Acute home treatment as an alternative to inpatient care for children and adolescents with mental health crisis
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Copyright (c) 2026 Revista de Psiquiatría Infanto-Juvenil
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
DOI:
https://doi.org/10.31766/revpsij.v43n1a2Keywords:
intensive care, acute home treatment, mental health crisis, inpatient care, children and adolescentsAbstract
Introduction: Following the COVID-19 pandemic, there has been a surge in psychiatric disorders among children and adolescents, leading to overcrowding in emergency services and conventional inpatient units. In response, Hospital Clínic in Barcelona has implemented a Child and Adolescent Acute Home Hospitalisation (HDOM PIJ) programme, a therapeutic model centred on the child within their own environment, minimising environmental disruption and restrictive measures. With short waiting times, the HDOM PIJ programme facilitates intervention at the onset of the acute phase. Methods: A retrospective analytical observational study evaluating the first twenty-one months of the HDOM PIJ programme (June 2021–March 2023). All patients admitted during this period were included. Results: A total of 116 patients were included (mean age 14.72 years; 69.8% female). The average length of stay was 19.67 days, and the main reason for referral was suicidal ideation. Depressive disorders were the most prevalent, followed by eating disorders, neurodevelopmental disorders and psychotic disorders. 37.1% of patients were referred from conventional hospitals, followed by the Child and Adolescent Mental Health Centre (CSMIJ, 32.7%) and emergency services (26.7%). Upon discharge from the HDOM PIJ programme, 92.2% were referred to a lower-intensity care resource. Conclusion: Home treatment represents an effective alternative to conventional hospitalisation. It reduces hospital overcrowding and provides a comprehensive approach in the patient’s natural environment. It offers shorter waiting times, sustained outcomes comparable to conventional hospitalisation and reduced resource use at discharge.
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Boege I, Corpus N, Weichard M, Schepker R, Young P, Fegert JM. Long?term outcome of intensive home treatment for children and adolescents with mental health problems – 4 years after a randomized controlled clinical trial. Child Adolesc Ment Health. 2021;26(4):310-9. https://doi.org/10.1111/camh.12500
Sacco R, Camilleri N, Eberhardt J, Umla-Runge K, Newbury-Birch D. Systematic review on the prevalence of mental disorders among children and adolescents in Europe. Eur Child Adolesc Psychiatry. 2024;33(12): 2877-94. https://doi.org/10.1007/s00787-022-02131-2
Boege I, Corpus N, Schepker R, Kilian R, Fegert JM. Cost-effectiveness of intensive home treatment enhanced by inpatient treatment elements in child and adolescent psychiatry in Germany: A randomised trial. Eur Psychiatry. 2015;30(5): 583-9. https://doi.org/10.1016/j.eurpsy.2015.01.009
Garriga M, Agasi I, Fedida E, Pinzón-Espinosa J, Vazquez M, Pacchiarotti I, et al. The role of mental health home hospitalization care during the COVID?19 pandemic. Acta Psychiatr Scand. 2020;141(5): 479-80. https://doi.org/10.1111/acps.13173
Samji H, Wu J, Ladak A, Vossen C, Stewart E, Dove N, et al. Review: Mental health impacts of the COVID?19 pandemic on children and youth – a systematic review. Child Adolesc Ment Health. 2022;27(2): 173-89. https://doi.org/10.1111/camh.12501
Marin D, Di Gennaro G, Baracetti M, Zanetti R, Balestrieri M, Cogo P, et al. Confirmation of increased and more severe adolescent mental health-related in-patient admissions in the COVID-19 pandemic aftermath: A 2-year follow-up study. Psychiatry Res Commun. 2023;3(2): 100119. https://doi.org/10.1016/j.psycom.2023.100119
Foremnik K, Sroczynski G, Stratil J, Neumann A, Buchberger B. Efficacy of home-based and inpatient treatment for children and adolescents in psychiatric crisis: A systematic review protocol. PLoS One. 2025;20(3): e0318792. https://doi.org/10.1371/journal.pone.0318792
Organización Mundial de la Salud. Qualityrights. Instrumentos de Calidad y Derechos de la OMS. Evaluando y mejorando la calidad y los derechos humanos en los establecimientos de salud mental y de apoyo social. 2012
Noguero Alegre A, Peregalli Politi S. Alternativas a los internamientos en salud mental: hospitalización domiciliaria desde la perspectiva española y anglosajona. Rev Bioet Derecho. 2021;(53): 37-55. https://doi.org/10.1344/rbd2021.53.34726
Johnson S, Dalton-Locke C, Baker J, Hanlon C, Salisbury TT, Fossey M, et al. Acute psychiatric care: approaches to increasing the range of services and improving access and quality of care. World Psychiatry. 2022;21(2): 220-36. https://doi.org/10.1002/wps.20962
Ougrin D, Corrigall R, Poole J, Zundel T, Sarhane M, Slater V, et al. Comparison of effectiveness and cost-effectiveness of an intensive community supported discharge service versus treatment as usual for adolescents with psychiatric emergencies: a randomised controlled trial. Lancet Psychiatry. 2018;5(6): 477-85. https://doi.org/10.1016/S2215-0366(18)30129-9
Sjølie H, Karlsson B, Kim HS. Crisis resolution and home treatment: structure, process, and outcome - a literature review: Crisis resolution and home treatment. J Psychiatr Ment Health Nurs. 2010;17(10): 881-92. https://doi.org/10.1111/j.1365-2850.2010.01621.x
Beecham J. Annual Research Review: Child and adolescent mental health interventions: a review of progress in economic studies across different disorders. J Child Psychol Psychiatry. 2014;55(6): 714-32. https://doi.org/10.1111/jcpp.12216
Lamb CE. Alternatives to admission for children and adolescents: providing intensive mental healthcare services at home and in communities: what works? Curr Opin Psychiatry. 2009;22(4): 345-50. https://doi.org/10.1097/yco.0b013e32832c9082
Graf D. Treatment outcome of an intensive psychiatric home treatment for children and adolescents: a non-randomized controlled pilot evaluation. Eur Child Adolesc Psychiatry. 2023;32(4): 685-95. https://doi.org/10.1007/s00787-021-01919-y
Mötteli S, Jäger M, Hepp U, Wyder L, Vetter S, Seifritz E, et al. Home treatment for acute mental healthcare: Who benefits most? Community Ment Health J. 2021;57(5): 828-35. https://doi.org/10.1007/s10597-020-00618-3
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. (5th ed., Text Revision). 2013. Washington, DC. APA.
Muskens JB, Herpers PCM, Hilderink C, van Deurzen PAM, Buitelaar JK, Staal WG. Intensive home treatment for adolescents in psychiatric crisis. BMC Psychiatry. 2019;19(1): 412. https://doi.org/10.1186/s12888-019-2407-x
Vázquez-Bourgon J, Salvador-Carulla L, Vázquez-Barquero JL. Community alternatives to acute inpatient care for severe psychiatric patients. Actas Esp Psiquiatr. 2012;40(6): 323-32.
Kwok KHR, Yuan SNV, Ougrin D. Review: Alternatives to inpatient care for children and adolescents with mental health disorders. Child Adolesc Ment Health. 2016;21(1): 3-10. https://doi.org/10.1111/camh.12123
Colom Masfret M. Trabajo social sanitario: fundamentos y práctica profesional. Barcelona: Editorial Síntesis; 2020.
Khalfan N, Coventry C, Cawthorpe D. A new acute-at-Home child and adolescent clinical service: Evaluation of impact. Psychiatry Investig. 2022;19(1): 29-36. https://doi.org/10.30773/pi.2021.0158
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