Home-based multisystemic therapy as an alternative to the hospitalization of youths in psychiatric crisis: clinical outcomes.
OBJECTIVE
The primary purpose of this study was to determine whether multisystemic therapy (MST), modified for use with youths presenting psychiatric emergencies, can serve as a clinically viable alternative to inpatient psychiatric hospitalization.


METHODS
One hundred sixteen children and adolescents approved for emergency psychiatric hospitalization were randomly assigned to home-based MST or inpatient hospitalization. Assessments examining symptomatology, antisocial behavior, self-esteem, family relations, peer relations, school attendance, and consumer satisfaction were conducted at 3 times: within 24 hours of recruitment into the project, shortly after the hospitalized youth was released from the hospital (1-2 weeks after recruitment), and at the completion of MST home-based services (average of 4 months postrecruitment).


RESULTS
MST was more effective than emergency hospitalization at decreasing youths' externalizing symptoms and improving their family functioning and school attendance. Hospitalization was more effective than MST at improving youths' self-esteem. Consumer satisfaction scores were higher in the MST condition.


CONCLUSIONS
The findings support the view that an intensive, well-specified, and empirically supported treatment model, with judicious access to placement, can effectively serve as a family- and community-based alternative to the emergency psychiatric hospitalization of children and adolescents.
Henggeler
S W
SW
Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston 29425, USA. henggesw@musc.edu
Rowland
M D
MD
Randall
J
J
Ward
D M
DM
Pickrel
S G
SG
Cunningham
P B
PB
Miller
S L
SL
Edwards
J
J
Zealberg
J J
JJ
Hand
L D
LD
Santos
A B
AB
D000203:Activities of Daily Living; D000293:Adolescent; D016497:Adolescent Health Services; D004636:Emergency Service, Hospital; D005260:Female; D006699:Home Care Services; D006760:Hospitalization; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D011613:Psychotherapy; D012649:Self Concept