1
|
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 DOI: 10.3390/jcm13092660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| | - 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
| | - 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
| | - 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
| | - 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
| |
Collapse
|
2
|
Green S, Rosenbaum D, Beder M. Heat Resilience and Severe & Persistent Mental Illness. Can J Psychiatry 2024; 69:239-241. [PMID: 38115689 PMCID: PMC10924578 DOI: 10.1177/07067437231220797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Affiliation(s)
- Samantha Green
- Department of Family & Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
- Unity Health Toronto Ringgold Standard Institution, Toronto, Canada
| | - Daniel Rosenbaum
- Department of Psychiatry, University of Toronto Faculty of Medicine Ringgold Standard Institution–Psychiatry, Toronto, Canada
| | - Michaela Beder
- Department of Psychiatry, University of Toronto Faculty of Medicine Ringgold Standard Institution–Psychiatry, Toronto, Canada
| |
Collapse
|
3
|
Rühl F, Lambert M, Rohenkohl A, Kraft V, Daubmann A, Schneider BC, Luedecke D, Karow A, Gallinat J, Leicht G, Schöttle D. Remission with or without comorbid substance use disorders in early psychosis: long-term outcome in integrated care (ACCESS III study). Front Psychol 2023; 14:1237718. [PMID: 38187418 PMCID: PMC10768197 DOI: 10.3389/fpsyg.2023.1237718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 12/04/2023] [Indexed: 01/09/2024] Open
Abstract
Introduction Schizophrenia-Spectrum-Disorders are associated with poor long-term outcome as well as disability and often severely affect the lives of patients and their families often from symptom onset. Up to 70% of first episode psychosis (FEP) patients suffer from comorbid substance use disorders (SUD). We aimed at studying the course of illness in FEP patients within evidence-based care, with and without comorbid SUD, to examine how decreased, remitted or persistent substance use impacted rates of a combined symptomatic and functional long-term recovery compared with patients without SUD. Methods ACCESS III is an integrated care model for FEP or patients in the early phase of non-affective and affective psychotic disorders. Treatment trajectories of patients, who had been in ACCESS care for 1 year, with and without SUD were compared with regard to the course of illness and quality of life using Mixed Model Repeated Measures (MMRM) and recovery rates were compared using binary logistic regression. Change in substance use was coded as either persistent, decreased/remitted or no use. Results ACCESS III was a prospective 1-year study (N = 120) in patients aged 12-29 years. Of these, 74 (61.6%) had a comorbid SUD at admission. There were no group differences regarding the course of illness between patients with or without comorbid SUD or between patients with a substance abuse or substance dependence. The only outcome parameter that was affected by SUD was quality of life, with larger improvement found in the group without substance use (p = 0.05) compared to persistent and remitted users. Using LOCF, 44 patients (48.9%) fulfilled recovery criteria at the endpoint; recovery did not differ based on substance use status. Discussion SUD and especially substance dependence are common in psychotic disorders even in FEP patients. Evidence-based integrated care led to long-term improvement in patients with comorbid SUD and rate of recovery did not differ for patients with substance use.
Collapse
Affiliation(s)
- Friederike Rühl
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Lambert
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anja Rohenkohl
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Vivien Kraft
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Daubmann
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Brooke C. Schneider
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Luedecke
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Karow
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jürgen Gallinat
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gregor Leicht
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Schöttle
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
4
|
Rohenkohl AC, Sowada P, Lambert M, Gallinat J, Karow A, Lüdecke D, Rühl F, Schöttle D. Service users' perceptions of relevant and helpful components of an integrated care concept (ACCESS) for psychosis. Front Psychol 2023; 14:1285575. [PMID: 38192398 PMCID: PMC10773616 DOI: 10.3389/fpsyg.2023.1285575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/23/2023] [Indexed: 01/10/2024] Open
Abstract
Introduction Psychotic disorders have a significant impact on patients' lives and their families, and long-term treatment with individually tailored multimodal combinations of therapies is often required. Integrated care (IC) concepts such as the "Hamburg Model (ACCESS)" with a focus on psychotic disorders, includes different (therapeutic) components with pharmaco- and psychotherapy, family involvement, home treatment and the option of using a 24/7 crisis hotline. All components are offered by a therapeutically-oriented assertive community treatment (TACT) team in a need-adapted manner. So far, however, little is known about which specific components are regarded as especially relevant and helpful by the users of IC. Methods Patients currently participating in IC completed a questionnaire as part of the continuous quality assurance study (ACCESS II) in which they were asked to rate the different components of treatment according to their relevance and helpfulness, considering the individual's unique experiences with IC and needs in mental health care. Furthermore, they were asked to make suggestions regarding additional helpful components of treatment. Results Fifty patients participated in this survey (23% of the patients currently participating in the IC concept). For participants, the most helpful and important factors were having the same therapist in the long-term and the 24/7 crisis telephone. Additional components suggested by patients included more addiction-specific therapies and increased focus on vocational rehabilitation and integration. Conclusion From the perspective of the users of IC, long-term care from a trusted therapist with whom there is a therapeutic relationship and the possibility to reach someone they already know from the TACT team 24/7 serves as the best basis for effective care, fostering trust, understanding, and open communication. In contrast, home treatment remains a relevant aspect of evidence-based care for people with severe mental illness, but perhaps surprisingly, is not viewed as the most important issue.
Collapse
|
5
|
Schwarz J, Wolff J, Heinze M, von Peter S, Habicht JL. How to measure staff continuity in intensive psychiatric home treatment: a routine data and single case analysis. Front Psychiatry 2023; 14:1166197. [PMID: 37229387 PMCID: PMC10204706 DOI: 10.3389/fpsyt.2023.1166197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/18/2023] [Indexed: 05/27/2023] Open
Abstract
Background Intensive forms of outreach mental health care (IOC) such as crisis resolution or home treatment teams are increasingly implemented as alternatives to inpatient admission, providing recovery-oriented treatment at home at comparable costs and outcomes. However, one issue with IOC is the lack of continuity regarding staff members who provide home visits, complicating relationship building and meaningful therapeutic exchange. The aim of this study is to validate existing primarily qualitative findings using performance data and to explore a possible correlation between the number of staff involved within IOC treatment and the service users' length of stay (LOS). Methods Routine data from an IOC team in a catchment area in Eastern Germany were analyzed. Basic parameters of service delivery were calculated and an in-depth descriptive analysis regarding staff continuity was performed. Further, an exploratory single case analysis was conducted, presenting the exact sequence of all treatment contacts for one case with low and one with high staff continuity. Results We analyzed 10.598 face-to-face treatment contacts based on 178 IOC users. The mean LOS was 30.99 days. About 75% of all home visits were conducted by two or more staff members simultaneously. Service users saw an average of 10.24 different staff per treatment episode. On 11% of the care days, only unknown staff, and on 34% of the care days at least one unknown staff member conducted the home visit. 83% of the contacts were performed by the same three staff members and 51% were made by one and the same staff member. A significant positive correlation (p = 0.0007) was found between the number of different practitioners seen by a service user in the first seven days of care and the LOS. Conclusion Our results suggest that a high number of different staff in the early period of IOC episodes correlates with an extended LOS. Future research must clarify the exact mechanisms of this correlation. Furthermore, it should be investigated how the multiple professions within IOC teams influence the LOS and the quality of treatment and what quality indicators may be suitable to ensure treatment processes.
