and mental health care. Whilst many CYPs with low-to-medium levels of psychiatric distress can be treated in outpatient services, CYPs in crisis often require inpatient hospital treatment. Although necessary in many cases, inpatient care can be distressing for CYPs and their families. Amongst other things, inpatient stays often isolate CYPs from their support networks and disrupt their education. In response to such limitations, and in order to effectively support CYPs with complex mental health needs, intensive community-based treatment models, which are known in this paper as intensive community care services (ICCS), have been developed. Although ICCS have been developed in a number of settings, there is, at present, little to no consensus of what ICCS entails. METHODS: A group of child and adolescent mental health clinicians, researchers and academics convened in London in January 2023. They met to discuss and agree upon the minimum requirements of ICCS. The discussion was semi-structured and used the Dartmouth Assertive Community Treatment Fidelity Scale as a framework. Following the meeting, the agreed features of ICCS, as described in this paper, were written up. RESULTS: ICCS was defined as a service which provides treatment primarily outside of hospital in community settings such as the school or home. Alongside this, ICCS should provide at least some out-of-hours support, and a minimum of 90% of CYPs should be supported at least twice per week. The maximum caseload should be approximately 5 clients per full time equivalent (FTE), and the minimum number of staff for an ICCS team should be 4 FTE. The group also confirmed the importance of supporting CYPs engagement with their communities and the need to remain flexible in treatment provision. Finally, the importance of robust evaluation utilising tools including the Children's Global Assessment Scale were agreed. CONCLUSIONS: This paper presents the agreed minimum requirements of intensive community-based psychiatric care. Using the parameters laid out herein, clinicians, academics, and related colleagues working in ICCS should seek to further develop the evidence base for this treatment model.

Self-Harm in Children and Adolescents Who Presented at Emergency Units During the COVID-19 Pandemic: An International Retrospective Cohort Study.

OBJECTIVE: To compare psychiatric emergencies and self-harm at emergency departments (EDs) 1 year into the pandemic, to early pandemic and pre-pandemic, and to examine the changes in the characteristics of self-harm presentations. METHOD: This retrospective cohort study expanded on the Pandemic-Related Emergency Psychiatric Presentations (PREP-kids) study. Routine record data in March to April of 2019, 2020, and 2021 from 62 EDs in 25 countries were included. ED presentations made by children and adolescents for any mental health reasons were analyzed. RESULTS: Altogether, 8,174 psychiatric presentations were recorded (63.5% female; mean [SD] age, 14.3 [2.6] years), 3,742 of which were self-harm presentations. Rate of psychiatric ED presentations in March to April 2021 was twice as high as in March to April 2020 (incidence rate ratio [IRR], 1.93; 95% CI, 1.60-2.33), and 50% higher than in March to April 2019 (IRR, 1.51; 95% CI, 1.25-1.81). Rate of self-harm presentations doubled between March to April 2020 and March to April 2021 (IRR, 1.98; 95% CI, 1.68-2.34), and was overall 1.7 times higher than in March to April 2019 (IRR, 1.70; 95% CI, 1.44-2.00). Comparing self-harm characteristics in March to April 2021 with March to April 2019, self-harm contributed to a higher proportion of all psychiatric presentations (odds ratio [OR], 1.30; 95% CI, 1.05-1.62), whereas female representation in self-harm presentations doubled (OR, 1.98; 95% CI, 1.45-2.72) and follow-up appointments were offered 4 times as often (OR, 4.46; 95% CI, 2.32-8.58). CONCLUSION: Increased pediatric ED visits for both self-harm and psychiatric reasons were observed, suggesting potential deterioration in child mental health. Self-harm in girls possibly increased and needs to be prioritized. Clinical services should continue using follow-up appointments to support discharge from EDs. DIVERSITY & INCLUSION STATEMENT: One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.

Pilot Study: Cut the Cut-A Treatment Program for Adolescent Inpatients with Nonsuicidal Self-Injury.

