Griffiths Helen, Noble Abbi, Duffy Fiona, Schwannauer Matthias
Child and Adolescent Mental Health Services, NHS Lothian, Edinburgh, UK.
Department of Clinical and Health Psychology, School of Health in Social Science, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, UK.
Child Adolesc Ment Health. 2017 Sep;22(3):170-174. doi: 10.1111/camh.12181. Epub 2016 Jul 20.
To present clinical outcome data of the Adolescent Mentalization-based Integrative Treatment (AMBIT)-trained NHS Lothian Tier 4 child and adolescent mental health service in the context of service utilization and engagement.
Data were obtained for a 2-year period that included details of all face-to-face contacts between young people and clinicians along with routinely collected clinical outcomes data relating to anxiety, depression, symptoms of psychosis and quality of life.
Improvements were observed in quality of life, symptoms and distress across the course of the intervention. Overall attendance rates were high (80%). Relative to those who were better engaged, the less well-engaged group received the same number of appointments but spent longer in the service (χ (1) = 5.26, p = .022), had more professionals involved in their care (χ (1) = 4.91, p = .027) and showed a nonsignificant trend to more inpatient admissions. Later engagement was not associated with distress or symptoms at entry into the service with the exception of negative symptoms in the Early Psychosis Support Service cohort. Age and two quality of life factors were associated with later engagement (p < .05).
Our AMBIT-trained Tier 4 CAMH service demonstrates change over the course of intervention consistent with the service model's theoretical expectations. Engagement with the service may be associated more with factors related to social circumstance and functioning than with key symptoms and distress. Less well-engaged young people utilize increased service resource. AMBIT's mentalizing focus may improve service provision for young people who are poorly engaged with mental health services.
在服务利用和参与的背景下，呈现接受基于青少年心理化整合治疗（AMBIT）培训的NHS Lothian 4级儿童和青少年心理健康服务的临床结果数据。
获取了为期2年的数据，包括年轻人与临床医生之间所有面对面接触的详细信息，以及常规收集的与焦虑、抑郁、精神病症状和生活质量相关的临床结果数据。
在干预过程中，生活质量、症状和痛苦程度均有改善。总体出勤率较高（80%）。与参与度较高的人群相比，参与度较低的人群预约次数相同，但在服务中花费的时间更长（χ(1)=5.26，p=0.022），参与其护理的专业人员更多（χ(1)=4.91，p=0.027），且住院人数有不显著的增加趋势。除早期精神病支持服务队列中的阴性症状外，后期参与度与进入服务时的痛苦或症状无关。年龄和两个生活质量因素与后期参与度相关（p<0.05）。
我们接受AMBIT培训的4级儿童和青少年心理健康服务在干预过程中显示出变化，符合服务模式的理论预期。与服务的参与度可能更多地与社会环境和功能相关因素有关，而不是与关键症状和痛苦有关。参与度较低的年轻人使用了更多的服务资源。AMBIT的心理化重点可能会改善为与心理健康服务参与度低的年轻人提供的服务。
