Trial of Therapeutic Assessment in London: randomised controlled trial of Therapeutic Assessment versus standard psychosocial assessment in adolescents presenting with self-harm.

摘要

OBJECTIVE: To determine whether Therapeutic Assessment (TA) versus assessment as usual (AAU) improves engagement with follow-up in adolescents presenting with self-harm. DESIGN: Randomised controlled trial with 3 months naturalistic follow-up. SETTING: Child and adolescent mental health services in two London National Health Service Trusts. PARTICIPANTS: 26 clinicians randomised into TA and AAU groups recruited 70 newly referred adolescents with self-harm. INTERVENTIONS: TA, a manualised procedure including a basic psychosocial assessment and a 30 min therapeutic intervention; AAU, standard psychosocial assessment. MAIN OUTCOME MEASURES: Attendance at the first follow-up session; number of the follow-up sessions attended and changes in Strengths and Difficulties Questionnaire and Children's Global Assessment Scale scores. All measures were adjusted for clustering, social class, changes of therapist and previous contact with services. RESULTS: Using the data on all participants (n=70), those in the TA group were significantly more likely to attend the first follow-up appointment: 29 (83%) versus 17 (49%), OR 5.12, 95% CI (1.49 to 17.55) and more likely to attend four or more treatment sessions: 14 (40%) versus 4 (11%), OR 5.19, 95% CI (2.22 to 12.10). Three months after the initial assessment there were no statistically significant differences between the groups on Strengths and Difficulties Questionnaire scores: 15.6 versus 16.0, mean difference -0.37, 95% CI (-3.28 to 2.53) or Children's Global Assessment Scale scores: 64.6 versus 60.1, mean difference 4.49, 95% CI (-0.98 to 9.96). CONCLUSIONS: TA was associated with statistically significant improvement in engagement. TA could be usefully applied at the point of initial assessment for adolescents with self-harm. TRIAL REGISTRATION: ISRCTN 81605131 http://www.controlled-trials.com/ISRCTN81605131/.