Innovations in Practice: Effectiveness of specialist adolescent outreach service for at-risk adolescents

Intensive Outreach for Mental Health: Young People's Experiences of an Intensive Outreach Model on Recovery and Engagement

Engagement with traditional mental health services can be particularly challenging for young people experiencing severe and complex mental health problems. Assertive community treatment-based services providing mobile outreach, such as Intensive Mobile Youth Outreach Services (IMYOS), operate across Australia to support these young people's mental health needs in the transition to adulthood. Past research on IMYOS has focused on quantitative outcome measures, and young people's experiences of this type of model are poorly understood. This study explored youth service users' experiences of an IMYOS program, focusing on the model and intervention aspects perceived as barriers and facilitators to their overall recovery and service engagement. Semi-structured, in-depth interviewing was undertaken with nine young people aged 16-19 years (M = 17.61 years) who were current or recent service users of an IMYOS program in Melbourne, Australia. Data were analysed using thematic analysis. Having a therapeutic space, clinicians' specialised expertise, use of an outreach and community-oriented approach, and care continuity and availability across settings were program aspects identified by young people as facilitating their recovery and service engagement. Program aspects perceived as barriers to recovery and engagement were clinical unsuitability and ineffectiveness of the program and interventions, and conflicts between personal autonomy and assertive care. Young people's perceptions of clinical suitability and therapeutic relevance influenced their evaluations of the overall effectiveness of the IMYOS service, which subsequently impacted their engagement. The findings provide opportunities for IMYOS clinicians to enhance young people's recovery and engagement outcomes and have implications for the improvement of this innovative service for at-risk young people.

The Impact of Community Mental Health Programs for Australian Youth: A Systematic Review

Australia has undergone significant youth mental health reform over the past 10 years, leading to numerous studies examining the effects of community-based mental health care programs for Australian youth. However, no synthesis of this literature currently exists. Therefore, this systematic review aimed to: (1) describe the types of community-based mental health programs that have been delivered to Australian youth in the past 10 years; and (2) examine their impact in improving young people’s mental health symptomology and psychosocial functioning. A systematic search of the peer-reviewed literature was conducted. Studies were included if they evaluated the extent to which such programs improved mental health symptomology (e.g., depression, anxiety, substance use) and/or psychosocial outcomes (e.g., social functioning, school engagement, employment) for Australian youth aged 10–25 years. Thirty-seven studies were included. Four types of community-based youth mental health care programs were identified: therapy (n = 16), case management (n = 9), integrated ‘one-stop-shop’ (n = 6) and lifestyle (n = 6) programs. The majority of therapeutic programs were effective in reducing mental health symptomology. Case management and integrated approaches consistently yielded significant improvements in both symptomology and psychosocial outcomes. Lifestyle programs were effective in alleviating depressive symptoms, but inconclusive for other outcomes. This review provides support for youth-friendly, systemic, multidisciplinary and integrated assertive outreach models of community mental health care to improve outcomes for young Australians experiencing mental health concerns. Several recommendations for future research are provided to strengthen the local evidence-base supporting community mental health programs to ultimately enhance young people’s life trajectory.

Review of services to inform clinical frameworks for adolescents and young adults with severe, persistent and complex mental illness

OBJECTIVE

Severe, persistent and complex mental illness (SPCMI) affects a small proportion of young people but is associated with severe disability and a large burden on families and health services. This article identifies and describes service models for adolescents and young adults with SPCMI.

METHODS

A systematic search was conducted for services for young people aged 12-25 years with SPCMI. The review sought service models providing extended care and/or multidisciplinary services to meet the complex and long-term needs of this population.

RESULTS

A total of 43 sources were identified. Evidence of effectiveness was found for both community- and bed-based services. Specific components suggested as important in service delivery included care provided by multidisciplinary teams, consumer and family involvement in care planning, intensive case management and service integration through the continuum of care.

CONCLUSION

Clinical frameworks for this population must incorporate effective community care integrated with inpatient treatment of short duration. Frameworks require consumer and family-centred care with flexibility to support progression through developmental stages and tasks while addressing issues related to risk management, fluctuation in illness severity and stages of recovery. A continuum of care is necessary to meet the needs that arise from SPCMI in adolescents and young adults.

The effect of youth assertive community treatment: a systematic PRISMA review

BACKGROUND

During the past decades deinstitutionalisation policies have led to a transition from inpatient towards community mental health care. Many European countries implement Assertive Community Treatment (ACT) as an alternative for inpatient care for "difficult to reach" children and adolescents with severe mental illness. ACT is a well-organized low-threshold treatment modality; patients are actively approached in their own environment, and efforts are undertaken to strengthen the patient's motivation for treatment. The assumption is that ACT may help to avoid psychiatric hospital admissions, enhance cost-effectiveness, stimulate social participation and support, and reduce stigma. ACT has been extensively investigated in adults with severe mental illness and various reviews support its effectiveness in this patient group. However, to date there is no review available regarding the effectiveness of youth-ACT. It is unknown whether youth-ACT is as effective as it is in adults. This review aims to assess the effects of youth-ACT on severity of psychiatric symptoms, general functioning, and psychiatric hospital admissions.

METHOD

A systematic literature search was conducted in PubMed, Cochrane Library, PsychINFO and CINAHL published up to March 2017. To assess methodological quality of the included studies, the Oxford Centre of Evidence-Based Medicine grading system was used.

RESULTS

Thirteen studies were included in this review. There are indications that youth-ACT is effective in reducing severity of psychiatric symptoms, improving general functioning, and reducing duration and frequency of psychiatric hospital admissions.

CONCLUSIONS

The current literature on youth-ACT is limited but promising. There are indications that youth-ACT is effective in reducing severity of psychiatric symptoms, improving general functioning, and reducing duration and frequency of psychiatric hospital admissions. The effect of youth-ACT may be comparable with the effect of ACT in adults. Similar as in adult ACT, the studies on youth-ACT found effects that vary from small to large. Randomized experimental research designs are needed to further corroborate effectiveness.