Authors' objectives: Adolescents experiencing psychiatric emergencies often require intensive interventions to prevent hospitalisation and support their return to education, employment or training. Intensive Community Care Services aim to provide an alternative to inpatient care. Adolescents in psychiatric crises often need intensive help to avoid hospital admission and get back into education, employment or training. Intensive Community Care Services aim to offer an alternative to hospital care for these young people.

Authors' results and conclusions: Of the approximately 977 adolescents screened, 36 were randomised in a 1 : 1 ratio using a web-based randomisation system stratified by the NHS trust using variable block sizes to receive either Intensive Community Care Services or treatment as usual. A key reason for poor recruitment was the absence of an alternative to Intensive Community Care Services. The recruitment rate did not meet pre-specified progression criteria (n = 55 by the first 6 months of recruitment), and conducting a full evaluation trial was deemed not feasible. Thirty participants from the pilot sample (83.3%) returned to education, employment or training during the 6-month follow-up period, with a median time to education, employment or training of 9 days (interquartile range 1–49). The median time to education, employment or training was lower in the Intensive Community Care Services group (6 days) compared to the treatment-as-usual group (12 days), with a hazard ratio of 1.34 (95% confidence interval 0.63 to 2.86). Estimated effect sizes for secondary outcomes were also in the direction of a benefit under Intensive Community Care Services, with higher satisfaction with services and improvements in clinical symptoms and functioning. There was a greater total average cost for the treatment-as-usual group at £15,155 (standard deviation 31,560), compared to £7063 (standard deviation 10,605) for Intensive Community Care Services. Due to the small sample size, no inferences regarding Intensive Community Care Services effectiveness or cost-effectiveness can be drawn. Fourteen young people participated in the process evaluation. Inpatient care received both praise for effective diagnoses and therapeutic interventions and criticism for a sterile approach and inadequate staff attention. Intensive Community Care Services was valued for the personalised approach, exemplified by beneficial home visits. During COVID-19, there was a significant reduction in emergency presentations of young people, followed by a significant increase post pandemic. The follow-up attendance rate increased by more than three times if the follow-up appointment was offered by the same clinician who saw the young person in an emergency room (odds ratio 3.66, 95% confidence interval 1.65 to 8.13). Intensive Community Care Services teams should use the modified Dartmouth Assertive Community Treatment Fidelity Scale to assess their quality. Recruitment to a randomised controlled trial of this kind can be improved if all new Intensive Community Care Services teams are considered to be experimental services and an equipoise between Intensive Community Care Services and existing services acknowledged. No definitive conclusions can be drawn from this study. Preliminary results suggest that Intensive Community Care Services may support a faster return to education, employment or training than treatment as usual. Intensive Community Care Services may be cost-effective compared to treatment as usual. Additional mental health professionals should be deployed to Intensive Community Care Services during future lockdowns. The same Intensive Community Care Services professionals should offer assessments in emergency departments and provide community follow-up. Research with a larger sample is warranted to confirm these findings. Out of 36 participants, 30 (83.3%) returned to education, employment or training within 6 months. The Intensive Community Care Services group returned faster (about 6 days) than the treatment-as-usual group (12 days), though the difference was not statistically significant. Still, Intensive Community Care Services showed some positive trends, like higher service satisfaction. Costs were lower for Intensive Community Care Services (£7063 on average) compared to treatment as usual (£15,155). Fourteen participants shared their experiences of using services; while hospital care was sometimes praised, Intensive Community Care Services was valued for its personalised approach. During COVID-19, fewer young people came to emergency departments, but this rose again afterwards. Follow-up attendance tripled when the same clinician was involved in emergency assessments and follow-up. Although the study did not provide conclusive results, Intensive Community Care Services shows promise in helping young people return to education, employment or training faster and maybe more cost-effective than treatment as usual. We recommend more mental health staff for Intensive Community Care Services in future lockdowns. The same clinicians should handle both emergency assessments and follow-up care. Further research with more participants is needed to confirm these findings.

Authors' methods: A multicentre, parallel-group, single-blinded, randomised controlled trial, including an internal feasibility phase, across seven NHS trusts in the United Kingdom. Adolescents aged 12–17 were randomised to receive either Intensive Community Care Services or treatment as usual. The primary outcome was the time to start or return to education, employment or training within a 6-month observation period. Secondary outcomes included clinical symptoms, functioning and service satisfaction. Process evaluation used semistructured visual interviews followed by thematic decomposition analysis. The impact of COVID-19 and the importance of continuity of care were explored in a series of cohort studies based in emergency departments. A consensus meeting was held to define the features of Intensive Community Care Services. The most significant limitation of this pilot study is the very small sample size, which was a direct result of recruitment difficulties. As a result, we were unable to draw any inferences about the effectiveness or cost-effectiveness of Intensive Community Care Services relative to treatment as usual. It was not possible to blind participants to the intervention they were receiving. The 6-month follow-up period may have been insufficient to capture important long-term outcomes. We conducted a study across seven NHS trusts in the UK, where adolescents aged 12–17 were randomly assigned to receive either Intensive Community Care Services or treatment as usual. The main goal was to measure the time it took for them to start or return to education, employment or training within 6 months. We also looked at their clinical symptoms, daily functioning and service satisfaction. We used interviews to evaluate their experiences and also studied how COVID-19 and continuity of care affected outcomes.

Project Status: Completed

URL for project: https://www.journalslibrary.nihr.ac.uk/programmes/hta/NIHR127408

Year Published: 2026

URL for published report: https://www.journalslibrary.nihr.ac.uk/hta/GJDO2425

URL for additional information: English

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: England, United Kingdom

DOI: 10.3310/GJDO2425

Organisation Name: NIHR Health Technology Assessment programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk