Background
Methods
Inclusion criteria
Assessment instruments
Literature search
Selection procedure
Data extraction
Quality appraisal
Referencea
| Study design (time-frame) | Core elements of youth-ACT | Problems treated | Nb
| Age (years) | Gender (%) | Ethnic group (%) | Team staff | Level of evidencec
| ||
---|---|---|---|---|---|---|---|---|---|---|---|
Adrian & Smith (2014) GBR [46] | Pre-post test (2001–2011) | Home-based treatment: | Yes | Serious mental illness in crisis, admission is considered | 287 | Range: 12–17 Mean: 16 | Boys: 38 Girls: 62 | White: Black: Asian: Other: | 73 13 4 10 | Psychiatrist Nurse practitioner Psychologist Support worker Administrator | 2bc
|
Small caseload (size < 10): | NRd
| ||||||||||
Hardly assessable patients: | Yes | ||||||||||
Transition case management: | Yes | ||||||||||
Early intervention: | Yes | ||||||||||
Psychiatric assessment at home: | Yes | ||||||||||
Family support: | Yes | ||||||||||
Therapye: | Yes | ||||||||||
Pharmacology: | Yes | ||||||||||
Ahrens et al. (2007) USA [47] | Pre-post test (1998–2000) | Home-based treatment: | Yes | Long-term mental healthcare needs in transition to adulthood | 15 | Range: 15–20 Mean: 17 | Boys: 80 Girls: 20 | White: Black: | 80 20 | Interdisciplinary, not specified | 2bc
|
Small caseload (size < 10): | NRd
| ||||||||||
Hardly assessable patients: | Yes | ||||||||||
Transition case management: | Yes | ||||||||||
Early intervention: | Yes | ||||||||||
Psychiatric assessment at home: | Yes | ||||||||||
Family support | Yes | ||||||||||
Therapye: | Yes | ||||||||||
Pharmacology: | Yes | ||||||||||
Baier et al. (2013) CHE [6] | Pre-post test (2009–2010) | Home-based treatment: | Yes | Psychiatric symptoms and avoiding outpatient care | 35 | Range: 13–18 Mean: 16 | Boys: 43 Girls: 57 | NRd
| Child psychiatrist Social workers Nurses | 2bc
| |
Small caseload (size < 10): | Yes | ||||||||||
Hardly assessable patients: | Yes | ||||||||||
Transition case management: | Yes | ||||||||||
Early intervention: | Yes | ||||||||||
Psychiatric assessment at home | Yes | ||||||||||
Family support: | Yes | ||||||||||
Therapye: | Yes | ||||||||||
Pharmacology: | Yes | ||||||||||
Chai et al. (2012) AUS [48] | Pre-post test (2006–2008) | Home-based treatment: | Yes | Psychiatric symptoms and avoiding outpatient care | 59 | Range: 11–17 Modal: 15 | Boys: 32 Girls: 68 | NRd
| Psychiatrist Social workers “Clinicians” | 2bc
| |
Small caseload (size < 10): | Yes | ||||||||||
Hardly assessable patients: | Yes | ||||||||||
Transition case management: | Yes | ||||||||||
Early intervention: | Yes | ||||||||||
Psychiatric assessment at home: | NRd
| ||||||||||
Family support: | Yes | ||||||||||
Therapye: | Yes | ||||||||||
Pharmacology: | Yes | ||||||||||
Godley et al. (2002) USA [49] | RCT (1999–2001) | Home-based treatment: | Yes | Alcohol/ drugs dependence or abuse | 114 | Range: 12–17 Mean: 16 | Boys: 80 Girls: 20 | White: Black: Other: | 74 17 9 | Case manager (not specified) | 2bc
|
Small caseload (size < 10): | Yes | ||||||||||
Hardly assessable patients: | Yes | ||||||||||
Transition case management: | Yes | ||||||||||
Early intervention: | Yes | ||||||||||
Psychiatric assessment at home: | Yes | ||||||||||
Family support: | Yes | ||||||||||
Therapye: | Yes | ||||||||||
Pharmacology: | NRd
| ||||||||||
Godley et al. (2006) USA [50] | RCT (1999–2003) | Home-based treatment: | Yes | Alcohol/ drugs dependence or abuse | 183 | Range: 12–18 Mean: 16 | Boys: 71 Girls: 29 | White: Black: Other: | 73 18 9 | Case manager (not specified) | 2bc