Collapse
Affiliation(s)
- Julian Schwarz
- Department of Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
- Center for Health Service Research Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Jan Wolff
- Peter L. Reichertz Institute for Medical Informatics of TU Braunschweig and Hannover Medical School, Hannover, Germany
- Evangelical Foundation Neuerkerode, Braunschweig, Germany
| | - Martin Heinze
- Department of Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
- Center for Health Service Research Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Sebastian von Peter
- Department of Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Juri Luis Habicht
- Department of Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
- Department of Neurology with Experimental Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
6
|
Abufarsakh B, Kappi A, Pemberton KM, Williams LB, Okoli CTC. Substance use outcomes among individuals with severe mental illnesses receiving assertive community treatment: A systematic review. Int J Ment Health Nurs 2022; 32:704-726. [PMID: 36534491 DOI: 10.1111/inm.13103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2022] [Indexed: 12/23/2022]
Abstract
Assertive Community Treatment (ACT) is a multidisciplinary treatment approach to support people with severe mental illnesses (SMI) in their recovery. While the majority of ACT recipients report co-morbid substance use issues, limited reviews have evaluated the impact of receiving ACT services on substance use outcomes. The purpose of this systematic review was to evaluate the impact of ACT involvement on substance use outcomes among people with SMI. A systematic literature search was conducted including articles published prior to April 2021. Twenty-nine studies were included in this review. Of them, 15 studies implemented a controlled design (six studies demonstrated high quality) and 14 studies implemented a cohort design. From a synthesis of the reviewed studies, five areas of changes associated with substance use emerged including reduced alcohol and drug use severity, lower prevalence of alcohol and drug use, increased stage of change in substance use treatment, and fewer days of hospitalization and intoxication. Thus, future studies should examine the integration of substance use treatment services as part of ACT interventions for opportunities to enhance recovery outcomes among individuals with SMI.
Collapse
Affiliation(s)
| | - Amani Kappi
- University of Kentucky College of Nursing, Lexington, Kentucky, USA
| | - Kylie M Pemberton
- University of Kentucky College of Education, Lexington, Kentucky, USA
| | | | | |
Collapse
|
7
|
Mak CCM, Mao DRH, Siddiqui FJ, Lim A, Davamoni-Thomas J, Tang JP, Bachik R, Ng CWL, Kandasami G, Lee C. A new paradigm in management of frequent attenders to emergency departments with severe alcohol use disorder-A pilot study for assertive community treatment in Singapore. Front Health Serv 2022; 2:1029455. [PMID: 36925838 PMCID: PMC10012780 DOI: 10.3389/frhs.2022.1029455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
Introduction A majority of frequent users of emergency medical services in Singapore present with alcohol-related problems. These patients are known to engage poorly with traditional addiction services and frequently attend Emergency Departments (EDs) instead, resulting in high healthcare burden. Assertive Community Treatment (ACT) is an alternative intervention to traditional addiction management. ACT involves community visits with focus on holistic care and harm-reduction. Materials and methods We conducted a prospective before-and-after cohort study at the major tertiary center for addiction disorders in Singapore. The main objective was to evaluate effectiveness of ACT in reducing alcohol-related attendances at EDs nationwide. Socio-demographics, alcohol-related ED attendances, and the Christo Inventory for Substance-misuse Services (CISS) scores were collected for the patients recruited from April 2018 to March 2019. Descriptive analyses and the Wilcoxon Signed-Rank Test were performed. Results All 14 patients were male with a mean age of 55 years. There was a significant 45.3% reduction in average alcohol-related ED attendances from 6.8 (range 3-22, median 5.5) in the pre-intervention 6-month period, to 3.7 (range 0-28, median 1.5) in the post-intervention 6-month period (Z = -2.244, p = 0.025). CISS scores showed significant improvement from a pre-intervention median of 13.5 (range 9-16) to a post-intervention median of 6.5 (range 1-10, p = 0.001), corresponding to reduction in alcohol-related problem severity. Conclusion This pilot study suggests that ACT can be effective in reducing alcohol-related ED attendances and alcohol-related problem severity in patients with AUD who frequently attend ED. A multicenter, prospective study using ACT for such patients across four hospitals in Singapore is currently underway.
Collapse
Affiliation(s)
- Charles Chia Meng Mak
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore
| | | | - Fahad Javaid Siddiqui
- Prehospital and Emergency Care Research Center (PERC), Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Alex Lim
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore
| | - Jayson Davamoni-Thomas
- Population Health & Community Transformation, Khoo Teck Puat Hospital, Singapore, Singapore
| | - June Peiwen Tang
- Clinical and Forensic Psychology Service, Ministry of Social and Family Development, Singapore, Singapore
| | - Rozinah Bachik
- Education Office, Institute of Mental Health, Singapore, Singapore
| | - Charis Wei Ling Ng
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore
| | | | - Cheng Lee
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore
| |
Collapse
|
8
|
Belden CM, Gilbert AR, Easter MM, Swartz MS, Swanson JW. Appropriateness of psychiatric advance directives facilitated by peer support specialists and clinicians on Assertive Community Treatment teams. J Ment Health 2021; 31:239-245. [PMID: 34269634 DOI: 10.1080/09638237.2021.1952946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Psychiatric advance directives (PADs) are used to document a person's treatment preferences for a future mental health crisis. Peer support specialists have been proposed to facilitate PADs, but little is known about the quality of peer versus clinician facilitated PADs. AIMS This study examined whether PAD documents facilitated by peer specialists and non-peer clinicians differed in the mix of treatment requests and refusals and expert ratings of feasibility and consistency. METHODS Analyses were conducted of content and expert ratings of 72 PAD documents from a randomized trial of PAD facilitation by peers and clinicians on Assertive Community Treatment (ACT) teams. A count of treatment refusals and requests was used to classify documents as predominantly prescriptive, proscriptive, or balanced. Regression was used to estimate relationships between PAD facilitator type and content. RESULTS Peer-facilitated PADs were significantly more likely to be predominantly prescriptive than were PADs facilitated by non-peer clinicians. Prescriptive PADs were more likely to receive expert ratings of high feasibility and consistency. CONCLUSIONS Results should alleviate some clinicians' apprehensions regarding the appropriateness of peer-facilitated PADs, such as the concern that people with lived experience with mental illness might encourage other consumers to use their PAD primarily for treatment refusals.