Non-suicidal-self-injury (NSSI) in adolescents needing inpatient treatment is a serious health risk behaviour. NSSI-specific treatment programs for inpatients hardly exist. "Cut the Cut" (CTC) is a new treatment program in intervals, addressing this problem. Aim of this pilot-study was to evaluate acceptability and feasibility of CTC. 23 female inpatients (12 CTC, 11 control, aged 15-17; mean = 16.80, SD.70) engaging in NSSI were evaluated for service user satisfaction, frequency, and severity of NSSI at T1 (admission), T2 (discharge after interval 1, CTC-group) and T3 (discharge). A qualitative interview was performed at T3. Significant improvement in NSSI-frequency was given (T1-T3: CTC p = 0.010; control p = 0.038). Severity of NSSI reduced slightly (mild NSSI: CTC p = 0.022, control p = 0.087; severe NSSI: CTC p = 0.111, control p = 0.066). Satisfaction of parents (T3 mean 28.38) and adolescents (T3 mean 26.11) in CTC was rated high. CTC is a feasible treatment option for inpatients engaging in NSSI. Further studies over time are needed.Trial registration Number DRKS00016762, 05.03.2019, retrospectively registered.

Long-term outcome of intensive home treatment for children and adolescents with mental health problems - 4 years after a randomized controlled clinical trial.

BACKGROUND: Admission rates to child and adolescent mental health inpatient units in Germany are substantial (58.831 admissions in 2019). Historically, different treatment pathways have not been available. The evidence suggests that home treatment could be an alternative. The objective of this study was to assess the long-term stability of treatment gains among children and adolescents treated for serious mental health problems with home treatment (HT) as compared with inpatient treatment-as-usual (TAU). METHODS: Hundred patients were enrolled and randomized into an intervention (HT n = 54) and control group (TAU n = 46). Follow-up data were available after 8.4 months (n = 78) (T3) and after 4.3 years (n = 51) (T4). The primary outcome measured was overall level of functioning, for which the Children's Global Assessment Scale (CGAS) was used. Secondary outcomes included severity of patient impairment and parental competency in dealing with their child's symptoms, measured using the Health of the Nation Outcome Scales (HoNOSCA). A qualitative interview with parents was performed at T3 and T4. RESULTS: Treatment effects remained stable for both groups at T3 and T4 (p < .001). After 4.3 years 70% of the parents in the intervention group stated satisfaction with the treatment received, while only 36.8% of the parents within the control group rated themselves as satisfied. 43.7% of parents in the home treatment group reported that the most helpful aspect of this pathway was the prompt and intensive professional help and advice they received as primary caregivers at home. CONCLUSIONS: Home treatment may be considered a viable alternative to inpatient care.

Debate: Quantity of impatient beds and quality of child psychiatric and psychotherapeutic care provision - a German perspective.

Provision of care for children with mental health disorders or behavioural difficulties differs from country to country. Historically, Germany has the highest number of inpatient beds throughout Europe (64 inpatient beds per 100,000 young people). In addition, nearly 146 departments for child and adolescent psychiatry offer day-care beds as well as ambulatory care. A high number of resident child and adolescent psychiatrists/psychotherapists (more than 12,000 professionals) complement provision of care in the different regions of Germany. Yet, only 50% of children and adolescents with mental health problems receive the treatment they need. Barriers to care - for example lack of transportation, fear of stigmatization, long distances in rural regions or fear of long hospital inpatient stays - keep families from presenting their child/adolescent to the relevant institutions. Recently, a new treatment module: StäB, an intensive daily home treatment, delivered by a multiprofessional team, has been added to the portfolio of treatment options in Germany. This closes the gap between highly intensive inpatient care and low-frequency outpatient treatment, allowing a continuum of care in intensity and frequency within the treatment alternatives.

[The Development of Medication and Psychotherapy from 1952 to 1957 in the Child and Adolescent Psychiatric Clinics Weissenau and Gütersloh]. / Die Entwicklung der Psycho- pharmakologischen Behandlung von 1952 bis 1957 in den kinder- und jugendpsychiatrischen Kliniken Weissenau und Gütersloh.

