Objective:Intensive psychiatric home treatment (IHT) in Germany provides, for the first time, a legal framework for delegating hospital psychiatric services to third-party providers. This study examines implementation models, incentives, prerequisites, challenges, and effects. Methods:Interviews with clinic representatives (n=13) and delegation partners (n=8) were analyzed using content analysis. Results:Three models emerge: cross-sectoral concepts, overcoming geographic barriers, and personnel substitution. Incentives include reimbursement and service expansion. Cooperation requires visibility, contracts, cost calculation, and information exchange. Challenges concern workflows, coordination, and team development. Effects include better continuity of care and mutual skill enhancement, but also risks of competitive disadvantages. Conclusion:Delegation can strengthen IHT and offers potential to advance community-based psychiatric care, but requires a clear framework.
Ecological Momentary Assessment (EMA) presents a promising method to study short-term occurrences and trajectories of suicidal thoughts. This study analyzed the feasibility of using intensive EMA to assess suicidal thoughts among adolescent psychiatric inpatients in Germany. Fifty-one adolescents (12-18 years old, 74.5% female) participated in 7 days of EMA data collection during their psychiatric inpatient stay. Participants reported on momentary feelings, including suicidal thoughts, via a lent smartphone 7 times per day. In addition to a baseline meeting, adolescents attended a follow-up meeting to collect quantitative and qualitative data about their experiences of participation. Quantitative and qualitative results show a high adherence rate (i.e. percentage of answered surveys) of 78.6%, a high average satisfaction with participation, and a low average perceived burden of participation. Several participants cherished the opportunity to self-reflect and to understand current emotions by answering questions about momentary feelings frequently. However, seven adolescents (13.7%) reported an increase in negative emotions and two adolescents (3.9%) indicated an increase in suicidal thoughts after responding to the EMA surveys. These findings suggest negative emotional reactivity among some adolescents and considerable interindividual differences in emotional reactivity to EMA surveys in general. Future studies may elaborate on potential safety concerns for participants and identify which adolescents benefit from or experience distress after reporting on momentary suicidal thoughts frequently.
Zusammenfassung Die stationsäquivalente psychiatrische Behandlung (StäB) eröffnet erstmals einen Rahmen zur Delegation von Krankenhausleistungen an gemeindepsychiatrische Versorgungsakteure. Untersucht werden Varianten, Bedingungen und Auswirkungen der Umsetzung. Qualitative Interviews mit Klinikvertretern (n=13) und Delegationspartnern (n=8) wurden inhaltsanalytisch ausgewertet. Die Delegation wird in StäB v. a. genutzt für sektorenübergreifende Konzepte, Überwindung von Distanzen und Personalersatz. Anreize sind vor allem Vergütung und Leistungserweiterung. Kooperationen erfordern Sichtbarkeit, klare Verträge, Kostenkalkulation und Informationsaustausch. Herausforderungen betreffen Abläufe, Koordination und Teamentwicklung. Auswirkungen sind bessere Kontinuität und Kompetenzerweiterung, teils aber auch Wettbewerbsnachteile. Delegation kann StäB stärken und Vernetzung mit gemeindepsychiatrischer Versorgung fördern, erfordert jedoch klare Rahmenbedingungen.
