Title: Comparison of Effectiveness and Cost-Effectiveness of Intensive Community Care Services versus Usual Inpatient Care for Young People with Psychiatric Emergencies (IVY): An Internal Pilot followed by a Randomised Controlled Trial Comprising All Intensive Community Service Care Teams in Great Britain.
Funder: Department of Health and Social Care

Abstract: Approximately 10% of adolescents in the UK experience severe mental health disorders and over 4000 are admitted to hospital for in-patient care every year. Little is known about the best way to care for adolescents who experience severe mental health disorders. The main aim of this study is to find out which of the two different ways of providing care to young people aged 12 to 18 is better. One way of providing care, called treatment as usual, involves usual admission for treatment in a hospital. The other way, called Intensive Community Care Service, provides treatment at home instead of in a hospital. Intensive Community Care Service teams quickly assess all young people being considered for admission, start a programme of home treatment with frequent visits (sometimes daily visits if needed) until the crisis has resolved and then they connect young people and their families with other services for any further care they may need._x000D_ 252 adolescents from different parts of England, Scotland and Wales will be randomised to one of the two ways of providing care. This means that they will have an equal chance of receiving treatment in a hospital or from an Intensive Community Care Service team. Six months after participants enter the study, the time it takes for young people to return or to start education, employment or training (EET) will be compared between the two groups. We will also compare the two groups in terms of their mental health, well-being and satisfaction with their care. In addition, we will collect information on all the health and social care services that these young people will have received so that we can estimate how much their care cost and evaluate which way of providing care was better value for money. We will do a smaller study, to begin with. If we are able to recruit enough participants in the smaller study, we will then proceed to complete the full study. The full study should tell us what the best way to provide care to young people with severe mental health disorders is. We will interview young people to understand their experience of receiving care. We will also interview healthcare workers to understand their experience of delivering care.

Lay abstract: Approximately 10% of adolescents in the UK experience impairing mental disorders and over 4000 are admitted for inpatient care every year. The average length of hospital stay of young people across all psychiatric units is 116 days in the UK, 74 days for general admissions, 103 days for Eating Disorders units and 307 days for Secure units, far greater than in many other countries. Little is known about the best models of care for adolescents presenting with psychiatric emergencies. The principal objective of this study is to evaluate two alternative pathways for the care of young people aged 12 to 18 requiring hospitalisation: treatment as usual (TAU), comprising inpatient adolescent unit admission, and intensive community care service (ICCS), an experimental care pathway. 252 adolescents authorised for admission at 6 NHS Trusts across the UK will be randomised to either TAU or the ICCS provided their risk profile is consistent with a possibility of intensive community treatment. All ICCS teams operating in the UK as of August 2018 will take part. Six months after randomisation, the time to returning/time to gaining education, employment or training (EET) as well as a range of other measures of mental health and well-being, patient satisfaction, service use and associated costs and cost-effectiveness will be compared between the two arms. Statistical analyses will be on the intention to treat basis. During the period of the trial, mental health professionals working on inpatient units will be expected to work for the ICCS and vice versa. The trial is expected to be completed within 42 months. The trial will include an internal pilot with clear stop/go rules depending on how successful recruitment is. An extensive process evaluation study using visual semi-structured interviews with 42 young people and 42 healthcare workers will be conducted.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MENTAL HEALTH