Effectiveness of intensive community care services for adolescents with acute psychiatric emergencies: findings from a feasibility multi-centre, parallel-group, single-blinded RCT.

Background: Adolescents experiencing psychiatric emergencies often require intensive interventions to prevent hospitalisation and support their return to education, employment or training. Intensive Community Care Services aim to provide an alternative to inpatient care. Aims: To evaluate the effectiveness of Intensive Community Care Services compared to treatment as usual in reducing the time to start or return to education, employment or training for young people with psychiatric emergencies. Method: A multicentre, parallel-group, single-blinded, randomised controlled trial, including an internal feasibility phase, across seven NHS trusts in the United Kingdom. Adolescents aged 12-17 were randomised to receive either Intensive Community Care Services or treatment as usual. The primary outcome was the time to start or return to education, employment or training within a 6-month observation period. Secondary outcomes included clinical symptoms, functioning and service satisfaction. Process evaluation used semistructured visual interviews followed by thematic decomposition analysis. The impact of COVID-19 and the importance of continuity of care were explored in a series of cohort studies based in emergency departments. A consensus meeting was held to define the features of Intensive Community Care Services. Results: Of the approximately 977 adolescents screened, 36 were randomised in a 1 : 1 ratio using a web-based randomisation system stratified by the NHS trust using variable block sizes to receive either Intensive Community Care Services or treatment as usual. A key reason for poor recruitment was the absence of an alternative to Intensive Community Care Services. The recruitment rate did not meet pre-specified progression criteria ( Future work: Rigorous post-implementation research is warranted for those areas that choose to implement Intensive Community Care Services. An adequately powered randomised controlled trial is needed to confirm the pilot findings of the IVY study and explore the full potential of Intensive Community Care Services as an alternative to inpatient and other community-based services for young people with severe mental health needs. Clinicians' experience delivering Intensive Community Care Services should be explored in further qualitative studies. Limitations: The most significant limitation of this pilot study is the very small sample size, which was a direct result of recruitment difficulties. As a result, we were unable to draw any inferences about the effectiveness or cost-effectiveness of Intensive Community Care Services relative to treatment as usual. It was not possible to blind participants to the intervention they were receiving. The 6-month follow-up period may have been insufficient to capture important long-term outcomes. Conclusions: No definitive conclusions can be drawn from this study. Preliminary results suggest that Intensive Community Care Services may support a faster return to education, employment or training than treatment as usual. Intensive Community Care Services may be cost-effective compared to treatment as usual. Additional mental health professionals should be deployed to Intensive Community Care Services during future lockdowns. The same Intensive Community Care Services professionals should offer assessments in emergency departments and provide community follow-up. Research with a larger sample is warranted to confirm these findings. Funding: This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number NIHR127408.