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Tsoli F, Botsari IA, Tsianeli A, Menti N, Kontoudi P, Peritogiannis V. Difficult-to-Engage Patients with Severe Mental Illness in Rural Community Settings: Results of the Greek Hybrid Assertive Community Treatment Model of Mental Healthcare. J Clin Med 2024; 13:2660. [PMID: 38731189 PMCID: PMC11084530 DOI: 10.3390/jcm13092660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 04/27/2024] [Accepted: 04/29/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Modified Assertive Community Treatment (ACT) in rural settings may be effective in the care of patients with severe mental illness (SMI) that are difficult to engage in community care. The objective of the present study was to explore the impact of the care by a hybrid ACT team on SMI patients' hospitalizations, length of hospital stay, symptomatology and functioning in a rural community treatment setting in Greece. Methods: The hybrid ACT team is an expansion of the services of the well-established generic Mobile Mental Health Unit in a rural area of Northwest Greece, and delivers home-based care for patients with SMI. This was a 3-year prospective, mirror image, pre-post observational study. Patients' symptomatology, functioning and general outcome were measured with the use of the Brief Psychiatric Rating Scale (BPRS), the Global Assessment of Functioning Scale (GAF), and the Health of the Nation Outcome Scale (HοNOS). Results: The mean age of the 23 enrolled patients was 52.4 years and the mean age of disease onset was 23.5 years, with a mean number of hospitalizations 10.74. Over the 16-month follow-up patients' hospitalizations, both voluntary and involuntary, had been significantly reduced by almost 80%. Length of hospital stay had been significantly reduced by 87%, whereas patients' functioning and symptomatology had been significantly improved, by 17% and 14.5%, respectively. Conclusions: The model of hybrid ACT in rural areas in Greece may be effective in the treatment of difficult-to-engage patients with SMI and may improve patients' outcomes.
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Affiliation(s)
- Fotini Tsoli
- Mobile Mental Health Unit of the Prefectures of Ioannina and Thesprotia, Society for the Promotion of Mental Health in Epirus, 45445 Ioannina, Greece; (F.T.); (A.T.); (N.M.); (P.K.)
| | - Ioanna Athina Botsari
- Early Intervention in Psychosis Unit, University Mental Health Research Institute, 11527 Athens, Greece;
| | - Agnes Tsianeli
- Mobile Mental Health Unit of the Prefectures of Ioannina and Thesprotia, Society for the Promotion of Mental Health in Epirus, 45445 Ioannina, Greece; (F.T.); (A.T.); (N.M.); (P.K.)
| | - Nefeli Menti
- Mobile Mental Health Unit of the Prefectures of Ioannina and Thesprotia, Society for the Promotion of Mental Health in Epirus, 45445 Ioannina, Greece; (F.T.); (A.T.); (N.M.); (P.K.)
| | - Panagiota Kontoudi
- Mobile Mental Health Unit of the Prefectures of Ioannina and Thesprotia, Society for the Promotion of Mental Health in Epirus, 45445 Ioannina, Greece; (F.T.); (A.T.); (N.M.); (P.K.)
| | - Vaios Peritogiannis
- Mobile Mental Health Unit of the Prefectures of Ioannina and Thesprotia, Society for the Promotion of Mental Health in Epirus, 45445 Ioannina, Greece; (F.T.); (A.T.); (N.M.); (P.K.)
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Trane K, Aasbrenn K, Rønningen M, Odden S, Lexén A, Landheim AS. Flexible Assertive Community Treatment in Rural and Remote Areas: A Qualitative Study of the Challenges and Adaptations of the Model. Front Public Health 2022; 10:913159. [PMID: 35983354 PMCID: PMC9379540 DOI: 10.3389/fpubh.2022.913159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundFlexible assertive community treatment (FACT) is an innovative model for providing long-term treatment to people with severe mental illness. The model was developed in the Netherlands but is now used in other countries, including Norway, which has a geography different from the Netherlands, with many rural and remote areas. Implementation of innovations is context dependent. The FACT model's potential in rural and remote areas has not been studied. Therefore, we aimed to gain knowledge regarding the challenges and modifications of the model in rural and remote contexts and discuss how they can affect the model's potential in such areas. This knowledge can improve the understanding of how FACT or similar services can be adapted to function most optimally in such conditions. We sought to address the following questions: Which elements of the FACT model do team leaders of the rural FACT teams find particularly challenging due to the context, and what modifications have the teams made to the model?MethodsDigital interviews were conducted with five team leaders from five rural FACT teams in different parts of Norway. They were selected using purposive sampling to include team leaders from some of the most rural teams in Norway. The interviews were analyzed using thematic text analysis.ResultsThe following three themes described elements of the FACT model that were experienced particularly challenging in the rural and remote context: multidisciplinary shared caseload approach, intensive outreach and crisis management. The following eight themes described the modifications that the teams had made to the model: intermunicipal collaboration, context-adaptive planning, delegation of tasks to municipal services, part-time employment, different geographical locations of staff, use of digital tools, fewer FACT board meetings, and reduced caseload.ConclusionsRural and remote contexts challenge the FACT model's potential. However, modifications can be made, some of which can be considered innovative modifications that can increase the model's potential in such areas, while others might move the teams further away from the model.
