title: Alternatives to admission for children and adolescents: providing intensive mental healthcare services at home and in communities: what works?
abstract: OBJECTIVE
  To review the evidence on alternatives to inpatient mental healthcare for children and adolescents requiring intensive treatment for severe and complex mental health problems.
  
  
  RESULTS
  Systematic reviews of intensive case management in adult mental healthcare conclude that intensive treatment models such as assertive community treatment and crisis resolution teams improve patient satisfaction and reduce hospital use in some circumstances. The relatively few studies on children suggest that intensive community-based services can be as effective as inpatient care for certain groups. However, the mental health needs of the young people involved in the studies, their social and family circumstances and the context of local mental health provision varied greatly.
  
  
  CONCLUSIONS
  There is little high-quality research into the effectiveness of alternatives to inpatient care for young people requiring intensive treatment for complex, severe mental health problems. Studies support the use of alternatives to inpatient admission for particular groups of young people and suggest a need for a combination of complementary models of specialist intensive provision. There is insufficient evidence on which to base decisions on which model is best for which group of young people and randomized control studies are urgently needed.
authors.affiliation: North Wales Adolescent Service, North Wales NHS Trust, Glan Clwyd Hospital, Bodelwyddan, Denbighshire, UK. clare.lamb@wales.nhs.uk
authors.forename: Clare E
authors.initials: CE
authors.lastname: Lamb
mesh_terms: D000293:Adolescent; D000328:Adult; D019090:Case Management / Q000458:organization & administration*; D002648:Child; D002653:Child Behavior Disorders / Q000175:diagnosis / Q000628:therapy; D002662:Child Health Services / Q000458:organization & administration*; D002675:Child, Preschool; D003156:Community Mental Health Services / Q000458:organization & administration*; D003419:Crisis Intervention / Q000458:organization & administration; D005196:Family Therapy / Q000458:organization & administration; D001068:Feeding and Eating Disorders / Q000175:diagnosis / Q000628:therapy; D005581:Foster Home Care / Q000458:organization & administration; D006699:Home Care Services / Q000458:organization & administration*; D006760:Hospitalization; D006801:Humans; D001523:Mental Disorders / Q000175:diagnosis / Q000628:therapy*; D008605:Mental Health Services / Q000458:organization & administration*; D019964:Mood Disorders / Q000175:diagnosis / Q000628:therapy; D011618:Psychotic Disorders / Q000175:diagnosis / Q000628:therapy; D011785:Quality Assurance, Health Care / Q000458:organization & administration; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D006113:United Kingdom