Syed, Shabeer; Sanchez, Ana Pascual; Adesiyan, Pleasant; Rabot, Katherine; Sanson, Leigh J; Eaton, Rebecca; Ougrin, Dennis; (2026) Systematic Review and Meta-Analysis: Effectiveness of Intensive Community Care Services and Psychosocial Interventions for Adolescents With Severe Mental Health Problems. Journal of the American Academy of Child and Adolescent Psychiatry 10.1016/j.jaac.2026.01.006. (In press).

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Abstract

OBJECTIVE: We conducted a systematic review and meta-analysis to assess the effectiveness of Intensive Community Care and Services (ICCS) compared with treatment as usual (TAU), including inpatient care, and to synthesize common psychosocial interventions used within ICCS. METHOD: We searched 14 databases from Jan 1, 1999, to May 30, 2025, for quantitative studies of ICCS for adolescents predominantly (aged 12-18 years) with mental health problems. We used a random-effects meta-analysis of randomized controlled trials (RCTs) comparing ICCS versus TAU (and inpatient care only), on psychosocial functioning, mental health and cost-effectiveness outcomes. We used a narrative synthesis with an adapted Delphi approach to identify common psychosocial interventions and theoretical mechanisms. The protocol was registered in PROSPERO. RESULTS: We included 48 publications on 35 unique ICCS evaluations (N=6917 adolescents; median age 14.5 years) involving admission avoidance/home treatment, assertive outreach and family preservation models. Meta-analysis of 11 unique RCTs (range: 297-1176 participants per outcome) showed that, compared with TAU, ICCS yielded statistically significant improvements in psychosocial functioning (Hedges' g= 0.15, 95% CI=0.04, 0.26; 9 RCTs), reductions in inpatient admission days (-0.48 -0.82, -0.15; 4 RCTs), total emotional and behavioral problems (-0.15, -0.30, -0.01; 5 RCTs), and externalizing symptoms (-0.18, -0.30,-0.06; 6 RCTs) post-treatment. The effect for psychosocial functioning increased and remained significant when comparing ICCS with inpatient care only (0.25, 0.04, 0.46; 5 RCTs). No significant differences were found for internalizing symptoms, family functioning, or total costs. The narrative synthesis showed that psychosocial interventions consistently included enhanced engagement strategies, cognitive behavioral therapy, family systems approaches, and dialectical behavior therapy skills. CONCLUSION: For adolescents with severe mental health problems, ICCS yielded small but significant improvements in psychosocial functioning, reductions in inpatient days and emotional and behavioral symptoms, while achieving comparable effects for other outcomes. Findings support the expansion of ICCS as a viable alternative to inpatient care. Future research should prioritize multisite RCTs and developing and evaluating standardized psychosocial intervention guidelines to enhance treatment fidelity and outcomes.

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