Hospital-at-home care in child and adolescent psychiatry is an innovative strategy that has been successfully developed in other countries and began to be implemented at the Hospital Clínic Barcelona almost two-and-a-half years ago. This new approach aims to provide medical and psychotherapeutic care to children and adolescents suffering from severe mental health disorders, similar to the care they would receive on a hospital ward, but in their family environment. The aim of the programme is to adapt the treatment to meet the individual needs of each child or adolescent and their family. Since the programme started in June 2021, 166 minor patients have been admitted for with an average stay of 20 days. A decrease of 20% in hospital admissions and up to 70% in A&E visits has been observed in the 6 months following hospital-at-home care.
Health professionals work closely with families to provide personalized care, taking into account the patient’s family, school and social environment. Moreover, they supervise the transition to everyday activities that have been disrupted by the illness. This environment provides more comfort for the patient, greater adherence to and continuity of treatment, more family involvement and avoids the risks of psychiatric hospitalization, being more effective in terms of cost.
It is led by a multidisciplinary team made up of a child psychiatrist and two nurses, and forms part of the hospital’s home hospitalization unit. The programme has 5 beds and is designed to treat a wide range of disorders such as autism spectrum disorders, psychotic disorders, mood disorders, anxiety disorders, obsessive-compulsive disorders, behavioural disorders and eating disorders. The care plan is personalized for each patient and includes daily visits 7 days a week by the psychiatrist and/or nurse as well as coordination with social services and schools. Home hospitalization of minors with acute mental disorders is proposed as a resource for some patients when the recovery process involves a reorientation of the individual and the involvement of their family in the therapeutic process. A central role is given to coping strategies in the natural environment and the empowerment of the patient and family. This type of intervention clearly reduces the stigma associated with hospitalization.
According to Dr. Luisa Lázaro, head of the Child and Adolescent Psychiatry and Psychology Service at the Hospital Clínic, “this programme allows us to provide boys and girls with more intensive treatment, especially working with their families, in a more natural environment, without the more negative aspect of hospitalization. Of course, we need the close collaboration of the parents in order to carry out the prescribed therapeutic treatment”,
Care for patients with greater social problems
In order to offer greater assistance to children with psychological disorders, the hospital also implements the Home Intensification Programme (PID). This provides comprehensive care and facilitates accessibility to mental health care for minors and their families who find it more difficult to access the usual resources. Since the start of the programme in December 2022, 32 minor patients have been treated, with 481 interventions at home, at school and in other favourable environments. The recovery and subsequent linkage to community mental health resources has been positive in 98% of cases. This programme is part of the Master Plan for Mental Health and Addictions (PdSMiA) promoted by the Catalan Ministry of Health and is being extended throughout Catalonia.
The Home Intensification Programme at the Hospital Clínic forms part of the community care team for children and adolescents in the Eixample district (CSMIJ). The CSMIJ professionals themselves identify families who have a minor with severe mental health problems, often with a significant functional impairment, and a shared intervention is initiated, at home and sometimes also in the CSMIJ. The participation of the social educator and the occupational therapist facilitate educational interventions in the minor's natural environment.
These initiatives were started in response to the post-pandemic crisis characterized by the increase in demand in the A&E department with regard to mental health problems in children and adolescents and the consequent overloading of the care network. The effective functioning of both teams has helped improve the quality of life of minors with mental disorders, and has significantly reduced the need for hospital care.
The Hospital Clínic Barcelona, renowned for its excellence in medical care and research, continues to lead the way in the field of child and adolescent psychiatry by implementing this innovative approach to the treatment of patients.