Collapse
Affiliation(s)
- Charles M Belden
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA.,Center for Health Policy and Inequalities Research, Duke University, Durham, NC, USA
| | - Allison R Gilbert
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA.,Wilson Center for Science and Justice, Duke University, Durham, NC, USA
| | - Michele M Easter
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA.,Wilson Center for Science and Justice, Duke University, Durham, NC, USA
| | - Marvin S Swartz
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA.,Wilson Center for Science and Justice, Duke University, Durham, NC, USA
| | - Jeffrey W Swanson
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA.,Wilson Center for Science and Justice, Duke University, Durham, NC, USA
| |
Collapse
|
9
|
Tjaden CD, Boumans J, Mulder CL, Kroon H. Interpersonal Relations Within the Context of Resource Groups for People With Severe Mental Illness: A Narrative Approach. Front Psychiatry 2021; 12:632437. [PMID: 33643099 PMCID: PMC7907181 DOI: 10.3389/fpsyt.2021.632437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/19/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: The resource group method intends to promote patients' agency and self-management and to organize meaningful partnerships between patients and their informal and formal support systems. The aim of this study was to enhance the understanding of interpersonal dynamics that arise within resource groups for people with severe mental illness. Insight into these unfolding processes would enable improved implementation of the resource group method so that it contributes to establishing a positive social environment, which can lead to more enduring recovery. Methodology: We performed a narrative analysis of transcripts and field notes obtained in a longitudinal, qualitative study on the resource group method. The stories of four different resource groups were reconstructed and analyzed in depth. Data included a total of 36 interviews (with patients, significant others, and mental health professionals) and 18 observations of resource group meetings. Results: The degree to which the resource group method actually contributes to recovery was based on the extent to which the existing roles of and patterns between the patient and his/her resource group members were altered. Breaking through old patterns of inequality and the joint search for a new balance in relationships proved to be crucial processes for establishing an empowering resource group. The four cases showed that it takes time, patience, and small steps back and forth to overcome the struggles and fears related to finding new ways of relating to each other. An honest and reflective atmosphere in which all participants are encouraged to participate and be curious about themselves and each other is essential for changes in interpersonal dynamics to emerge. Such changes pave the way for individuals with SMI to find their own voices and pursue their unique recovery journeys. Conclusions: The functioning of the resource group and the ability of the involved members to respond in new ways are important when working toward the patient's recovery goals. The resource group method should therefore not be considered an intervention to organize informal support for the patient, but a platform to expose and adjust the functioning of the patient's social network as a whole.
Collapse
Affiliation(s)
- Cathelijn D. Tjaden
- Department of Reintegration and Community Care, Trimbos Institute, Utrecht, Netherlands
- Department of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, Tilburg, Netherlands
| | - Jenny Boumans
- Department of Reintegration and Community Care, Trimbos Institute, Utrecht, Netherlands
| | - Cornelis L. Mulder
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, Netherlands
- Research Department ESPRi, Parnassia Psychiatric Institute, Rotterdam, Netherlands
| | - Hans Kroon
- Department of Reintegration and Community Care, Trimbos Institute, Utrecht, Netherlands
- Department of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, Tilburg, Netherlands
| |
Collapse
|
10
|
Siskind D, Dark F, Carney K, Gore-Jones V, Kar Ray M, Steginga A, Suetani S, Kisely S. Placing rehabilitation at the core of assertive community treatment. Australas Psychiatry 2021; 29:47-51. [PMID: 32469640 DOI: 10.1177/1039856220928876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Assertive community treatment (ACT) teams are increasingly being adapted to suit the needs of consumers who have never experienced long-term institutional care yet struggle to retain community tenure and quality of life due to residual functional disabilities associated with severe mental illness. Support needs can be provided by the growing disability support sector but recovery-orientated rehabilitation services delivered by specialist rehabilitation clinicians are also required. The Mobile Intensive Rehabilitation Team (MIRT) within the Metro South Addiction and Mental Health Service has adapted the ACT model to deliver assertive outreach that aims to work collaboratively with the person and their chosen supports to improve their function and their sense of self-efficacy in illness self-management. We described the characteristics of the consumers referred to MIRT over a 20-month time period, and reported on on their discharge location. CONCLUSION After two years with MIRT, half the participants were discharged out of case-management. Being on clozapine was a barrier to discharge from case-management despite functional improvement. Psychiatric hospitalisations predicted longer duration working with MIRT.
Collapse
Affiliation(s)
- Dan Siskind
- Metro South Addiction and Mental Health Service, Australia; and University of Queensland, School of Clinical Medicine, Australia
| | - Frances Dark
- Metro South Addiction and Mental Health Service, Australia; and University of Queensland, School of Clinical Medicine, Australia
| | - Kylie Carney
- Metro South Addiction and Mental Health Service, Australia
| | | | - Manaan Kar Ray
- Metro South Addiction and Mental Health Service, Australia
| | - Anne Steginga
- Metro South Addiction and Mental Health Service, Australia
| | - Shuichi Suetani
- Metro South Addiction and Mental Health Service, Australia; and Griffith University, Australia
| | - Stephen Kisely
- Metro South Addiction and Mental Health Service, Australia; and University of Queensland, School of Clinical Medicine, Australia
| |
Collapse
|
11
|
Benrimoh D, Sheldon A, Sibarium E, Powers AR. Computational Mechanism for the Effect of Psychosis Community Treatment: A Conceptual Review From Neurobiology to Social Interaction. Front Psychiatry 2021; 12:685390. [PMID: 34385938 PMCID: PMC8353084 DOI: 10.3389/fpsyt.2021.685390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/18/2021] [Indexed: 11/13/2022] Open
Abstract
The computational underpinnings of positive psychotic symptoms have recently received significant attention. Candidate mechanisms include some combination of maladaptive priors and reduced updating of these priors during perception. A potential benefit of models with such mechanisms is their ability to link multiple levels of explanation, from the neurobiological to the social, allowing us to provide an information processing-based account of how specific alterations in self-self and self-environment interactions result in the experience of positive symptoms. This is key to improving how we understand the experience of psychosis. Moreover, it points us toward more comprehensive avenues for therapeutic research by providing a putative mechanism that could allow for the generation of new treatments from first principles. In order to demonstrate this, our conceptual paper will discuss the application of the insights from previous computational models to an important and complex set of evidence-based clinical interventions with strong social elements, such as coordinated specialty care clinics (CSC) in early psychosis and assertive community treatment (ACT). These interventions may include but also go beyond psychopharmacology, providing, we argue, structure and predictability for patients experiencing psychosis. We develop the argument that this structure and predictability directly counteract the relatively low precision afforded to sensory information in psychosis, while also providing the patient more access to external cognitive resources in the form of providers and the structure of the programs themselves. We discuss how computational models explain the resulting reduction in symptoms, as well as the predictions these models make about potential responses of patients to modifications or to different variations of these interventions. We also link, via the framework of computational models, the patient's experiences and response to interventions to putative neurobiology.
