PERCIVAL project: Italian adaptation of Intensive Outreach Teams for the treatment of psychiatric emergencies in adolescence

Rationale: “PERCIVAL” project is conceived to guarantee appropriateness of care for patients and families in a situation of shortage of inpatient beds in Child and Adolescent Neuropsychiatry in the Milan region. Its intent is to offer a prompt response to acute psychiatric adolescent patients and their families, through an intensive pathway of care that may act in an outpatient setting, at home and in hospital as needed, as an alternative to ordinary hospitalization and to prevent residential care. The project will test the feasibility, effectiveness, costs, sustainability and applicability to the Italian reality of a modified IOT (Intensive Outreach Team) paradigm. Methods: The intended target population of “PERCIVAL” project are adolescents in the 12-18 age range who show psychiatric symptoms in the I and II Rosenn and Gail classification. The psychiatric evaluation and the treatment plan design are conducted by a multiprofessional team which includes 4 neuropsychiatrists, 1 psychologist, 1 social worker, 2 professional educators and 2 psychiatric rehabilitation experts.Protocol Description. The treatment goals are differentiated according to the clinical stage (pre acute, acute and post acute), and work up includes the following: • Diagnostic assessment • Triggers checklist • Risk assessment and symptoms management • Design and sharing of a crisis plan shaped on the patient and his community context • Design of a therapy plan focused on the patient and caregiver’s needs and strengths with the intent of: i) reducing hospitalizations ii) managing the acute symptoms; ii) empowering the family in dealing with new breakdown episodes. • Facilitation of the post-emergency care treatments within the locally available outpatient units The treatment includes 4 stages: 1. 0-2 weeks: assessment, crisis plan design and individual intensive treatment. The assessment is aimed at identifying i) actual psychopathological condition underlying the acute breakdown, ii) presence of self and etero aggressive behaviors, iii) global and family functioning, iv) quality of life. The CANS communimetric tool and its related versions (HEADS-ED and CAT) are used in order to plan the intervention and to evaluate and monitor the results of the treatment 2. 2-12 weeks: multidisciplinary treatment at patient’s home and in the community with different levels of intensity (high intensity: 5-7 treatments/week; medium intensity: 2-3 treatments/week; low intensity: 1-2 treatments/week). Individual treatments or small groups treatments, focusing on self harming behaviors or other behaviors that may disrupt or impair the functioning of the patient may be provided. 3. 2-3 weeks: new psychiatric evaluation, assessment of fulfilled goals and design of a new management plan for the transition to the territorial healthcare service 4. Follow up at 6 and 12 months. Conclusions: “PERCIVAL” project aims at verifying an innovative clinical approach (outreach) able to offer immediate and multi professional responses to adolescent psychiatric emergencies by identifying new strategies aimed to deal with the patient crisis in his family context, facilitating natural networks response, and managing the transition to the proper healthcare providers for the future.