Community Services for Psychiatric Adolescents: When Planning a Residential or Semi-residential Treatment

Background: Adolescence psychopathology often represents a challenge in regards of the way it is treated, due to the shortage of public mental health resources like Wellbeing Centers and daily Services, that differ from hospitals. From our experience in a daily Semi-residential Service for Children and Adolescents, part of the Public Neuropsychiatry Unit in Padua - Italy, we carried out a retrospective analysis in order to identify which factors could be the best indicators for the referral of a young person to a residential or a semi-residential placement.

Scope: We aimed to identify which variables, detectable at an early stage of treatment, may be good predictors for the referral of the young person, either to a daily semi-residential facility, or to recommend a more intensive treatment in a residential unit.

Methods: The sample consists of 102 adolescents referred to the daily Semi-residential Service. It was later on divided into two groups: one group stayed in the Semi-residential Service and the second group pursued a referral in a residential child care institution. All patients were assessed using the Youth Self Report Form YSR (11-18) and the Global Assessment of Functioning Scale (GAF) with a test – retest methodology. For each patient the following data were collected: personal and family details, schooling, diagnosis, therapeutic objectives, adolescent‘s level of cooperation, their families’, and type of intervention submitted. All data were analyzed and compared to find out the most predictive factors towards the best placement for the patient.

Results: It emerged that residential child care institution was recommended for adolescents with the following features: aged under 14, living with single parent, affected by externalizing problems, displaying a poor therapeutic compliance and with non cooperative families.

Conclusions: This study showed the importance to identify which predictive factors are related to a better outcome in patients who used alternative services to hospitalization, considering these factors also necessary in terms of a better therapeutic intervention.