Collapse
Affiliation(s)
- David Benrimoh
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Andrew Sheldon
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Ely Sibarium
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Albert R Powers
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| |
Collapse
|
12
|
Mauer-Vakil D, Bahji A, Pikard J. The Impact of Community Treatment Orders on Substitute Decision Makers. Can J Psychiatry 2021; 66:64-65. [PMID: 32787576 PMCID: PMC7890587 DOI: 10.1177/0706743720949345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Dane Mauer-Vakil
- Institute of Health Policy, Management and Evaluation, 7938University of Toronto, Ontario, Canada.,Department of Psychiatry, 4257Queen's University, Kingston, Ontario, Canada
| | - Anees Bahji
- Department of Psychiatry, 4257Queen's University, Kingston, Ontario, Canada.,Department of Public Health Sciences, 4257Queen's University, Kingston, Ontario, Canada
| | - Jennifer Pikard
- Department of Psychiatry, 4257Queen's University, Kingston, Ontario, Canada
| |
Collapse
|
13
|
Ben-Zeev D, Buck B, Meller S, Hudenko WJ, Hallgren KA. Augmenting Evidence-Based Care With a Texting Mobile Interventionist: A Pilot Randomized Controlled Trial. Psychiatr Serv 2020; 71:1218-1224. [PMID: 32631130 PMCID: PMC7708508 DOI: 10.1176/appi.ps.202000239] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This study aimed to evaluate the feasibility and clinical utility of training intensive psychiatric community care team members to serve as "mobile interventionists" who engage patients in recovery-oriented texting exchanges. METHODS A 3-month pilot randomized controlled trial was conducted to compare the mobile interventionist approach as an add-on to assertive community treatment (ACT) versus ACT alone. Participants were 49 individuals with serious mental illness (62% with schizophrenia/schizoaffective disorder, 24% with bipolar disorder, and 14% with depression). Clinical outcomes were evaluated at baseline, posttreatment, and 6-month follow-up, and satisfaction was evaluated posttreatment. RESULTS The intervention appeared feasible (95% of participants assigned to the mobile interventionist arm initiated the intervention, texting on 69% of possible days and averaging four messages per day), acceptable (91% reported satisfaction), and safe (no adverse events reported). Exploratory posttreatment clinical effect estimations suggested greater reductions in the severity of paranoid thoughts (Cohen's d=-0.61) and depression (d=-0.59) and improved illness management (d=0.31) and recovery (d=0.23) in the mobile interventionist group. CONCLUSIONS Augmentation of care with a texting mobile interventionist proved to be feasible, acceptable, safe, and clinically promising. The findings are encouraging given the relative ease of training practitioners to serve as mobile interventionists, the low burden placed on patients and practitioners, and the simplicity of the technology. The technical resources are widely accessible to patients and practitioners, boding well for potential intervention scalability. When pandemics such as COVID-19 block the possibility of in-person patient-provider contact, evidence-based texting interventions can serve a crucial role in supporting continuity of care.
Collapse
Affiliation(s)
- Dror Ben-Zeev
- Department of Psychiatry and Behavioral Sciences, BRiTE Center, University of Washington, Seattle (Ben-Zeev, Buck, Meller, Hallgren); Department of Psychological and Brain Sciences, Dartmouth College, and Department of Psychiatry, Dartmouth Geisel School of Medicine, Hanover, New Hampshire (Hudenko)
| | - Benjamin Buck
- Department of Psychiatry and Behavioral Sciences, BRiTE Center, University of Washington, Seattle (Ben-Zeev, Buck, Meller, Hallgren); Department of Psychological and Brain Sciences, Dartmouth College, and Department of Psychiatry, Dartmouth Geisel School of Medicine, Hanover, New Hampshire (Hudenko)
| | - Suzanne Meller
- Department of Psychiatry and Behavioral Sciences, BRiTE Center, University of Washington, Seattle (Ben-Zeev, Buck, Meller, Hallgren); Department of Psychological and Brain Sciences, Dartmouth College, and Department of Psychiatry, Dartmouth Geisel School of Medicine, Hanover, New Hampshire (Hudenko)
| | - William J Hudenko
- Department of Psychiatry and Behavioral Sciences, BRiTE Center, University of Washington, Seattle (Ben-Zeev, Buck, Meller, Hallgren); Department of Psychological and Brain Sciences, Dartmouth College, and Department of Psychiatry, Dartmouth Geisel School of Medicine, Hanover, New Hampshire (Hudenko)
| | - Kevin A Hallgren
- Department of Psychiatry and Behavioral Sciences, BRiTE Center, University of Washington, Seattle (Ben-Zeev, Buck, Meller, Hallgren); Department of Psychological and Brain Sciences, Dartmouth College, and Department of Psychiatry, Dartmouth Geisel School of Medicine, Hanover, New Hampshire (Hudenko)
| |
Collapse
|
14
|
Morse G, Monroe-DeVita M, York MM, Peterson R, Miller J, Hughes M, Carpenter-Song E, Akiba C, McHugo GJ. Implementing illness management and recovery within assertive community treatment teams: A qualitative study. Psychiatr Rehabil J 2020; 43:121-131. [PMID: 31478709 PMCID: PMC7050388 DOI: 10.1037/prj0000387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The study purpose was to assess the feasibility, advantages/disadvantages, and factors that hinder or facilitate the implementation of illness management and recovery (IMR) within assertive community treatment (ACT) teams. METHOD A qualitative study was conducted with 11 ACT teams that implemented IMR. We conducted semistructured individual interviews with 17 persons enrolled in services and 55 ACT staff in individual and focus groups. Questions were designed to assess perceptions of IMR implementation, effects of IMR, staff training considerations, and recommendations. Data were analyzed using an inductive, consensus-building, thematic analysis, which included multiple research staff reviewing interview transcripts and field notes, developing and refining a codebook, constructing data summaries, and thematic synthesis. RESULTS The analysis revealed six major themes: (a) a generally positive fit exists between the two models and population served, (b) both people with serious mental illness and staff benefited from ACT + IMR, (c) ACT teams encountered significant implementation barriers, (d) relationships and engagement with participants facilitated implementation, (e) taking a flexible approach to IMR and ACT improved implementation, and (f) programs should focus on greater integration of IMR within ACT teams. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE While there can be barriers to implementing IMR within ACT teams, there is generally a positive fit, it is feasible to implement, and it offers meaningful benefits. ACT teams should improve their recovery orientation by more widespread implementation of IMR. Future research on ACT + IMR should include mixed-methods approaches, implementation methodologies to identify barriers and facilitators, and idiographic measures that capture the individualized recovery goals of people with serious mental illness. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Collapse
|
15
|
Doré-Gauthier V, Miron JP, Jutras-Aswad D, Ouellet-Plamondon C, Abdel-Baki A. Specialized assertive community treatment intervention for homeless youth with first episode psychosis and substance use disorder: A 2-year follow-up study. Early Interv Psychiatry 2020; 14:203-210. [PMID: 31274239 DOI: 10.1111/eip.12846] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 04/19/2019] [Accepted: 06/09/2019] [Indexed: 11/29/2022]
Abstract
AIM No previous study has investigated interventions for homeless youth suffering from first episode psychosis and comorbid substance use disorder (HYPS). An intensive assertive community intervention team (IACIT) offering outreach interventions, housing support as well as integrated care for early psychosis and substance use disorder (SUD) was created in 2012 at the Centre Hospitalier de l'Université de Montréal (CHUM). To explore the impact of the addition of an IACIT to an early intervention for psychosis service (EIS) on housing stability, functional and symptomatic outcomes and mental health service use. METHODS A two-year longitudinal study comparing the outcome of HYPS receiving combined EIS and IACIT since 2012, to a historical cohort of HYPS receiving EIS only between 2005 and 2011. Socio-demographic data, housing stability, functioning, illness severity, SUD severity, emergency room visits and hospitalizations were assessed at admission, at 1 month, and every 3 months thereafter. RESULTS HYPS receiving EIS + IACIT achieved housing stability more rapidly and spent less time hospitalized than HYPS getting EIS only (RR 2.38, P = .017). HYPS with cocaine misuse were less likely to attain housing stability (RR 0.25, P = .04). No between-group differences were found for psychiatric symptoms, functioning and SUD outcomes. CONCLUSION The addition of IACIT-HYPS to EIS was associated with earlier housing stability and reduced total hospitalization days compared to EIS alone.
