Understandably, but sometimes incorrectly, families of mentally ill patients think that because serious medical conditions are best treated at a hospital, serious mental health issues are also best treated in the same fashion, at residential facilities or in an out-patient clinical setting.
But let’s consider a different approach that is proving effective in numerous trials and could have transformative implications for adolescent mental health. Evidence-Based Practices (EBPs) that utilize home-based, family-focused protocols are showing success among youth in the juvenile justice and child welfare systems, and offer enormous promise for the broader population.
In programs undertaken by The New York Foundling, we have worked with EBP developers to create multi-faceted treatment programs with highly effective home-based interventions. In addition to efficacy, home-based protocols provide a number of advantages over traditional inpatient care:
- Patients are seen within the context of their natural environment, allowing greater potential to understand and treat a dysfunctional ecology that may be contributing to their psychological issues;
- Intensive social services, such as support with housing, education and employment training, are provided to patients and their families;
- Clinicians go to the patient, and therefore lower the rate of absenteeism and increase the percentage of patients who complete a full course of treatment.
These programs have achieved better results than traditional courses of treatment for similar populations and at a fraction of the cost. In one of our programs targeting juvenile offenders, 90 percent of participants saw treatment through to completion and the rate of “no-shows” was only three percent.
Certainly, some clinicians will argue that having the patient come to the physician is crucial, as the motivation for treatment must reside within the patient. Our evidence-based models, however, hold the clinician responsible for the motivation and engagement of patients and families and provide them with professional training in engagement strategies. As a result of this fundamental protocol difference, we have found a higher percentage of our patients completing a full course of treatment than in traditional models.
Another advantage of evidence-based models is that they follow clear, data-driven protocols and rigorous evaluation criteria – evaluations that can be peer reviewed and analyzed. We track our results against the goals set at the beginning of each clinical relationship. We tape sessions and review the performance of our clinicians. And for quality assurance purposes, we include scrutiny by third-party experts.
This careful tracking enables us to work with insurers, mental health professionals and, indeed, patients themselves, to formulate clear metrics to define a successful, but cost-effective, course of treatment.
Certainly, this model is not a solution for everyone. But given the dramatic results we are achieving with some of the most troubled young people in our society, why not consider applying it to some of the many other young people who are so desperately in need of help?
Bill Baccaglini is the CEO of New York Foundling, a New York City-based multi-service provider for youths and families that are in crisis or suffer from disabilities.
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