Efficacy of home treatment and inpatient treatment for children and adolescents in psychiatric crisis: a systematic review and meta-analysis

Inpatient treatment is widely used for children and adolescents in psychiatric crisis but may disrupt family life and routines. Home treatment offers a less restrictive alternative. This systematic review and meta-analysis compared both approaches regarding psychopathology, family functioning, psychosocial functioning, and readmissions, considering post-treatment vs. follow-up effects and sequential vs. stand-alone models. Following PRISMA 2020, systematic searches were conducted in Medline, Cochrane Library, Embase, PsycInfo, and trial registries. Two reviewers independently screened articles, extracted data, and assessed risk of bias. Random-effects meta-analyses were conducted where feasible, and certainty of evidence was rated using Grading of Recommendations Assessment, Development and Evaluation (GRADE). The protocol was registered in PROSPERO (CRD42023458888). Fifteen studies (N = 617 participants) were included, with eleven contributing to meta-analyses. No significant differences were found between HT and IT for psychopathology, psychosocial functioning, or readmissions. A significant subgroup difference between post-treatment and follow-up was observed for psychosocial functioning (p = 0.0058), with inpatient treatment showing short-term advantages and HT more favorable outcomes at follow-up. Effects on psychopathology were small and non-significant, and readmission rates did not differ (risk ratio (RR) = 1.27, 95% CI [0.93-1.74]). Evidence on sequential models and family functioning was limited and showed no clear superiority of either approach. HT appears comparable to IT and may offer more sustained improvements in psychosocial functioning. Due to the limited quality of the included studies, these results should be interpreted with caution.