Collapse
Affiliation(s)
| | - Jean-Philippe Miron
- Department of Psychiatry, Université de Montréal, Montréal, Québec, Canada.,Department of Psychiatry, CHUM, Université de Montréal, Montréal, Quebec, Canada.,CRCHUM, Université de Montréal, Montréal, Quebec, Canada
| | - Dider Jutras-Aswad
- Department of Psychiatry, Université de Montréal, Montréal, Québec, Canada.,Department of Psychiatry, CHUM, Université de Montréal, Montréal, Quebec, Canada.,CRCHUM, Université de Montréal, Montréal, Quebec, Canada
| | - Clairélaine Ouellet-Plamondon
- Department of Psychiatry, Université de Montréal, Montréal, Québec, Canada.,Department of Psychiatry, CHUM, Université de Montréal, Montréal, Quebec, Canada.,CRCHUM, Université de Montréal, Montréal, Quebec, Canada
| | - Amal Abdel-Baki
- Department of Psychiatry, Université de Montréal, Montréal, Québec, Canada.,Department of Psychiatry, CHUM, Université de Montréal, Montréal, Quebec, Canada.,CRCHUM, Université de Montréal, Montréal, Quebec, Canada
| |
Collapse
|
16
|
Karow A, Brettschneider C, Helmut König H, Correll CU, Schöttle D, Lüdecke D, Rohenkohl A, Ruppelt F, Kraft V, Gallinat J, Lambert M. Better care for less money: cost-effectiveness of integrated care in multi-episode patients with severe psychosis. Acta Psychiatr Scand 2020; 141:221-230. [PMID: 31814102 DOI: 10.1111/acps.13139] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/04/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To compare cost-effectiveness of integrated care with therapeutic assertive community treatment (IC-TACT) versus standard care (SC) in multiple-episode psychosis. METHOD Twelve-month IC-TACT in patients with schizophrenia-spectrum and bipolar I disorders were compared with a historical control group. Primary outcomes were entropy-balanced cost-effectiveness based on mental healthcare costs from a payers' perspective and quality-adjusted life years (QALYs) as a measure of health effects during 12-month follow-up. RESULTS At baseline, patients in IC-TACT (n = 214) had significantly higher illness severity and lower functioning than SC (n = 56). Over 12 months, IC-TACT had significantly lower days in inpatient (10.3 ± 20.5 vs. 28.2 ± 44.9; P = 0.005) and day-clinic care (2.6 ± 16.7 vs. 16.4 ± 33.7; P = 0.004) and correspondingly lower costs (€-55 084). Within outpatient care, IC-TACT displayed a higher number of treatment contacts (116.3 ± 45.3 vs. 15.6 ± 6.3) and higher related costs (€+1417). Both resulted in lower total costs in IC-TACT (mean difference = €-13 248 ± 2975, P < 0.001). Adjusted incremental QALYs were significantly higher for IC-TACT versus SC (+0.10 ± 0.37, P = 0.05). The probability of cost-effectiveness of IC-TACT was constantly higher than 99%. CONCLUSION IC-TACT was cost-effective compared with SC. The use of prima facies 'costly' TACT teams is highly recommended to improve outcomes and save total cost for patients with severe psychotic disorders.
Collapse
Affiliation(s)
- A Karow
- Competence Centre for Integrated Care in Mental Disorders, Centre for Psychosocial Medicine, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Brettschneider
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - H Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C U Correll
- Recognition and Prevention Program, Zucker Hillside Hospital, New York, NY, USA.,Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, New York, NY, USA.,Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - D Schöttle
- Competence Centre for Integrated Care in Mental Disorders, Centre for Psychosocial Medicine, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - D Lüdecke
- Competence Centre for Integrated Care in Mental Disorders, Centre for Psychosocial Medicine, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Rohenkohl
- Competence Centre for Integrated Care in Mental Disorders, Centre for Psychosocial Medicine, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - F Ruppelt
- Competence Centre for Integrated Care in Mental Disorders, Centre for Psychosocial Medicine, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - V Kraft
- Competence Centre for Integrated Care in Mental Disorders, Centre for Psychosocial Medicine, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Gallinat
- Competence Centre for Integrated Care in Mental Disorders, Centre for Psychosocial Medicine, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Lambert
- Competence Centre for Integrated Care in Mental Disorders, Centre for Psychosocial Medicine, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
17
|
Broersen M, Frieswijk N, Kroon H, Vermulst AA, Creemers DHM. Young Patients With Persistent and Complex Care Needs Require an Integrated Care Approach: Baseline Findings From the Multicenter Youth Flexible ACT Study. Front Psychiatry 2020; 11:609120. [PMID: 33324268 PMCID: PMC7724087 DOI: 10.3389/fpsyt.2020.609120] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 10/29/2020] [Indexed: 12/27/2022] Open
Abstract
Background: The Multicenter Youth Flexible ACT Study is an ongoing observational prospective cohort study that examines the effects of Youth Flexible ACT (Assertive Community Treatment) on young people with complex care needs who are difficult to engage in traditional (office-based) mental health services. However, a clear and detailed description of this patient group is lacking. In the current paper, we present baseline characteristics and psychosocial outcomes of the Youth Flexible ACT target group and explore the existence of underlying specific patient subgroups. Methods: Sixteen Youth Flexible ACT teams from seven mental healthcare institutes in the Netherlands participated in the study. Research participants were monitored for 18 months and administered questionnaires measuring psychiatric- and social functioning every 6 months, yielding four measurements. Baseline data were obtained from 199 adolescents, their mental health workers, and parents/carers. Latent Class Analysis based on HoNOSCA scores (measuring psychosocial and daily functioning) was conducted to identify underlying subgroups. Results: The target group of Youth Flexible ACT mainly consisted of patients older than 15 years of age with a history of (specialized) mental healthcare. They face many complex problems, including trauma; developmental, mood, and anxiety disorders; and problems with school attendance, family life, and peer relationships. Other frequently reported difficulties were substance misuse, the involvement of the legal system or police, problems with intellectual functioning, and personal finance. Patients were classified into four distinct classes: the "internalizing," "externalizing," "non-specific," and the "overly impulsive" subgroup. Each subgroup had its unique pattern of difficulties and focus, respectively, high levels of depression and anxiety, disruptive behavior, unspecific difficulties, and substance misuse. Conclusions: As expected, patients in Youth Flexible ACT experienced many severe problems, rendering them vulnerable to fragmented and, thus, ineffective care. Our findings underscore the need for an integrated care approach with a multidisciplinary team of skilled professionals that can bridge these wide-ranging psychosocial problems, as each class of participants experienced a different set of difficulties. Youth Flexible ACT teams need to adjust their care services accordingly.