|
Small caseload (size < 10) | Yes | ||||||||||
Hardly assessable patients: | Yes | ||||||||||
Transition case management: | Yes | ||||||||||
Early intervention: | Yes | ||||||||||
Psychiatric assessment at home: | Yes | ||||||||||
Family support: | Yes | ||||||||||
Therapye: | Yes | ||||||||||
Pharmacology: | NRd
| ||||||||||
Godley et al. (2010) USA [51] | RCT (2002–2007) | Home-based treatment: | Yes | Alcohol /drugs dependence or abuse | 320 | Range: 12–18 Mean: 16 | Boys: 76 Girls: 24 | White: Black: Other: | 73 13 14 | Case manager (not specified) | 2bc
|
Small caseload (size < 10): | No | ||||||||||
Hardly assessable patients: | Yes | ||||||||||
Transition case management: | Yes | ||||||||||
Early intervention: | Yes | ||||||||||
Psychiatric assessment at home: | Yes | ||||||||||
Family support: | Yes | ||||||||||
Therapye: | Yes | ||||||||||
Pharmacology: | NRd
| ||||||||||
Godley et al. (2015) USA [52] | RCT (2004–2008) | Home-based treatment: | Yes | Alcohol /drugs dependence or abuse | 305 | Range: 12–18 Mean: 16 | Boys: 63 Girls: 37 | White: Black: Other: | 70 12 18 | Case manager (not specified) | 2bc
|
Small caseload (size < 10): | NRd
| ||||||||||
Hardly assessable patients: | Yes | ||||||||||
Transition case management: | Yes | ||||||||||
Early intervention: | Yes | ||||||||||
Psychiatric assessment at home: | Yes | ||||||||||
Family support: | Yes | ||||||||||
Therapye: | Yes | ||||||||||
Pharmacology: | NRd
| ||||||||||
McFarlane et al. (2014) USA [40] | Quasi-experimental (2007–2010) | Home-based treatment: | Yes | Risk or early symptoms of psychosis | 337 | Range: NRd
Mean: 17 | Boys: 60 Girls: 40 | White: Black: Other: | 62 9 19 | Psychiatrist Nurse practitioner Nurse Occupational therapist Clinical counsellors | 2bc
|
Small caseload (size < 10): | Yes | ||||||||||
Hardly assessable patients: | Yes | ||||||||||
Transition case management: | Yes | ||||||||||
Early intervention: | Yes | ||||||||||
Psychiatric assessment at home: | Yes | ||||||||||
Family support | Yes | ||||||||||
Therapye: | Yes | ||||||||||
Pharmacology: | Yes | ||||||||||
McGarvey et al. (2014) USA [41] | Pre-post test (2007–2010) | Home-based treatment: | Yes | Substance use or co-occurring disorder and low income | 147 | Range: 12–18 Mean: 16 | Boys: 60 Girls: 40 | White: Black: Other: | 62 9 19 | Psychiatrist Nurse practitioner Nurse Occupational therapist Clinical counsellors | 2bc
|
Small caseload (size < 10): | NRd
| ||||||||||
Hardly assessable patients: | Yes | ||||||||||
Transition case management: | Yes | ||||||||||
Early intervention: | Yes | ||||||||||
Psychiatric assessment at home: | NRd
| ||||||||||
Family support: | Yes | ||||||||||
Therapye: | Yes | ||||||||||
Pharmacology: | Yes | ||||||||||
Schley et al. (2008) AUS [42] | Pre-post test (2000–2004) | Home-based treatment: | Yes | Psychiatric symptoms, with high-risk of self-harm or harming others, avoiding outpatient care | 47 | Range: 12–18 Mean: 16 | Boys: 77 Girls: 23 |
City
| Clinical trainers Therapist (not specified) | 2bc
| |
White: Black: | 52 48 | ||||||||||
Small caseload (size < 10): | Yes | ||||||||||
County
| |||||||||||
White: Black: | 63 37 | ||||||||||
Hardly assessable patients: | Yes | ||||||||||
Transition case management: | Yes | ||||||||||
Early intervention: | Yes | ||||||||||
Psychiatric assessment at home: | Yes | ||||||||||
Family support: | Yes | ||||||||||
Therapye: | Yes | ||||||||||
Pharmacology: | NRd
| ||||||||||
