Intensive Community Care Services for Adolescents with Acute Psychiatric Emergencies: Trial Feasibility Findings from the Pilot Phase of a Multi-centre Randomised Controlled Trial
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Background
Adolescents experiencing psychiatric emergencies often require intensive intervention to avoid hospital admission and support their transition into education, employment, or training (EET). Intensive Community Care Services (ICCS) offer a potential alternative to inpatient care. This pilot study aimed to assess the feasibility of conducting a randomised controlled trial (RCT) to evaluate the effectiveness of ICCS compared to treatment as usual (TAU) in reducing time to start or return to EET.
Methods
A multi-centre, parallel-group, single-blinded randomised controlled trial (RCT) with an internal pilot phase was conducted across seven NHS Trusts in the UK. Adolescents aged 12–17 experiencing psychiatric emergencies were randomised to ICCS or treatment as usual (TAU). The primary outcome was time to start or return to EET within six months. Secondary outcomes included clinical symptoms, functioning, service satisfaction, service use, and health-related quality of life. Descriptive statistics and hazard ratios were calculated to explore group differences. Feasibility was assessed against pre-specified progression criteria.
Results
Thirty-six adolescents were randomised during the internal pilot phase. The recruitment rate did not meet the progression criteria, and continuation to a full evaluation trial was deemed unfeasible. During follow-up, 83.3% (n=30) returned to EET, with a median time to EET of nine days (IQR: 1–49). Median time to EET was shorter in the ICCS group (6 days) compared to TAU (12 days), with a hazard ratio of 1.34 (95% CI: 0.63–2.86). ICCS was associated with improved service satisfaction, clinical symptoms, and functioning. The average cost per participant was higher in the TAU group (£15,155, SD 31,560) compared to ICCS (£7,063, SD 10,605), with minimal differences in quality-adjusted life years (QALYs). Fourteen safety events were reported across both groups.
Conclusions
A full evaluation trial was not feasible due to recruitment challenges, primarily arising from limited-service capacity to deliver two treatment pathways concurrently. Despite this, ICCS showed promising trends in clinical and functional outcomes and may offer a viable alternative to inpatient care. Further research is needed to explore the implementation and effectiveness of ICCS in routine practice.
Trial registration
ISRCTN, ISRCTN42999542 . Registered 29/04/2020, https://doi.org/10.1186/ISRCTN42999542