Collapse
Affiliation(s)
- Marieke Broersen
- GGZ Oost Brabant, Oss, Netherlands.,Tranzo - Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | | | - Hans Kroon
- Tranzo - Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands.,Trimbos Institute, Utrecht, Netherlands
| | | | | |
Collapse
|
18
|
Clausen H, Ruud T, Odden S, Benth JŠ, Heiervang KS, Stuen HK, Landheim A. Improved Rehabilitation Outcomes for Persons With and Without Problematic Substance Use After 2 Years With Assertive Community Treatment-A Prospective Study of Patients With Severe Mental Illness in 12 Norwegian ACT Teams. Front Psychiatry 2020; 11:607071. [PMID: 33424668 PMCID: PMC7785822 DOI: 10.3389/fpsyt.2020.607071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/11/2020] [Indexed: 12/04/2022] Open
Abstract
Background: Persons with severe mental illness often face difficulties in accessing and receiving adequate services enabling them to live independently. Many have co-occurring substance use problems that increase the risk of adverse outcomes. Community-based service models have been implemented around the world, including assertive community treatment (ACT), but the knowledge of rehabilitation outcomes in different subgroups is limited. We aimed to explore rehabilitation outcomes among patients suffering severe mental illness with and without substance use problems who had received ACT services for at least 2 years. Additionally, we compared differences in changes between the two groups. Methods: A total of 142 patients who received services for 2 years from the first 12 Norwegian ACT teams were included. Eighty-four (59%) had problematic substance use, while 58 (41%) did not. Data regarding housing, activity, symptoms, functioning, and subjective quality of life were collected upon enrollment into ACT and at 2 years of follow-up. Clinician-rated scales and self-report questionnaires were used. Changes within the two groups and differences in change between the groups were assessed using generalized linear mixed models. Results: Both groups were more likely to have good housing, higher level of functioning, and less anxiety and depressive symptoms after 2 years. The odds of good housing among participants with problematic substance use increased only after adjusting for age and gender. Participants with problematic substance use had less severe symptoms, particularly negative and manic symptoms, while participants without problematic substance use reported improved satisfaction with life in general. Neither group experienced a change in having a meaningful daily activity, positive symptoms, practical and social functioning, or subjective quality of life. The reduction of manic symptoms in the substance use group was the only difference between the groups. Conclusion: After 2 years, patients with and without problematic substance use experienced improvements in several important domains. Furthermore, the improvements were similar in both groups for most outcomes. This may suggest that ACT has a place in the continued effort toward integrated and comprehensive community services empowering patients with severe mental illness to achieve and sustain an independent life, including marginalized groups with severe substance use.
Collapse
Affiliation(s)
- Hanne Clausen
- Department of Research and Development, Division of Mental Health Services, Akerhus University Hospital, Lørenskog, Norway.,Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway
| | - Torleif Ruud
- Department of Research and Development, Division of Mental Health Services, Akerhus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Sigrun Odden
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Kristin Sverdvik Heiervang
- Department of Research and Development, Division of Mental Health Services, Akerhus University Hospital, Lørenskog, Norway.,Centre for Medical Ethics, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Hanne Kilen Stuen
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway.,Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Anne Landheim
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway.,Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| |
Collapse
|
19
|
Lofthus AM, Westerlund H, Bjørgen D, Lindstrøm JC, Lauveng A, Rose D, Ruud T, Heiervang K. Recovery concept in a Norwegian setting to be examined by the assertive community treatment model and mixed methods. Int J Ment Health Nurs 2018; 27:147-157. [PMID: 28026106 DOI: 10.1111/inm.12304] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2016] [Indexed: 11/26/2022]
Abstract
Recovery is a crucial concept in the mental health field. The research of recovery is split into the categories of personal, social and clinical recovery. The purpose of this study was to explore the fragmented concept of recovery in light of assertive community treatment (ACT) in Norway. The study has a mixed methods design with a pragmatic approach. The Questionnaire about the Process of Recovery and open-ended questions posed to 70 participants from 12 ACT teams in Norway, gathered by the "Users interview users" method, are combined with interviews or focus groups with eight of these participants. Surprisingly those under a community treatment order (CTO) report the highest degree of personal recovery. The qualitative material shows that the service users interpreted the concept of recovery differently than researchers and professionals. The ACT service users highlighted three important elements: flexible treatment, medication and access to a car. They emphasized the necessity for basic needs to be met in order to experience a meaningful recovery process, and these basic needs may be of even greater importance to those under CTOs. Their experiences should imply a greater emphasis on securing basic needs such as secure housing, sounder finances and access to the normal benefits offered by society.
Collapse
Affiliation(s)
- Ann-Mari Lofthus
- Division Mental Health Services, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Regional Research Network in Psychotic Disorders, University of Oslo, Oslo, Norway
| | - Heidi Westerlund
- National Centre for Knowledge Through Experience in Mental Health, Skien, Norway
| | - Dagfinn Bjørgen
- National Centre for Knowledge Through Experience in Mental Health, Skien, Norway
| | | | - Arnhild Lauveng
- Division Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | - Diana Rose
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Torleif Ruud
- Division Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | - Kristin Heiervang
- Division Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| |
Collapse
|
20
|
Wullschleger A, Berg J, Bermpohl F, Montag C. Can "Model Projects of Need-Adapted Care" Reduce Involuntary Hospital Treatment and the Use of Coercive Measures? Front Psychiatry 2018; 9:168. [PMID: 29765339 PMCID: PMC5939233 DOI: 10.3389/fpsyt.2018.00168] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 04/12/2018] [Indexed: 11/13/2022] Open
Abstract
Intensive outpatient models of need-adapted psychiatric care have been shown to reduce the length of hospital stays and to improve retention in care for people with severe mental illnesses. In contrast, evidence regarding the impact of such models on involuntary hospital treatment and other coercive measures in inpatient settings is still sparse, although these represent important indicators of the patients' wellbeing. In Germany, intensive models of care still have not been routinely implemented, and their effectiveness within the German psychiatric system is only studied in a few pioneering regions. An innovative model of flexible, assertive, need-adapted care established in Berlin, Germany, in 2014, treating unselected 14% of the catchment area's patients, was evaluated on the basis of routine clinical data. Records of n = 302 patients diagnosed with severe mental disorders, who had been hospitalized at least once during a 4-year-observational period, were analyzed in a retrospective individual mirror-image design, comparing the 2 years before and after inclusion in the model project regarding the time spent in hospital, the number and duration of involuntary hospital treatments and the use of direct coercive interventions like restraint or isolation. After inclusion to the project, patients spent significantly less time in hospital. Among patients treated on acute wards and patients with a diagnosis of psychosis, the number of patients subjected to provisional detention due to acute endangerment of self or others decreased significantly, as did the time spent under involuntary hospital treatment. The number of patients subjected to mechanical restraint, but not to isolation, on the ward decreased significantly, while the total number of coercive interventions remained unchanged. Findings suggest some potential of intensive models of need-adapted care to reduce coercive interventions in psychiatry. However, results must be substantiated by evidence from randomized-controlled trials and longer observation periods.