Urben et al. (2015) CHE [8] | Pre-post test (2010–2013) | Home-based treatment: | Yes | Psychiatric symptoms and avoiding outpatient care | 98 | Range: NRd
Mean: 17 | Boys: 53 Girls: 47 | NRd
| Psychiatrist Psychologist Social workers Occupational therapist Psychiatric nurse | 2bc
| |
Small caseload (size < 10): | Yes | ||||||||||
Hardly assessable patients: | Yes | ||||||||||
Transition case management: | Yes | ||||||||||
Early intervention: | Yes | ||||||||||
Psychiatric assessment at home: | Yes | ||||||||||
Family support: | Yes | ||||||||||
Therapye: | Yes | ||||||||||
Pharmacology: | Yes | ||||||||||
Urben et al. (2016) CHE [43] | Pre-post test (NRd) | Home-based treatment: | Yes | Psychiatric symptoms and avoiding outpatient care | 47 | Range: 13–18 Mean: NRd
| Boys: 61 Girls: 39 | NRd
| Psychiatrist Psychologist Social workers Occupational therapist Psychiatric nurse | 2bc
| |
Small caseload (size < 10): | Yes | ||||||||||
Hardly assessable patients: | Yes | ||||||||||
Transition case management: | Yes | ||||||||||
Early intervention: | Yes | ||||||||||
Psychiatric assessment at home: | Yes | ||||||||||
Family support: | Yes | ||||||||||
Therapye: | Yes | ||||||||||
Pharmacology: | Yes |
Clinical relevance
Strength of recommendation
Results
Study designs and level of evidence
Sample
Measurements
Effect on severity of psychiatric symptoms
Reference | Main results | Psychiatric disorders in sample (%) | Follow-up (months) | Assessment instruments | Effect sizea & 95% CIb
| ||
---|---|---|---|---|---|---|---|
Adrian & Smith (2014) [46] | Youth-ACT with hospital care and without hospital care was associated with reductions in severity of psychiatric symptoms. Larger effect sizes were found for psychotic symptoms, ASD and mood disorders than for self-harm, eating, and neurotic disorders | Mood: | 33 | P-Tc
| HoNOSCA | Reduction HoNOSCA Sum-scores Both groups: Patients that needed inpatient care during ACT treatment: Patients with only ACT: | 1.2 (1.1, 1.4) 1.2 (0.9, 1.5) 1.3 (1.1, 1.5) |
Anxiety: | 26 | ||||||
Psychotic: | 21 | ||||||
Self-harm: | 12 | ||||||
ASD: | 2 | ||||||
Eating: | 2 | ||||||
Other: | 10 | ||||||
Baier et al. (2013) [6] | Youth-ACT is associated with reduction of psychiatric symptoms | Psychotic: | 51 | P-Tc
| HoNOSCA | Reduction HoNOSCA Sum-scores: Disruptive behaviour: Hyperactivity: Self-injury: Substance abuse: Hallucinations: Non-organic: Emotional: | 1.3 (0.8, 1.8) 0.1 (−0.4, 0.5) 0.3 (−0,1, 0.8) 0.7 (0.2, 1.1) 0.2 (−0.2, 0.6) 1.0 (0.5, 1.4) 0.2 (−0.3, 0.7) 0.8 (0.3, 1.3) |
Schizophrenia: | 23 | ||||||
Mood: | 14 | ||||||
Anxiety: | 9 | ||||||
Conduct: | 26 | ||||||
Godley et al. (2002) [49] | Preliminary outcomes of Godley et al. (2006) [50]. Significantly more abstinent from marijuana in youth-ACT + Usual Continuing Care (UCC) group compared to only UCC | Substance: | 100 | 3 | GAIN TLFB Urine tests Breath-analyser Interviews | Alcohol use: Abstinence at follow-up: Marijuana, 3 months: | 0.1 (−0.2, 0.4) 0.4 (0.1, 0.8) |
Godley et al. (2006) [50] | Significantly more long-term abstinent from marijuana in youth-ACT + Usual Continuing Care (UCC) compared to only UCC | Substance: | 100 | 3, 6, 9 | GAIN TLFB Urine tests Breath-analyser Interviews | Abstinence at follow-up: Alcohol, 3 and 9 months: Marijuana, 3 and 9 months both: Other drugs, 3 months: 9 months: | 0.1 (−0.2, 0.4) 0.3 (0.0, 0.6) 0.2 (−0.1, 0.5) 0.1 (−0.1, 0.3) |
Mood: | 38 | ||||||
Anxiety: | 38 | ||||||
PTSD: | 36 | ||||||
ADHD: | 57 | ||||||
Conduct: | 67 | ||||||