The Development of Medication and Psychotherapy from 1952 to 1957 in the Child and Adolescent Psychiatric Clinics Weissenau and Gütersloh Abstract. Objective: As a result of recent discussions concerning the misuse of medication in children in postwar Germany, the paper analyzes the treatment methods, especially psychopharmacotherapy, as well as therapeutic approaches employed in two German child and adolescent psychiatric hospitals (Weissenau and Guetersloh). We investigated the progression of prescription and the administration of psychotropic and experimental drugs between 1952 and 1957. Methods: In total, 966 health records were extensively studied for the time period in question. Results: The use of psychotropic drugs was similar in both hospitals, yet even at that time the use of already established psychotropic drugs differed depending on the concept. Medication-induced fever and shock therapy via insulin were still in use in 1957. Occasionally, initial concepts of a therapeutic treatment approach were observed. Both institutions administered experimental drugs, albeit not in systematic clinical trials. Conclusion: The varying methods of treatment and medication strategies reflect the different setup and concept of the respective hospitals. Indications of dangerous medication trials were not detected. Keywords: child and adolescence psychiatry, psychotropic drugs, neuroleptics, experimental drugs, treatment methods.

Therapeutic drug monitoring of children and adolescents treated with aripiprazole: observational results from routine patient care.

Although aripiprazole is one of the most used antipsychotics, knowledge about serum concentrations in children and adolescents is scarce and age-specific therapeutic ranges have not been established yet. Data of a routine therapeutic drug monitoring service were analyzed in order to evaluate the relationship between dose and serum concentration of aripiprazole in children and adolescents. The study also aimed to evaluate whether the therapeutic reference range defined for adults with schizophrenia (100-350 ng/ml) is applicable for minors. Data from 130 patients (aged 7-19 years) treated with aripiprazole for different indications in doses of 2-30 mg/day were evaluated. Patient characteristics, doses, serum concentrations and therapeutic outcome were assessed by standardized measures. A positive mean correlation between body weight-corrected daily dose and aripiprazole concentration was found (rp = 0.59, p < 0.001) with variation in dose explaining 35% of the variability in serum concentrations. Girls had on average 41% higher dose-corrected concentrations than boys (244.9 versus 173.4 mg/l; p = 0.006). Aripiprazole concentrations did not vary with co-medication (p = 0.22). About 70% of all measured serum concentrations were within the recommended therapeutic range for adults. Using a calculation method in all responding patients with an ICD-10 F2 diagnosis for a rough estimation of a preliminary therapeutic window also demonstrated a similar therapeutic range of aripiprazole in minors (105.9-375.3 ng/ml) than for adults. If confirmed in larger samples and more controlled study designs, these data may contribute to the definition of a therapeutic range of aripiprazole concentrations in children and adolescents.

[From home treatment to psychiatric ward-equivalent treatment (StäB) - A systematic review of outpatient treatment in Germany]. / Vom Hometreatment zur stationsäquivalenten Behandlung (StäB).

From home treatment to psychiatric ward-equivalent treatment (StäB) - A systematic review of outpatient treatment in Germany Abstract. Objective: In the past, home treatment was not available in Germany for children and adolescents with mental health problems. However, enactment of the PsychVVG law on 1 January 2017 has changed this, so that intensive home treatment (stationsäquivalente Behandlung, StäB) can now be offered as an alternative to inpatient treatment. This literature review a) analyzes existing German home treatment studies for effectiveness, b) determines from international reviews criteria for effective home treatment, and c) aligns these with the standardized StäB criteria. Method: We performed a systematic literature search in PubMed, Scopus, PsycINFO, and Cochrane Library referencing "hometreatment AND children" as well as "hometreatment AND adolesc*. Results: Flexibility, mobility, multiprofessionality, a wide spectrum of possible interventions, the option of inpatient admission, 24/7 availability as well as daily treatment sessions have been found to be factors for effective home treatment. In German studies, home treatment was shown to enhance psychosocial functioning, parental competences, long-term effectiveness, and acceptance by the families. The highest effect for home treatment was demonstrated in children and adolescents with externalizing disorders. Conclusion: Intensive home treatment (StäB) meets the criteria identified in the literature and is a good addition to existing treatment options for children and adolescents with mental health problems in Germany.

