PROGRAM DEFINITION 1. Intensive In-Home services are intensive, time limited interventions provided mainly in the residence of the child. Individuals must demonstrate a clinical necessity arising from a severe condition due to mental, behavioral, or emotional illness that results in significant functional impairments in major life activities.
What is intensive residential treatment services?
Intensive Residential Treatment Services. Intensive Residential Treatment Services (IRTS) are time-limited mental health services provided in a residential setting. Recipients of IRTS are in need of more restrictive settings (versus community settings) and at risk of significant functional deterioration if they do not receive these services.
What is the intensive in-Home Service?
Service Definition and Required Components The Intensive In-Home (IIH) service is a team approach designed to address the identified needs of children and adolescents who, due to serious and chronic symptoms of an emotional, behavioral, or substance use disorder, are unable to remain stable in the community without intensive interventions.
What is intensive therapy?
The phrase intensive therapy usually refers to the level of psychotherapy and related services administered, rather than to the intensity of medical treatment. There is no standard definition in medical literature for what constitutes intensive therapy.
What is intensive inpatient addiction treatment?
Intensive inpatient programs help individuals heal from addiction to alcohol, prescription medications or illicit drugs. Inpatient addiction treatment usually requires a stay of one to three months. During this time, intensive therapy is the mainstay of treatment.
How does IHT work?
IHT is a treatment modality that addresses some of the imperfections of inpatient care by providing care in the patients’ home setting in the least restrictive environment; ‘normal’ life is disrupted as little as possible. In this way collaboration with and utilization of the patient’s social system can be maximised. During the first contact, patient, professionals and the most involved members of the patient’s social system discuss the problems or goals to be addressed during treatment. Collectively the priority of aims to achieve will be determined. In addition, the ways in which to achieve the aims, who takes responsibility for which part of the treatment plan and with whom the progress will be evaluated after 3 and 6 weeks is collectively decided. IHT professionals have the capacity to visit the patient at home, up to three times per day. The patient (and his/her relatives) can reach the IHT professionals 14 h per day, seven days a week (from 8.30 AM till 10:00 PM), while PES can be reached outside these hours if necessary. The IHT team starts as soon as possible after treatment allocation and remains involved until the crisis is resolved, for an average duration of 6 weeks. After IHT, the patient is referred to appropriate follow-up treatment if necessary.
How are patients screened for IHT?
Patients will be screened and pre-randomised by members of the IHT teams or by the patient placement desks of the treatment organisations. For the members of these teams, an online pre-randomisation tool to check whether the in- and exclusion criteria are met has been developed. Patients who do not meet the in- and exclusion criteria will not be included in the study and receive any treatment deemed necessary. Patients who meet the in- and exclusion criteria will be pre-randomised to IHT or CAU.
What is an IHT team?
The IHT team is a multidisciplinary team consisting of a psychiatrist, a psychiatry resident, a psychologist and (social) psychiatric nurses. All members of the team received additional education in family and relational treatment. Professionals of the IHT can provide:
How does hospitalization help with psychiatric crisis?
Hospitalization is a common method to intensify care for patients experiencing a psychiatric crisis. A short-term, specialised, out-patient crisis intervention by a Crisis Resolution Team (CRT) in the Netherlands, called Intensive Home Treatment (IHT), is a viable intervention which may help reduce hospital admission days. However, research on the (cost-)effectiveness of alternatives to hospitalisation such as IHT are scarce. In the study presented in this protocol, IHT will be compared to care-as-usual (CAU) in a randomized controlled trial (RCT). CAU comprises low-intensity outpatient care and hospitalisation if necessary. In this RCT it is hypothesized that IHT will reduce inpatient days by 33% compared to CAU while safety and clinical outcomes will be non-inferior. Secondary hypotheses are that treatment satisfaction of patients and their relatives are expected to be higher in the IHT condition compared to CAU.
What is intensive therapy?
The phrase intensive therapy usually refers to the level of psychotherapy and related services administered, rather than to the intensity of medical treatment. There is no standard definition in medical literature for what constitutes intensive therapy. The intensity of treatment can be determined in one of four ways:
What is the ultimate goal of intensive therapy?
In intensive therapy, the ultimate goal of treatment is to increase self-efficacy, which is a patient’s belief that most routine stresses can be handled and most problems can be managed. To accomplish this larger goal, intensive therapy uses several other goals:
How Long Does Intensive Therapy Last?
The most acute types of traditional treatment are inpatient hospitalizations, which typically lasts from several weeks to three months.