Collapse
Affiliation(s)
- Alexandre Wullschleger
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jürgen Berg
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Christiane Montag
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| |
Collapse
|
21
|
Penzenstadler L, Machado A, Thorens G, Zullino D, Khazaal Y. Effect of Case Management Interventions for Patients with Substance Use Disorders: A Systematic Review. Front Psychiatry 2017; 8:51. [PMID: 28428761 PMCID: PMC5382199 DOI: 10.3389/fpsyt.2017.00051] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 03/20/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Substance use disorder (SUD) is an important health problem that requires a complex range of care because of the chronic nature of the disorder and the multiple psychosocial problems involved. Current outpatient programs often have difficulties in delivering and coordinating ongoing care and access to different health-care providers. Various case management (CM) models have been developed, first for patients in other psychiatric domains and then for patients with SUD, in order to improve treatment outcomes. AIM This paper aims to assess the effectiveness of CM for patients with SUD. METHODS We performed a systematic review of CM interventions for patients with SUD by analyzing randomized controlled studies published on the subject between 1996 and 2016 found on the electronic database PubMed. RESULTS AND CONCLUSION Fourteen studies were included in the analysis. Differences between studies in outcome measures, populations included, and intervention characteristics made it difficult to compare results. Most of these studies reported improvement in some of the chosen outcomes. Treatment adherence mostly improved, but substance use was reported to decrease in only a third of the studies. Overall functioning improved in about half of the studies. The heterogeneity of the results might be linked to these differences between studies. Further research is needed in the field.
Collapse
Affiliation(s)
| | | | - Gabriel Thorens
- Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Daniele Zullino
- Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Yasser Khazaal
- Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, Geneva University, Geneva, Switzerland.,Research Center, Montreal University Institute of Mental Health, Montreal, QC, Canada
| |
Collapse
|
22
|
Affiliation(s)
- Paula N Goering
- Affiliate Scientist, Centre for Addiction and Mental Health, Toronto, Ontario; Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - David L Streiner
- Professor, Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario; Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario
| |
Collapse
|
23
|
Abstract
The aim of the present article is to review QoL scales used in studies investigating patients with schizophrenia over the past 5 years, and to summarize the results of QoL assessment in clinical practice in these patients. Literature available from January 2009 to December 2013 was identified in a PubMed search using the key words "quality of life" and "schizophrenia" and in a cross-reference search for articles that were particularly relevant. A total of n=432 studies used 35 different standardized generic and specific QoL scales in patients with schizophrenia. Affective symptoms were major obstacles for QoL improvement in patients with schizophrenia. Though positive symptoms, negative symptoms, and cognitive functioning may be seen as largely independent parameters from subjective QoL, especially in cross-sectional trials, long-term studies confirmed a critical impact of early QoL improvement on long-term symptomatic and functional remission, as well as of early symptomatic response on long-term QoL. Results of the present review suggest that QoL is a valid and useful outcome criterion in patients with schizophrenia. As such, it should be consistently applied in clinical trials. Understanding the relationship between symptoms and functioning with QoL is important because interventions that focus on symptoms of psychosis or functioning alone may fail to improve subjective QoL to the same level. However, the lack of consensus on QoL scales hampers research on its predictive validity. Future research needs to find a consensus on the concept and measures of QoL and to test whether QoL predicts better outcomes with respect to remission and recovery under consideration of different treatment approaches in patients with schizophrenia.
Collapse
Affiliation(s)
- Anne Karow
- Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Linus Wittmann
- Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Schöttle
- Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ingo Schäfer
- Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Lambert
- Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
24
|
McFarlane WR, Levin B, Travis L, Lucas FL, Lynch S, Verdi M, Williams D, Adelsheim S, Calkins R, Carter CS, Cornblatt B, Taylor SF, Auther AM, McFarland B, Melton R, Migliorati M, Niendam T, Ragland JD, Sale T, Salvador M, Spring E. Clinical and functional outcomes after 2 years in the early detection and intervention for the prevention of psychosis multisite effectiveness trial. Schizophr Bull 2015; 41:30-43. [PMID: 25065017 PMCID: PMC4266296 DOI: 10.1093/schbul/sbu108] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To test effectiveness of the Early Detection, Intervention, and Prevention of Psychosis Program in preventing the onset of severe psychosis and improving functioning in a national sample of at-risk youth. METHODS In a risk-based allocation study design, 337 youth (age 12-25) at risk of psychosis were assigned to treatment groups based on severity of positive symptoms. Those at clinically higher risk (CHR) or having an early first episode of psychosis (EFEP) were assigned to receive Family-aided Assertive Community Treatment (FACT); those at clinically lower risk (CLR) were assigned to receive community care. Between-groups differences on outcome variables were adjusted statistically according to regression-discontinuity procedures and evaluated using the Global Test Procedure that combined all symptom and functional measures. RESULTS A total of 337 young people (mean age: 16.6) were assigned to the treatment group (CHR + EFEP, n = 250) or comparison group (CLR, n = 87). On the primary variable, positive symptoms, after 2 years FACT, were superior to community care (2 df, p < .0001) for both CHR (p = .0034) and EFEP (p < .0001) subgroups. Rates of conversion (6.3% CHR vs 2.3% CLR) and first negative event (25% CHR vs 22% CLR) were low but did not differ. FACT was superior in the Global Test (p = .0007; p = .024 for CHR and p = .0002 for EFEP, vs CLR) and in improvement in participation in work and school (p = .025). CONCLUSION FACT is effective in improving positive, negative, disorganized and general symptoms, Global Assessment of Functioning, work and school participation and global outcome in youth at risk for, or experiencing very early, psychosis.