[Intensive outpatient treatment - a therapy option for all patients in child and adolescent psychiatry or just for a few?] / Kinder- und jugendpsychiatrische stationsäquivalente Behandlung (StäB): Therapieoption ­ für alle oder für wenige?

Intensive outpatient treatment - a therapy option for all patients in child and adolescent psychiatry or just for a few? Abstract. Objective: "Child and adolescent psychiatric ward-equivalent treatment" (= stationsäquivalente Behandlung, StäB) is an intensive daily home treatment that has now become available in Germany. Conditions for StäB services were negotiated were negotiated, authorized and came into force by German healthcare commissioners and hospitals on 1 January 2018. However, to date few hospitals in Germany offer StäB, and its feasibility has been questioned. This study evaluates the first 58 cases of StäB in the Department of Child and Adolescent Psychiatry, ZfP Südwürttemberg (2018-2019). Method: All patients admitted consecutively to StäB from 1 January 2018 to 15 August 2019 were included and evaluated solely using descriptive analyses in SPSS.25. Results: The average length of stay in StäB was 37.95 days (SD 15.35). 86.2 % of the families completed treatment, with 3 patients discontinuing treatment and 5 patients needing inpatient admission. Unlike in the literature, internalising disorders predominated (70.7 %), whereas externalizing disorders were diagnosed in only 27.8 % of the patients. The cost of treatment in StäB was on average 8779.25 €. Conclusions: StäB is a viable and well-accepted new treatment alternative for patients requiring inpatient admission. The multiprofessionality of treatment as well as daily contacts are required. Feasibility under the conditions set is given. The average length of stay is slightly longer, but the costs are lower than those of inpatient treatment.

CCSchool: a multicentre, prospective study on improving continuum of care in children and adolescents with mental health problems associated with school problems in Germany.

BACKGROUND: Most psychiatric disorders in childhood and adolescence cause impairment in academic performance. Early interventions in school are thought to reduce the burden of disorder and prevent chronicity of disorder, while a delay in reachable help may result in more severe symptoms upon first time presentation, often then causing upon first-time presentation immediate need of inpatient care. METHODS: The study aims at reducing hospitalization rates and increasing social participation and quality of life among children and adolescents by establishing collaborations between schools, mental health care services and youth welfare services. CCSchool offers children and adolescents, aged six to 18 years, who present with psychiatric problems associated to school problems, a standardized screening and diagnostic procedure as well as treatment in school if necessary. Students can participate in CCSchool in three federal states of Germany if they a) show symptoms vindicating a mental health diagnosis, b) present with confirmed school problems and c) have a level of general functioning below 70 on the children global assessment of Functioning (C-GAF). Intervention takes place in three steps: module A (expected n = 901, according to power calculation) with standardized diagnostic procedures; module B (expected n = 428) implies a school-based assessment followed by a first intervention; module C (expected n = 103) offering school-based interventions with either four to six sessions (basic, 80% of patients) or eight to 12 sessions (intensive, 20% of patients). Primary aim is to evaluate the effectiveness of CCSchool, in reducing the need of hospitalization in children with mental health problems. The analyses will be conducted by an independent institute using mainly data collected from patients and their caregivers during study participation. Additionally, claims data from statutory health insurances will be analysed. Relevant confounders will be controlled in all analyses. DISCUSSION: Evaluation may show if CCSchool can prevent hospitalizations, enhance social participation and improve quality of life of children and adolescents with mental health problems by providing early accessible interventions in the school setting. TRIAL REGISTRATION: Deutsches Register Klinischer Studien, Trial registration number: DRKS00014838 , registered on 6th of June 2018.

[Hometreatment- an effective alternative to inpatient treatment in child and adolescent psychiatry?]. / Hometreatment -Eine effektive Alternative zu konventionellen Behandlungsformen? .