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Affiliation(s)
- Kristin Trane
- The Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Inland Hospital Trust, Hamar, Norway
- *Correspondence: Kristin Trane
| | | | | | - Sigrun Odden
- The Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Inland Hospital Trust, Hamar, Norway
| | | | - Anne Signe Landheim
- The Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Inland Hospital Trust, Inland Norway University of Applied Sciences, Hamar, Norway
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Bond GR, Drake RE. Assessing the Fidelity of Evidence-Based Practices: History and Current Status of a Standardized Measurement Methodology. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2019; 47:874-884. [PMID: 31691055 DOI: 10.1007/s10488-019-00991-6] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Evidence-based practices are effective only when implemented faithfully. This paper explicates the history, standardization, and methods for developing and validating measures of fidelity. We overviewed the past 20 years of developing fidelity measures, summarized standardization of the development procedures, and described needed psychometric assessments. Fidelity assessment has become the sine qua non of implementation, technical assistance, and research on evidence-based practices. Researchers have established standardized procedures for scale development and psychometric testing. Widescale use of fidelity measurement remains challenging. The implementation of evidence-based practice and the development and validation of fidelity measures are interdependent. International improvements of mental health care will require attention to both.
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Affiliation(s)
- Gary R Bond
- Westat, Rivermill Commercial Center, 85 Mechanic Street, Suite C3-1, Lebanon, NH, 03766, USA.
| | - Robert E Drake
- Westat, Rivermill Commercial Center, 85 Mechanic Street, Suite C3-1, Lebanon, NH, 03766, USA
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Schroeder RA. Unique Practice, Unique Place: Exploring Two Assertive Community Treatment Teams in Maine. Issues Ment Health Nurs 2018; 39:499-505. [PMID: 29370560 DOI: 10.1080/01612840.2017.1413460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Assertive Community Treatment (ACT) is a model of care that provides comprehensive community-based psychiatric care for persons with serious mental illness. This model has been widely documented and has shown to be an evidence-based model of care for reducing hospitalizations for this targeted population. Critical ingredients of the ACT model are the holistic nature of their services, a team based approach to treatment and nurses who assist with illness management, medication monitoring, and provider collaboration. Although the model remains strong there are clear differences between urban and rural teams. This article describes present day practice in two disparate ACT programs in urban and rural Maine. It offers a new perspective on the evolving and innovative program of services that treat those with serious mental illness along with a review of literature pertinent to the ACT model and future recommendations for nursing practice. The success and longevity of these two ACT programs are testament to the quality of care and commitment of staff that work with seriously mentally ill consumers. Integrative care models such as these community-based treatment teams and nursing driven interventions are prime elements of this successful model.
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Svensson B, Hansson L, Markström U, Lexén A. What matters when implementing Flexible Assertive Community Treatment in a Swedish healthcare context: A two-year implementation study. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2017. [DOI: 10.1080/00207411.2017.1345041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Bengt Svensson
- Department of Health Sciences/Mental Health and Mental Health Services Research, Lund University, Lund, Sweden
| | - Lars Hansson
- Department of Health Sciences/Mental Health and Mental Health Services Research, Lund University, Lund, Sweden
| | | | - Annika Lexén
- Department of Health Sciences/Mental Health and Mental Health Services Research, Lund University, Lund, Sweden
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Caxaj CS. A Review of Mental Health Approaches for Rural Communities: Complexities and Opportunities in the Canadian Context. ACTA ACUST UNITED AC 2016. [DOI: 10.7870/cjcmh-2015-023] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Three mental health approaches with potential relevance to rural Canada were reviewed: telepsychiatry, integrated mental health models, and community-based approaches. These approaches have been evaluated in relation to their cost-effectiveness, comprehensiveness, client-centredness, cultural appropriateness, acceptability, feasibility and fidelity; criteria that may vary amidst rural contexts. Collaborative approaches to care, technologies fully integrated into local health systems, multi-sectoral capacity-building, and further engagement with informal social support networks may be particularly promising strategies in rural communities. More research is required to determine rural mental health pathways among diverse social groups, and further, to establish the acceptability of novel approaches in mental health.
