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Review: limited evidence to support specialist mental health services as alternatives to inpatient care for young people with severe mental health disorders

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Question

Question:

Do community based specialist mental health services provide effective alternatives to inpatient mental health care for children and young adults?

Outcomes:

Disease specific symptoms and general psychological functioning (using various scales including the Global Severity Index (GSI) of brief symptoms, Child Behaviour Checklist (CBC), Family Adaptability and Cohesion Evaluation Scale (FACES)), acceptability and cost.

Methods

Design:

Systematic review.

Data sources:

Cochrane Effective Practice and Organisation of Care Group Specialised Register (2007), the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, PsycINFO, the British Nursing Index and RCN database; numerous other electronic resources (including SIGLE, King’s Fund); hand search of child mental health journals and bibliographies of retrieved articles.

Study selection and analysis:

Two independent reviewers assessed studies for inclusion and extracted data. Inclusion criteria: randomised controlled trials, well designed controlled before–after studies and interrupted time series comparing inpatient care for young people with one or more alternative specialist mental health services (beyond normal outpatient provision); only studies in young people aged 5–18 years with a serious mental health problem requiring more than generic outpatient services. Exclusion criteria: studies where the inpatient group was clinically different at baseline from those …

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