Camilleri Nigel, Newbury-Birch Dorothy, McArdle Paul, Stocken Deborah D, Thick Tony, Le Couteur Ann
Institute of Health and Society, Newcastle University, Baddilley-Clarke Building, Richardson Street, Newcastle upon Tyne, NE2 4AX, UK.
Tees Esk and Wear Valleys NHS Foundation Trust, Edward Pease Way, Darlington, County Durham DL2 2TS, UK.
Child Adolesc Ment Health. 2017 Feb;22(1):49-57. doi: 10.1111/camh.12202. Epub 2016 Nov 23.
Innovations Project (IP) was a new multidisciplinary team based within an inner city, walk-in health centre, North East England (throughout 2011). The aim was to describe the social and mental disorders of the hard to reach young people (HTRYP) from the IP and compare with a matched sample who attended a Community Mental Health Team (CMHT) and follow-up both samples 24 months after discharge.
A retrospective review of clinical case notes of YP who attended the IP and CMHT. A 24-month (postdischarge) follow-up evaluation of the mental state and social function of the YP in both groups using Health of the Nation Outcome Scales for Child and Adolescent Mental Health (HoNOSCA) and Children's Global Assessment Scale (CGAS).
Thirty-six referrals were accepted over a one-year period by the IP, 31 met criteria for the HTRYP, 15 were offered individually tailored therapy. The HTRYP who were more deprived compared to the CMHT matched sample (n = 115), experienced a higher median number of mental disorders (n = 3 compared to CMHT n = 1), higher severity scores and lower levels of social function (HTRYP HoNOSCA mean: 19.1 (95% CI 15.9-22.2) and CMHT mean: 11.2 (95% CI 2.0-23.0) p = <.001, and HTRYP CGAS mean: 51.0 (95% CI 46.0-56.2) and CMHT mean: 58.9 (95% CI 52.9-64.8), p = .05). The HTRYP made significantly greater improvement compared to CMHTYP; (HoNOSCA p = <.001 and CGAS p = <.002) at discharge. A total of 13 HTRYP and 9 CMHT YP attended the follow-up review at 24 months. There was substantial variability in terms of social function between the YP within each sample.
The term 'HTR' describes a state that may be often temporary, as opposed to lifelong. A bespoke service offering a developmental theoretical framework, regular reviews and an individualised care plan, was able to engage and had the potential to reduce morbidity suffered by HTRYP.
创新项目（IP）是2011年全年设在英格兰东北部市中心一家无需预约的健康中心内的一个新的多学科团队。其目的是描述来自该创新项目的难以接触到的年轻人（HTRYP）的社会和精神障碍，并与参加社区心理健康团队（CMHT）的匹配样本进行比较，并在出院24个月后对两个样本进行随访。
对参加创新项目和社区心理健康团队的年轻人的临床病例记录进行回顾性审查。使用儿童和青少年心理健康国家健康结果量表（HoNOSCA）和儿童总体评估量表（CGAS）对两组年轻人出院后24个月的精神状态和社会功能进行随访评估。
创新项目在一年期间接受了36例转诊，31例符合难以接触到的年轻人的标准，15例接受了个性化治疗。与社区心理健康团队的匹配样本（n = 115）相比，处境更不利的难以接触到的年轻人精神障碍的中位数更高（难以接触到的年轻人为n = 3，而社区心理健康团队为n = 1），严重程度得分更高，社会功能水平更低（难以接触到的年轻人HoNOSCA平均值：19.1（95%可信区间15.9 - 22.2），社区心理健康团队平均值：11.2（95%可信区间2.0 - 23.0），p = <.001；难以接触到的年轻人CGAS平均值：51.0（95%可信区间46.0 - 56.2），社区心理健康团队平均值：58.9（95%可信区间52.9 - 64.8），p = .05）。与社区心理健康团队的年轻人相比，难以接触到的年轻人在出院时改善更为显著（HoNOSCA p = <.001，CGAS p = <.002）。共有13名难以接触到的年轻人和9名社区心理健康团队的年轻人参加了24个月后的随访复查。每个样本中的年轻人在社会功能方面存在很大差异。
“难以接触到”一词描述的是一种可能经常是暂时的状态，而非终身状态。一项提供发展理论框架、定期复查和个性化护理计划的定制服务能够让难以接触到的年轻人参与进来，并有可能降低他们所遭受的发病率。