In many countries hometreatment (HT) offers a cost-effective alternative to hospitalization for children and adolescents with mental health problems requiring intensive mental healthcare. However, the database on HT varies as HT may refer to different models and settings of intensive outpatient treatment. In Germany HT is not used routinely in mental healthcare in child and adolescent psychiatry, therefore the data on HT in Germany, especially in child and adolescent psychiatry, are scarce although funding for studies investigating the effectiveness of HT is available. This review represents a comprehensive search in electronic databases (1980-2014) of literature on HT. It provides as well an overview of the underlying concepts of and the present evidence for HT. In addition, the evidence base on HT for specific child and adolescent mental health disorders is reviewed. Future prospects for the development of HT in Germany facing the upcoming change in health service commissioning (PEPP = «pauschalierendes Entgeltsystem in Psychiatric und Psychosomatik>>) are discussed, as HT in child and adolescent psychiatry, when accurately indicated, can be a valid alternative to inpatient treatment.

The situation of former adolescent self-injurers as young adults: a follow-up study.

BACKGROUND: Nonsuicidal self-injury (NSSI) in adolescence has been described as comorbid condition in affective or anxiety disorders, as well as borderline personality disorder (BPD) and is a risk factor for later suicide attempts. Prevalence rates of NSSI decline steeply from adolescence to young adulthood. Yet, to the best of our knowledge, the longitudinal development of adolescent psychiatric patients with NSSI into their young adulthood has not been investigated. The aim of this study was to assess current NSSI and psychological impairment of young adults, who had been in treatment for NSSI in their adolescence. METHODS: Former patients of the departments of child and adolescent psychiatry and psychotherapy in Ulm and Ravensburg, Germany (N = 52), who presented with NSSI in their adolescence, were recruited (average age: 21.5 years (SD = 2.6)). Data was assessed using questionnaires and structured clinical interviews. Two groups of participants with prevailing NSSI and ceased NSSI were compared concerning their current psychological impairment, history of NSSI, suicide attempts, and BPD diagnosis. RESULTS: Around half of all participants had engaged in NSSI within the last year, and around half met diagnostic criteria for BPD. Although there was no significant association between current NSSI and BPD, an earlier age of onset of NSSI and a longer duration of NSSI during adolescence was significantly predictive of adult BPD. Two thirds of participants still met criteria of an axis 1 psychiatric disorder. Suicide attempts were reported by 53.8 % of all participants. Participants with current NSSI were more likely to meet criteria for a current axis 1 disorder, had engaged in NSSI more often in their lifetime, and reported more suicide attempts. CONCLUSIONS: Reduction of NSSI from adolescence to young adulthood was lower than described in previous community samples. This may be due to the initial high psychiatric impairment of this sample in adolescence. Early onset of NSSI seemed to be a risk factor for a longer duration of NSSI during adolescence but not for NSSI prevailing into adulthood. However, it was a risk factor for adult BPD. Furthermore, the occurrence of suicidal thoughts and behaviors and prevailing NSSI was highly associated.

[Home treatment - especially effective among boys with externalizing disorders? Age- and sex-specific effectiveness of home treatment for internalizing and externalizing disorders]. / Home treatment - insbesondere für expansive Jungen? Alters- und geschlechtsspezifische Wirksamkeit von Home treatment bei internalisierenden vs. externalisierenden Störungen.

OBJECTIVE: Indications for home treatment for specific diagnoses in child and adolescent psychiatry have not yet been evaluated. METHOD: In a recent intervention study (primary outcome: length of stay), 92 patients aged 5 to 17 years were randomized into an intervention group (early discharge followed by home treatment in combination with inpatient treatment, where needed) and a control group (regular length inpatient treatment). The aim of this explorative analysis was to retrieve additional information on "what works for whom." Outcome parameters were as follows: Children's Global Assessment Scale (CGAS), Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA), Strengths and Difficulties Questionnaire (SDQ) and Columbia Impairment Scale (CIS) at T1 (within 14 days after intake), T2 (end of treatment) and T3 (∅ 8.4-month follow-up). Multiple regression was used to investigate the association between diagnoses, treatment setting, age, sex, and improvement in both groups. RESULTS: In children externalizing disorders were predominant, whereas in adolescents internalizing disorders were prominent. Patients improved equally under both types of treatment. Home treatment, however, was rated by the patients to be significantly more effective in adolescents (SDQ p = .017), boys (CIS p = .009, SDQ p < .001), and with externalizing disorders (SDQ p = .005). CONCLUSIONS: Home treatment may be considered an alternative to inpatient treatment, especially in boys with externalizing disorders.

