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.
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Funding The study was funded from the following three sources: Psychiatry Research Fund (Institute of Psychiatry, King's College London), Maudsley Charitable Funds (South London and Maudsley NHS Trust) and West London Research Consortium. The funders had no role in the study design in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. The researchers were independent from funders.
Competing interests All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare that: (1) DO has support from Psychiatry Research Trust, Maudsley Charitable Funds and West London Research Consortium for the submitted work; (2) AN, DO and TZ have royalties paid to them by Hodder Arnold Publishing that might have an interest in the submitted work; (3) the authors' spouses, partners, or children have no financial relationships that may be relevant to the submitted work; and (4) DO, TZ, AN, RB, AB and ET have no non-financial interests that may be relevant to the submitted work.
Ethical approval This study was approved by the Camden and Islington Community Local Research Ethics Committee on the 23 October 2007 (ref: 07/H0722/66) and written informed consent was given by all participating families.
Provenance and peer review Not commissioned; externally peer reviewed.
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