Godley et al. (2010) [51] | Youth-ACT had no additional effect on substance disorders compared to outpatient treatment only | Alcohol: | 49 | 3, 6, 9, 12 | GAIN substance problem scale Urine tests | Additional effect of youth-ACT in symptom reducing | 0.1 (−0.2, 0.4) |
Marijuana: | 75 | ||||||
Mood: | 28 | ||||||
Anxiety: | 8 | ||||||
PTSD: | 19 | ||||||
ADHD: | 34 | ||||||
Conduct: | 42 | ||||||
Godley et al. (2015) [52] | Significantly more long-term abstinent from marijuana and alcohol in youth-ACT compared to only Usual Continuing Care (UCC) | Alcohol: | 58 | 3, 6, 9, 12 | GAIN substance problem scale Urine tests Breathalyzer | Abstinence at follow-up: Alcohol: 12 months: Marijuana: 12 months: Other drug: 12 months: | 0.3 (0.1, 0.8) 0.3 (0.0, 0.6) 0.3 (0.0, 0.6) |
Marijuana: | 91 | ||||||
Mood: | 32 | ||||||
Anxiety: | 46 | ||||||
PTSD: | 33 | ||||||
ADHD: | 49 | ||||||
Conduct: | 65 | ||||||
McFarlane et al. (2014) [40] | Youth-ACT was superior in reducing positive, negative, disorganized symptoms and general symptoms in adolescents compared to community care | Substance: | 8 | 6, 12, 24 | SIPS SCID-I/CV | Symptom reduction: Positive symptoms: Negative symptoms: Disorganized: | 0.6 (0.4, 0.9) 0.3 (0.0, 0.5) 0.4 (0.2, 0.7) |
Mood: | 42 | ||||||
Anxiety: | 8 | ||||||
PTSD: | 8 | ||||||
OCD: | 7 | ||||||
Psychosis: | 13 | ||||||
McGarvey et al. (2014) [41] | Youth-ACT reduces marijuana use but does not reduce alcohol use | Substance or co-occurring disorder: | NRd
| 3, 6, 12 | GAIN Drug tests | Reduction in days marijuana use at follow-up: Boys at 3 months: 6 months: 12 months: Girls at 3 months: 6 month: 12 months: Alcohol use: Boys at 3 months: 12 months: Girls at 3 months: 12 months: | 0.6 (0.3, 0.9) 0.7 (0.5, 1.0) 0.6 (0.3, 0.8) 0.4 (0.1, 0.8) 0.7 (0.0, 1.1) 0.6 (0.1, 1.1) 0.2 (0.0, 0.5) 0.2 (0.0, 0.5) 0.1 (−0.4, 0.7) 0.1 (−0.4, 0.6) |
Schley et al. (2008) [42] | Pre-treatment compared to post-treatment showed significant reduction in suicidality and deliberate self-harm behaviour | Substance: | 31 | P-Tc
| Structured audit questionnaire developed by youth-ACT team | Suicidality: Deliberate self-harm: | 2.1 (1.4, 2.8) 2.5 (1.7, 3.3) |
Mood: | 40 | ||||||
Anxiety | 22 | ||||||
Psychotic: | 9 | ||||||
ADHD/Disrupt.: | 38 | ||||||
Eating: | 9 | ||||||
Other: | 18 | ||||||
Urben et al. (2015) [8] | Reduction in severity of psychiatric symptoms (pre-treatment compared to post-treatment) | Internalizing: | 36 | P-Tc
| HoNOSCA | Reduction in HoNOSCA-scores: Externalizing scale: Emotional scale | 0.3 (−0.1, 0.5) 0.6 (−0.3, 0.8) |
Externalizing: | 27 | ||||||
Mix: | 37 | ||||||
Urben et al. (2016) [43] | Reduction in severity of psychiatric Symptoms. | Mood: | 30 | 3, 6, 9 | HoNOSCA | Reduction in HoNOSCA Sum-scores: Emotional scale: | 0.6 (0.0, 1.2) 0.6 (0.0, 1.2) |
Anxiety: | 19 | ||||||
Conduct disorder: | 17 | ||||||
Psychosis: | 11 | ||||||
Personality disorder: | 4 |
Psychiatric symptoms in general
Emotional problems
Behavioral problems
Psychotic problems
Addiction problems
Effect on general functioning
Reference | Main results | Follow-up (months) | Assessment instruments | Effect sizea & 95% CIb
| |
---|---|---|---|---|---|
Adrian & Smith (2014) [46] | Compared to baseline 50% of the adolescents treated with youth-ACT showed improvement in general functioning according to CGAS score at discharge. Adolescents with psychotic and mood disorders improved more that patients with neurotic disorders | P-Tc
| CGAS | Baseline compared with discharge CGAS-scores: ACT combined with inpatient care: Only ACT: | 1.3 (1.0, 1.6) 1.5 (1.3, 1.7) |