Why is intensive therapy important?
One of the many advantages of intensive therapy is the ability to undergo a deep exploration of the underlying psychological factors that contribute to a substance use disorder or a chronic mental health condition. During intensive therapy, patients have more ability to discuss and address their internal vulnerabilities to unhealthy thoughts and behaviors.
How long does a partial hospital stay?
Partial hospitalization programs, which are one level down in acuity from inpatient hospitalization, can also last weeks to months. Intensive outpatient programs, which offer a balance between high-level treatment and autonomy, are usually designed to last at least one month.
When did intensive therapy become popular?
This type of delivery of therapy can be applied to many different models of psychotherapy. Intensive therapy models have been popular since the 1980s , and several of these models are effective in treating persistent mood disorders as well as with substance use disorders.
What is the most common form of short term therapy?
One of the most popular forms of high-frequency, short-term treatment is called intensive short-term dynamic psychotherapy.
What is intensive outpatient treatment for substance abuse?
Intensive outpatient programs for substance abuse offer many of the same services that inpatient programs do without you having to take time off of work or school and spend time away from family.
What Happens During Intensive Outpatient Treatment?
Upon entering an intensive outpatient program, you will be assessed and work with a treatment team that may consist of mental healthcare practitioners, treatment professionals, doctors, therapists, or nurses, depending on the level of care you’ll be receiving.
What is an IOP treatment team?
The team will work with you to create a treatment plan based on your intake evaluation and individual needs. IOP services are greatly focused on relapse prevention and developing healthy coping skills. 1
How long does an inpatient rehab program last?
Inpatient programs can last 30, 60, or 90 days , and sometimes longer if necessary. These programs can be a significant commitment if you have other responsibilities. Conversely, people attending an intensive outpatient rehab program can schedule treatment when it works best for them.
Why is an IOP less expensive than an inpatient recovery program?
Generally, an IOP costs less than an inpatient recovery program because it doesn’t provide food or housing. The cost will vary based on your insurance plan and how long you participate in the program. But it is likely that insurance will provide at least partial coverage.
How long does a rehab stay at home?
The biggest difference is that inpatient or residential rehab programs require that you live at the facility, while outpatient rehab programs allow you to return home when treatment sessions are finished. Inpatient programs can last 30, 60, or 90 days, and sometimes longer if necessary.
Why do people use IOP?
While some people use a substance abuse IOP as a primary type of care, others may transition to an IOP after completing an inpatient program to continue to build on coping skills and decrease the risk of relapse. Still others may require monitored detoxification and will transition to an IOP after going through detox.
Why do people need treatment in long term care?
People who are placed in long-term care facilities need robust treatment in order to recover and remain in the community. Currently people are referred to community behavioral health providers who may not be able to provide treatment robust enough for the person to remain successful in their community.
What is IRT in healthcare?
It is not meant to be a clinical guide and should not be used to make clinical decisions. Background . Intensive Residential Treatment teams (IRT) are part of Governor Jay Inslee’s plan to transition people out of the civil commitment wards in Washington’s state hospitals.
What is an ALF in a long term care facility?
Many adults who discharge to the community or are diverted from a state hospital are placed in an Adult Family Home (AFH) or Assisted Living Facility (ALF) to meet their basic needs and care for their activities of daily living (ADL). Often these individuals are not getting adequate behavioral health support from community behavioral health providers. AFHs and ALFs are great at caring for people’s basic needs. While staff in long-term care facilities are trained to take care a of a person’s daily needs, they are not trained to manage or treat the complex behavioral health needs of some of our most vulnerable people. People who are placed in long-term care facilities need robust treatment in order to recover and remain in the community. Currently people are referred to community behavioral health providers who may not be able to provide treatment robust enough for the person to remain successful in their community. This results in people returning to the behavioral health crisis system and back to a state hospitals.
What does a therapist do in a facility?
They will assist in scheduling and coordinating the functions of the facility. They can help with researching information and coordinating paperwork in the facility.
What is an MHP in IRT?
The MHP(s) for the IRT team are required to complete all intakes into services and sign completed recovery plans. MHPs provide oversight for other team members and must validate that services provided are working towards the goals of the recovery plan.
How long is a substance abuse treatment program?
This is a short-term service that may only be billed for 30 days in a 12-month period.
What is day treatment?
Day Treatment must address the age, behavior, and developmental functioning of each individual to ensure safety, health, and appropriate treatment interventions within the program milieu. Day Treatment provides mental health or substance use disorder interventions in the context of a therapeutic treatment milieu.