Pilot study: feasibility of using the Suicidal Ideation Questionnaire (SIQ) during acute suicidal crisis.

BACKGROUND: Assessing youths in acute suicidal crisis is a common jet pivotal task in child and adolescent psychiatry, usually relying primarily on the clinicians skills of assessment. The objective of this pilot-study was to evaluate feasibility and usefulness of questionnaires during assessment of youths in acute suicidal crisis. METHOD: 31 adolescents, presenting for suicide assessment, and their caregivers, were asked upon emergency presentation to fill in the Suicidal-Ideation-Questionnaire (SIQ) and the Youth Life Status Questionnaire (Y-LSQ) before receiving an assessment by a clinician. The SIQ has 30 items, 8 of which are defined as critical items able to predict suicidality with the highest probability. The Y-LSQ (30 items) measures the overall level of psychological distress. It has one suicidal item, which was used in this study for validation of the SIQ result. Clinical judgment and test results were collected and analyzed by an independent researcher. RESULTS: It was feasible to ask adolescents in acute suicidal crisis to fill in a questionnaire. Clinical assessment of suicidality did not correlate significantly with the overall SIQ-score (p = 0.089), however there was a significant correlation between the SIQ 8 critical item result and clinical judgement of suicidality (p = 0.050). CONCLUSION: The 8 critical SIQ items can be used to support clinical judgment of suicidality in acute crisis.

[Effectiveness of hometreatment in light of clinical elements, chances, and limitations]. / Behandelt zu Hause Gesund werden. Hometreatment in Verzahnung mit Klinikelementen, Chancen und Herausforderungen.

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.

Randomised controlled trial of therapeutic assessment versus usual assessment in adolescents with self-harm: 2-year follow-up.

BACKGROUND: An earlier randomised controlled trial demonstrated improved treatment engagement in adolescents who received Therapeutic Assessment (TA) versus Assessment As Usual (AAU), following an emergency presentation with self-harm. OBJECTIVES: To determine 2-year outcomes for the same adolescents focusing on frequency of Accident and Emergency (A&E) self-harm presentations and treatment engagement. METHOD: Patients in the TA groups (n=35) and the AAU group (n=34) were followed up 2 years after the initial assessment. Their primary and secondary care electronic records were analysed. RESULTS: There was no significant difference in the frequency of self-harm resulting in A&E presentations between the two groups (OR 0.69, 95% CI 0.23 to 2.13, p=0.53). Treatment engagement remained higher in the TA group than the AAU group. CONCLUSIONS: TA is not associated with a lower frequency of A&E self-harm presentations. The effect of TA on engagement is maintained 2 years after the initial assessment. Interventions to reduce self-harm in adolescents are needed. TRIAL REGISTRATION: ISRCTN 81605131, http://www.controlled-trials.com/ISRCTN81605131/

Brief report: the Self Harm Questionnaire: a new tool designed to improve identification of self harm in adolescents.

The Self Harm Questionnaire (SHQ) aiming at identification of self-harm in adolescents has been developed and piloted in a sample of 12-17 year olds (n = 100). The adolescents were recruited from both in- and outpatient psychiatric services. Concurrent validity of the SHQ was evaluated by comparing the SHQ results with recorded self harm in the entire clinical records, while the predictive value of the SHQ was assessed by reviewing the clinical records for further episodes of self harm after three months. 71% of the young people endorsed self harm on the SHQ. While 3% showed a false negative result on the SHQ, 20% of the participants disclosed self harm on the SHQ, which was not recorded in their clinical records. At three months follow up there was no statistically significant difference in either sensitivity .95, 95% CI [.72, 1.0] vs. .74, 95% CI [.49, .90] or specificity .35, 95% CI [.25, .46] vs. .51, 95% CI [.39, .62] between the SHQ and the entire clinical record in predicting future episodes of self harm. The SHQ is an important addition to the clinical repertoire designed to improve identification of self harm.