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Affiliation(s)
- C. Susana Caxaj
- University of British Columbia
- University of British Columbia
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Weaver A, Capobianco J, Ruffolo M. Systematic review of EBPs for SMI in rural America. JOURNAL OF EVIDENCE-INFORMED SOCIAL WORK 2015; 12:155-65. [PMID: 25661891 DOI: 10.1080/15433714.2013.765815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This systematic review of the implementation of evidence-based practices (EBPs) for adults with severe mental illnesses (SMI) in rural mental health settings examined peer-reviewed literature, grey literature, and public information. Included articles had to report implementation efforts of EBP(s) for SMI in rural settings or adaptations for rural service delivery. Only three peer-reviewed articles and two publicly available reports met inclusion criteria. Findings suggest little attention is focused on studying factors affecting implementation of EBPs for SMI in rural areas. Adaptations are occurring in rural settings, though rarely documented or tested; their impact on fidelity and consumer outcomes is unclear.
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Affiliation(s)
- Addie Weaver
- a Curtis Research Center, University of Michigan School of Social Work , Ann Arbor , Michigan , USA
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Adaptation of intensive mental health intensive case management to rural communities in the Veterans Health Administration. Psychiatr Q 2013; 84:103-14. [PMID: 22729625 DOI: 10.1007/s11126-012-9231-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
There has been increasing concern in recent years about the availability of mental health services for people with serious mental illness in rural areas. To meet these needs the Department of Veterans Affairs (VA) implemented the Rural Access Networks for Growth Enhancement (RANGE) program, in 2007, modeled on the Assertive Community Treatment (ACT) model. This study uses VA administrative data from the RANGE program (N = 343) to compare client characteristics at program entry, patterns of service delivery, and outcomes with those of Veterans who received services from the general VA ACT-like program (Mental Health Intensive Case Management (MHICM) (N = 3,077). Veterans in the rural program entered treatment with similar symptom severity, less likelihood of being diagnosed with schizophrenia and having had long-term hospitalization, but significantly higher suicidality index scores and greater likelihood of being dually diagnosed compared with those in the general program. RANGE Veterans live further away from their treatment teams but did not differ significantly in measures of face-to-face treatment intensity. Similar proportions of RANGE and MHICM Veterans were reported to have received rehabilitation services, crisis intervention and substance abuse treatment. The rural programs had higher scores on overall satisfaction with VA mental health care than general programs, slightly poorer outcomes on quality of life and on the suicidality index but no significant difference on other outcomes. These data demonstrate the clinical need, practical feasibility and potential effectiveness of providing intensive case management through small specialized case management teams in rural areas.
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Torrey WC, Bond GR, McHugo GJ, Swain K. Evidence-Based Practice Implementation in Community Mental Health Settings: The Relative Importance of Key Domains of Implementation Activity. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2011; 39:353-64. [DOI: 10.1007/s10488-011-0357-9] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Chen FP. Assisting adults with severe mental illness in transitioning from parental homes to independent living. Community Ment Health J 2010; 46:372-80. [PMID: 19898987 DOI: 10.1007/s10597-009-9263-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2008] [Accepted: 10/22/2009] [Indexed: 10/20/2022]
Abstract
This study explores mental health professionals' practices with adult clients and their parents at the departure of the clients' transition from the parental home to independent living. Using grounded theory methodology, the author interviewed 24 case managers in Assertive Community Treatment programs in Wisconsin and applied dimensional analysis to identify and categorize concepts in verbatim transcripts. Different client-parent relationships were sampled to compare practices on client independent living. Results show that case managers considered client independent living a desirable social norm and a practical approach to addressing long-term care concerns. Based on the status of parental approval of independent living, case managers applied various strategies to foster helpful parental emotional boundaries with clients in order to facilitate client independence. The author discussed implications for practice and suggested future research on clients' and parents' perspectives on independent living and the short-term and long-term effects of the transition on their well-being.
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Affiliation(s)
- Fang-Pei Chen
- Columbia University School of Social Work, 1255 Amsterdam Ave., New York, NY 10027, USA.
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