How many beds does a mental health facility have?
This service provides an alternative to hospitalization for adults who have a mental illness or substance use disorder. This is a 24-hour residential facility with 16 beds or less that provides support and crisis services in a community setting. This may be provided in a non- hospital setting for individuals in crisis who need short-term intensive evaluation, treatment intervention or behavioral management to stabilize acute or crisis situations.
What is the staff to individual ratio for a mental health facility?
This is a 24-hour service that is offered seven days a week, with a staff to individual ratio that ensures the health and safety of individuals served in the community and compliance with 10A NCAC 27E - Seclusion, Restraint and Isolation Time Out. At no time will staff to individual ratio be less than 1:6 for adults with a mental health disorder and 1:9 for adults with a substance use disorder.
Research Aims and Hypotheses
Secondary Hypotheses
- Safety. With regard to safety it is expected that patients in the IHT condition will report the same amount or less symptoms of social malfunctioning and aggression than CAU patients [17].
- Psychiatric symptoms. With regard to psychiatric symptoms it is expected that participants in the IHT condition will report the same amount or less symptoms than CAU patients [15].
- Safety. With regard to safety it is expected that patients in the IHT condition will report the same amount or less symptoms of social malfunctioning and aggression than CAU patients [17].
- Psychiatric symptoms. With regard to psychiatric symptoms it is expected that participants in the IHT condition will report the same amount or less symptoms than CAU patients [15].
- Treatment satisfaction. Higher treatment satisfaction treatment of the participants and their relatives [20, 25] in the IHT is expected compared to CAU.
Design
- The trial in this protocol is designed as a 2-centre, 2-arm Zelen double consent open label RCT, to test the efficacy and cost-effectiveness of IHT against CAU. This design is chosen after careful consideration and fruitful discussions between the researchers and the IHT professionals and has been approved by the Medical Ethics Committee of VU University Amsterdam (MEtC VUmc) as …
Study Procedure
- Recruitment
Arkin and GGZ inGeest are the two largest mental health care organisations in Amsterdam, the Netherlands and provide in- and outpatient psychiatric care in Amsterdam for children and adults of all ages. The Psychiatric Emergency Service Amsterdam (PES) is a cooperation between thes… - Participants
All patients are recruited from mental health care organisation Arkin and InGeest in Amsterdam which provide high intensive psychiatric care, IHT treatment or admission to a psychiatric ward. For this study the following in- and exclusion criteria apply:
Interventions
- Intensive home treatment
IHT is a treatment modality that addresses some of the imperfections of inpatient care by providing care in the patients’ home setting in the least restrictive environment; ‘normal’ life is disrupted as little as possible. In this way collaboration with and utilization of the patient’s socia… - Care as usual
Standard crisis care often includes admission or low intensity (i.e. less than 3 times a week) outpatient treatment. If admitted, the patient’s environment is generally highly structured at the outset (a closed ward, for example), and becomes less structured as the patient’s condition impr…
Measurements
- Measurements will be conducted at the start of the treatment (T0) and at 6, 26 and 52 weeks follow-up (T1, T2, T3; see Table 1). All self-report questionnaires, potential effect moderators and demographic variables will be collected using several assessment methods. Once written informed consent has been provided, the research team will conduct the data collection of the p…
Demographic Variables
- At baseline, participants complete questions concerning basic demographic details; those questions include age, gender, country of origin, parents or relative’s country of origin, domestic situation, education level, occupational status and income. Drug history will be requested from the pharmacy (with participant’s consent), while the use of mental health care in the year before allo…
Primary Outcome Measure
- The number of hospitalisation days in the 52 weeks after randomisation is the primary outcome measure. This includes the duration of the initial admission at baseline, and any subsequent psychiatric admission during the 12 months follow-up period of the study. Data will be collected from the EHR system of both mental health care organisations.
Other Outcomes of Interest
- 1) Social support and network:
- 2) Self-Efficacy: The Mental Health Confidence Scale (MHCS); 16-items questionnaire developed to measure self-efficacy in individuals diagnosed with mental disorders [48].
- 3) Quality of life:
- 4) Alcohol and substance use:
Handling and Storage of Data and Documents
- Once the participating patient provides written informed consent, a unique project number will be allocated to each participant. The key of these project numbers will only be available to the principal investigators, the relevant data managers and research assistants. All (paper and digital) questionnaires and data will be stored and handled using this project number (de-identified). Stu…