Outcome-Network.org

An International Database and eJournal for Outcome-Evaluation and Research

Paper

Multiprofessional intervention versus uniprofessional one: intensive treatment alternatives for adolescents with psychic and behavioural disease

abstract

Purpose. This work evaluates different ways of approaching adolescents with psychiatric and behavioural problems, with the aim of comparing multi-professional and single professional interventions in terms of their therapeutic efficacy. The context is that of a local service (second level service). Apart from its clinically based responsibilities for diagnosis and psychotherapy in relation to adolescent psychopathology, the service also has available a semi-residential unit for adolescents, with a team made up of social pedagogues, psychologists and child neuro-psychiatrists. The initial hypothesis was that a multi-professional intervention would be more effective than single professional one. Moreover, the authors wanted to study effectiveness of these interventions in relation to the following variables: psychiatric diagnosis, timing of intervention, therapeutic compliance, the degree of patient participation; different types of treatment-educational, psychological and psychiatric; interventions undertaken as a single professional or jointly, outcome evaluation.

Sample. 100 individuals, 66 males and 34 females, aged between 12 and 18 years affected by psycho-relational and behavioural problems, were selected, and divided into 5 groups on the basis of type of therapeutic treatment:

  • single professional psychological treatment (psychotherapeutic or psychological support);
  • single professional educational treatment;
  • joint psychological and educational treatment;
  • joint psychiatric (pharmacological) and psychological treatment;
  • joint psychological, psychiatric and educational treatment.

Methods. The subjects, following psychiatric diagnosis (ICD 10) and the drawing up of a therapeutic plan, are tested before and after treatment. The Global Assessment Functioning Scale (GAF) was used to evaluate the effectiveness of the therapeutic interventions. Patients were classified as improved, worse, or having stayed the same, depending on the scoring reported during re-testing. Data about patients was collected in an anamnestic schedule, and then transferred to a computerised database for data processing, using SSPS version 10 and SAS® packages. Clinical change was studied statistically in relation to the variables: psychiatric diagnosis (classified according to ICD10), length of intervention ( less than 3 months; 3-9 months; more than 9 months), therapeutic compliance (adequate, discontinued, absent), patient participation (active, passive, oppositional, ambivalent), and type of professional intervention (single or joint).

Statistical Analysis: the variables were expressed in a nominal scale. The comparison between the values and their significance was evaluated by c²-squared test and multivariate logistic regression. The value of p<0.05 was considered significant.

Findings. Results relating to an analysis of the frequency of the variables are shown in Tables 1-7.

 

Tab. 1- Age intervals

 

Tab. 2 -Diagnosis ICD10

 

 

 

Freq

%

 

 

Freq

%

12-14 yrs

43

43

 

Psychotic disorders

18

18

15-17 yrs

46

46

 

Affective Syndromes

21

21

17-19 yrs

11

11

 

Neurotic Syndromes

10

10

Total

100

100

 

Personality Disorders

21

21

 

 

 

 

Mental Def., Psychologic Dev. Alt.

6

6

 

 

 

 

Behaviour/emotional disorders

9

9

 

 

 

 

2 dgn in comorbidity (Person. D +...)

11

11

 

 

 

 

Eating disorders

4

4

 

 

 

 

Total

100

100

 

Tab. 3- Type of treatment

 

 

 

Tab. 4 - Timing of intervention

 

Freq

%

 

 

Freq

%

Educational treatment

16

16

 

<3 mths

19

19

Psychological treatment

15

15

 

3-9 mths

41

41

Educational+Psychological treatment

19

19

 

>9 mths

40

40

Psychological+Pharmacological tr.

15

15

 

Total

100

100

Educational+Pharmacological tr.

7

7

 

 

 

 

Ed.+Psych.+Pharm. Treatment

28

28

 

 

 

 

Total

100

100

 

 

 

 

 

Tab. 5 - Patients'
participation

 

Tab. 6 - Therapy adhesion

 

Tab. 7 - Therapeutic
efficacy (Gaf)

 

F

%

 

 

F

%

 

 

F

%

Active

53

53

 

Adequate

70

70

 

Improved

58

58

Passive

17

17

 

Discontinued

20

20

 

Unchanged

31

31

Opposition

8

8

 

Interrupted early

10

10

 

Got worse

11

11

Ambivalent

22

22

 

Total

100

100

 

Total

100

100

Total

100

100

 

 

 

 

 

 

 

 















The results of logistic regression analysis for patients with an efficacious therapy result (cases) compared to patients with non efficacious treatment (controls) are shown in Table 8.

Tab. 8 - Results of logistic regression analysis

Max
Likelihood

Std error

p-value

Odds ratio

95% ci

Therapy adhesion (ref. 'adequate')

1,751

0,656

0,0076

5,672

1,594-20,829

Type of intervention (ref. 'multiprofessional')

1,432

0,635

0,0242

4,187

1,205-14,544

Therapy duration ('<3 months' compared to '>9 months'

-1,483

0,617

0,0163

0,062

0,009-0,439

Patient's participation in the therapy (ref. 'active')

1,468

0,597

0,014

4,342

1,346-14,002

Likelihood ration test: p<0.0001

Ref, reference category

Ci, confidence intervals

Patients with a good therapeutic compliance have a probability 5,762 times higher of presenting a clinical improvement (p-value = 0,0076) compared with patients who are not compliant. A multiprofessional intervention (p-value = 0,0242) and active participation by the patient during the treatment (p-value = 0,014) gives a probability more than four times higher of obtaining a clinical improvement. The last variable entered in the model is 'therapy duration' (p-value = 0,0163): patients with a duration of < 3 months present a very lower probability (OR = 0,062, CI = 0,009 - 0,439) of clinical improvement compared with patients with a duration > 9 months.

The p-value of likelihood ratio test < 0,0001 indicates the high validity of the final model. The percentages of sensitivity and specificity are respectively 86,2% and 68,3%. Using the chi square test we obtain a statistically significant result with respect to the relationship between type of treatments and clinical change, as shown in Fig. 1.

It is clear that the patients who improved clinically were those who underwent multi-professional integrated therapy and in particular those who received joint psychological and educational intervention, (63%), psychological and psychiatric intervention (71%) and all three types of intervention (79%).

In conclusion, given the importance of factors such as therapeutic compliance, the patient's participation and joint interventions in obtaining positive clinical change in psychiatric patients, it is appropriate to organise services for adolescents according to two principles:

  • with respect to the professionals: to use multi-professional interventions, working as part of a team;
  • with respect to the patient-worker relationship: to ensure the adolescent's motivation is increased in order to achieve a therapeutic alliance involving the patient's participation and compliance.

Key references

Correale, A. (1996). L'equipe come supporto emotivo e di pensiero per gli operatori psichiatrici". Paper presented at the conference "Strumenti psicoanalitici in Psichiatria", Bologna.

Kaneclin, C., & Orsenigo, A. (1992). Il lavoro di Comunità. Roma: Nuova Italia Scientifica.

Pedriali, E. (2000). La Comunità Terapeutica come luogo d'integrazione fra differenti approcci. Paper presented at the conference of Windsor.

 Contacts: Michela Gatta M., Cattedra di Neuropsichiatria Infantile -Dipartimento di Pediatria- Università degli Studi di Padova, UOA di Neuropsichiatria dell'Infanzia e dell'Adolescenza - ULSS 16 Padova.

 

© copyright 2021 Outcome-Network.org all rights reserved, in partnership with FondazioneZancan | iaOBERfcs | read the legal notice.