PERCIVAL, Italian Intensive Outreach Team for the treatment of adolescent psychiatric emergency in the territory of Milan: preliminary results of nine months of activities

Rationale : PERCIVAL project is inspired by the international paradigm of Intensive Outreach Teams– IOT, and has three goals: 1. To Provide appropriate and prompt treatment for adolescents in psychiatric emergency living in Milan 2. To Determine the need of specific CANP inpatients beds in Milan 3. To Assess the effectiveness, costs and applicability of the IOT model in the Italian territory Methods: “PERCIVAL” project is aimed at adolescents 12-18 yrs with psychiatric symptoms in the 1 (life threatening conditions with an immediate need for treatment) and 2 (severe symptoms requiring an urgent response) Rosenn and Gail classification. The psychiatric evaluation and the treatment plan design are conducted by a multiprofessional team. The assessment is composed by: Crisis Assessment Tool-CAT, HoNOS-CA, HEADS-ED, CBCL, CGI, CGAS, Difficulties Emotion Regulation Scale, Barratt Impulsiveness Scale, Risk Taking-Self Harm Inventory, Personality Inventory DSM 5, Columbia Suicide Severity Rating Scale, Broset Violence Checklist, Pediatric Quality of life Inventory, Who Quality of Life, Score 15, Stress Index Parents of Adolescents, Orbetello Satisfaction Scale. This assessment is performed at the beginning and at the conclusion of the treatment and is completed again during follow up visits (6 and 12 months). The individual treatments can be developed at home with different level of intensity; in the outpatient clinic through individual and/or group therapy sessions; if necessary through hospitalization in pediatric ward or adult psychiatric ward (if the patient is ?16 years and Rosenn/Gail class I ). Results: During the first 9 months (1/9/15-30/6/16) 45 patients (18 males and 27 females, in the 11.2 to 18 years age range) have been evaluated.34 patients (76%) met inclusion criteria: 24% class I and 76% class II; 58.8% were females and 41.2% males.19 patients accessed “PERCIVAL” via emergency room (56%), 11 through hospitalization (32%) and 4 as outpatients (12%). 59% had depression with suicide attempts or thoughts, severe personality disorder, post traumatic stress disorders; 18% psychosis or bipolar disorder; 9% severe behavioral disorders; other disorder (14%) were individually unrepresentative. 9 patients (24%) were substance abusers (mainly cannabis). Intensive treatment has been activated for 31/34 patients; the remaining three patients have been reoriented to other services. 52% (16 patients) have only received intensive outpatient or home treatment; 48% (15 patients) have also received short term hospitalization. Conclusions: An Italian adaptation of IOT can represent an effective intervention for adolescents with acute psychiatric symptoms, nonetheless for a subset of patient with very complex needs specific inpatient CANP beds are mandatory