Baier et al. (2013) [6] | Youth-ACT associated with significant improvement in social functioning measured with HoNOSCA (school attendance, and peer and family relations) | P-Tc
| HoNOSCA | HoNOSCA-scores: Sum-score: Peer relations: Family relations: School attendance: | 1.3 (0.8, 1,8) 0.4 (0.0, 0.9) 0.5 (0.0, 1.0) 0.6 (0.1, 1.1) |
Chai et al. (2012) [48] | Significant improvement in clinician-rated levels of social functioning. Adolescents treated with youth-ACT showed increase in school attendance | P-Tc
| CGAS School attendance registration form | School attendance: | 0.7 (0.4, 1.1) |
Godley et al. (2015) [52] | Small significant improvement in pro-social activities. No significant differences in school attendance and family problems | 3, 6, 9, 12 | GAIN | Pro-social activities: | 0.2 (−0.2, 0.4) |
McFarlane et al. (2014) [40] | Adolescents with psychotic symptoms treated with youth-ACT showed significantly higher GAF-outcomes, increased school attendance or work (21%) compared to those who received Community Care (7.0%) | 6, 12, 24 | GAF | GAF-score: | 0.3 (0.0, 0.5) |
McGarvey et al. (2014) [41] | Decrease in average number of days missing school (5.3 to 2.6 days) or being expelled from school (0.2 to 0.01 days) compared to baseline | 3, 6, 12 | GAIN | School attendance: Decrease in days expelled from school: | 0.7 (0.4, 1.1) 0.6 (0.3, 0.9) |
Schley et al. (2008) [42] | Youth-ACT decreased the frequency of violence and crime | P-Tc
| Structured self-developed questionnaire | Crime: Violence: | 0.6 (0.1, 1.2) 0.9 (0.3, 1.5) |
Urben et al. (2016) [43] | Adolescents treated with youth-ACT showed significant improvements in HoNOSCA social-score which include the items family relations, peer relations and school attendance. | 3, 6, 9 | HoNOSCA | HoNOSCA Sum score: Social-score: School attendance: | 0.6 (0.0, 1.2) 0.8 (0.1, 1.2) 0.8 (0.2, 1.4) |
School attendance
Interpersonal relations
Effect on psychiatric hospital admissions
Reference | Main results | Follow-up (months) | Assessment instruments | Effect sizea & 95% CIb
| |
---|---|---|---|---|---|
Adrian & Smith (2014) [46] | Youth-ACT associated with reduction in length of hospital admission | 12 | Medical files | NRc
| |
Ahrens et al. (2007) [47] | Reduction in number of hospitalized days. Decrease in total number of days of inpatient psychiatric treatment, forensic treatment or incarceration | 24 | Medical files | Reduction admission days: Reduction in time in institutions, inpatient psychiatric treatment, and forensic treatment or incarceration: | 0.5 (−0.2, 1.3) 0.6 (−0.3, 1.4) |
Chai et al. (2012) [48] | Significant reduction in rates of admission in the youth-ACT sample. Percentage of adolescents with no admissions increased from 53% prior to referral to 83% post treatment | P-Td
| Medical files | Reduction admissions: | 1.0 (0.5, 1.6) |
Godley et al. (2015) [52] | Significant fewer days spent in residential treatment, juvenile detention, and hospitals over the 12 month follow-up period compared to UCC | 3, 6, 9, 12 | Medical files | Reduction admission days: | 0.3 (0.1, 0.6) |
Schley et al. (2008) [42] | Comparison of psychiatric hospital admission rates and average number of days in the hospital prior to and after youth-ACT treatment showed that admission rates decreased with 17% at 3 month, 29% at 6 month, 28% at 9 month and 22% at 12 month follow-up | 3, 6, 9, 12 | Structured self-developed questionnaire | Reduction in hospital admissions days: 3 months: 6 months: 12 months: | 1.6 (1.2, 2.1) 1.1 (0.7, 1.5) 0.7 (0.1, 1.2) |