Collapse
Affiliation(s)
- William R. McFarlane
- Tufts University School of Medicine, Boston, MA;,Maine Medical Center Research Institute, Portland, ME;,*To whom correspondence should be addressed; Maine Medical Center, 22 Bramhall Street, Portland, ME 04102, US; tel: 207-662-4348, e-mail:
| | - Bruce Levin
- Mailman School of Public Health, Columbia University, New York, NY
| | - Lori Travis
- Maine Medical Center Research Institute, Portland, ME
| | - F. Lee Lucas
- Maine Medical Center Research Institute, Portland, ME
| | - Sarah Lynch
- Maine Medical Center Research Institute, Portland, ME
| | - Mary Verdi
- Maine Medical Center Research Institute, Portland, ME
| | | | - Steven Adelsheim
- Department of Psychiatry, Stanford University School Of Medicine, Palo, Alto, CA
| | | | - Cameron S. Carter
- Department of Psychiatry, University of California at Davis, Sacramento, CA
| | | | - Stephan F. Taylor
- Department of Psychiatry, University of Michigan, Ann Arbor, MI;,Washtenaw Community Health Organization, Ypsilanti, MI
| | | | - Bentson McFarland
- Department of Psychiatry, Oregon Health Sciences University, Portland, OR
| | | | | | - Tara Niendam
- Department of Psychiatry, University of California at Davis, Sacramento, CA
| | - J. Daniel Ragland
- Department of Psychiatry, University of California at Davis, Sacramento, CA
| | - Tamara Sale
- Portland State University, Portland, OR;,Mid-Valley Behavioral Care Network, Salem, OR
| | - Melina Salvador
- Department of Psychiatry, Stanford University School Of Medicine, Palo, Alto, CA
| | | |
Collapse
|
25
|
Killaspy H, Mas-Expósito L, Marston L, King M. Ten year outcomes of participants in the REACT (Randomised Evaluation of Assertive Community Treatment in North London) study. BMC Psychiatry 2014; 14:296. [PMID: 25342641 PMCID: PMC4210468 DOI: 10.1186/s12888-014-0296-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 10/14/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A previous randomised controlled trial that investigated Assertive Community Treatment (ACT) in the UK (the REACT Study) found no clinical advantage over usual care delivered by Community Mental Health Teams (CMHTs) at 18 and 36 month follow-ups. No studies have investigated long term clinical and social outcomes for patients receiving ACT. METHOD We investigated inpatient service use, social outcomes, service contact and adverse events for the 251 REACT study participants 10 years after randomisation through case note review. Data were analysed using regression models adjusted for original treatment group allocation and changes in treatment group. RESULTS We found no statistically significant differences in outcomes by original treatment group over the 10 years. Those whose care remained with ACT, or transferred to ACT or forensic services, had more inpatient days over the 10 years (coefficient 223, 95% CI 83 to 363, p = 0.002) than those whose care remained with the CMHTs or were discharged to primary care. Being subject to a Community Treatment Order was associated with a greater chance of being under ACT at 10 year follow-up (OR 6.39, 95% CI 2.98 to 13.70, p <0.001). CONCLUSIONS The ACT teams in this study showed no clinical advantage over usual care provided by CMHTs at 10 year follow-up. We also found that the ACT teams accrued patients from the original study sample who had more complex needs than those who remained with or transferred to the CMHTs or primary care during this period. Further well conducted trials are needed to identify the most cost-effective approaches to supporting successful community living and optimum long term outcomes for this group.
Collapse
Affiliation(s)
- Helen Killaspy
- Division of Psychiatry, University College London (UCL), Charles Bell House, 67-73 Riding House Street, London W1W 7EJ, UK.
| | - Laia Mas-Expósito
- Research Associate, Research Unit, Centre d’Higiene Mental Les Corts, c/Numància 103-105 Baixos, 08029 Barcelona, Spain
| | - Louise Marston
- Research Department of Primary Care and Population Health, UCL Medical School, London, NW3 2PF UK ,UCL PRIMENT Clinical Trials Unit, UCL Medical School, Upper 3rd Floor, Royal Free Campus, Rowland Hill Street, London, NW3 2PF UK
| | - Michael King
- Division of Psychiatry, University College London (UCL), Charles Bell House, 67-73 Riding House Street, London, W1W 7EJ UK ,UCL PRIMENT Clinical Trials Unit, UCL Medical School, Upper 3rd Floor, Royal Free Campus, Rowland Hill Street, London, NW3 2PF UK
| |
Collapse
|
26
|
de Jong G, Schout G, Abma T. Prevention of involuntary admission through Family Group Conferencing: a qualitative case study in community mental health nursing. J Adv Nurs 2014; 70:2651-62. [PMID: 24815903 DOI: 10.1111/jan.12445] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2014] [Indexed: 11/29/2022]
Abstract
AIM To understand whether and how Family Group Conferencing might contribute to the social embedding of clients with mental illness. BACKGROUND Ensuring the social integration of psychiatric clients is a key aspect of community mental health nursing. Family Group Conferencing has potency to create conditions for clients' social embedding and subsequently can prevent coercive measures. DESIGN A naturalistic qualitative case study on the process of one conference that was part of 41 conferences that had been organized and studied from January 2011-September 2013 in a public mental health care setting in the north of the Netherlands. METHODS Semi-structured interviews (N = 20) were conducted with four stakeholder groups (N = 13) involved in a conference on liveability problems in a local neighbourhood wherein a man with schizophrenia resides. FINDINGS To prevent an involuntary admission to a psychiatric ward of a man with schizophrenia, neighbourhood residents requested a family group conference between themselves, the sister of the man and the mental health organization. As a possible conference aggravated psychotic problems, it was decided to organize it without the client. Nine months after the conference, liveability problems in the neighbourhood had been reduced and coercive measures adverted. The conference strengthened the community and resulted in a plan countering liveability problems. CONCLUSION The case indicates that social embedding of clients with severe psychiatric problems can be strengthened by Family Group Conferencing and that hence coercive measures can be prevented. A shift is required from working with the individual client to a community driven approach.
Collapse
Affiliation(s)
- Gideon de Jong
- Department of Medical Humanities, EMGO+, VU University Medical Center, Amsterdam, the Netherlands
| | | | | |
Collapse
|
27
|
Stobbe J, Wierdsma AI, Kok RM, Kroon H, Roosenschoon BJ, Depla M, Mulder CL. The effectiveness of assertive community treatment for elderly patients with severe mental illness: a randomized controlled trial. BMC Psychiatry 2014; 14:42. [PMID: 24528604 PMCID: PMC3928976 DOI: 10.1186/1471-244x-14-42] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 02/12/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Due to fragmented mental, somatic, and social healthcare services, it can be hard to engage into care older patients with severe mental illness (SMI). In adult mental health care, assertive community treatment (ACT) is an organizational model of care for treating patients with SMI who are difficult to engage. So far all outcome studies of assertive community treatment have been conducted in adults. METHODS In a randomized controlled trial design we compared the effectiveness of ACT for elderly patients with that of treatment as usual (TAU). Sixty-two outpatients (60 years and older) with SMI who were difficult to engage in psychiatric treatment were randomly assigned to the intervention or control group (32 to ACT for elderly patients and 30 to TAU). Primary outcomes included number of patients who had a first treatment contact within 3 months, the number of dropouts (i.e. those discharged from care due to refusing care or those who unintentionally lost contact with the service over a period of at least 3 months); and patients' psychosocial functioning (HoNOS65+ scores) during 18 months follow-up. Secondary outcomes included the number of unmet needs and mental health care use. Analyses were based on intention-to-treat. RESULTS Of the 62 patients who were randomized, 26 were lost to follow-up (10 patients in ACT for elderly patients and 16 in TAU). Relative to patients with TAU, more patients allocated to ACT had a first contact within three months (96.9 versus 66.7%; X2 (df = 1) = 9.68, p = 0.002). ACT for elderly patients also had fewer dropouts from treatment (18.8% of assertive community treatment for elderly patients versus 50% of TAU patients; X2 (df = 1) = 6.75, p = 0.009). There were no differences in the other primary and secondary outcome variables. CONCLUSIONS These findings suggest that ACT for elderly patients with SMI engaged patients in treatment more successfully. TRIAL REGISTRATION NTR1620.
Collapse
Affiliation(s)
- Jolanda Stobbe
- Department of Psychiatry, Epidemiological and Social Psychiatric Research institute, Erasmus MC, PO Box 2040 Dp-0122, Rotterdam, CA 3000, The Netherlands.
| | - André I Wierdsma
- Department of Psychiatry, Epidemiological and Social Psychiatric Research institute, Erasmus MC, PO Box 2040 Dp-0122, Rotterdam, CA 3000, The Netherlands
| | - Rob M Kok
- Parnassia Psychiatric Institute, department Parnassia, Centre for Mental Health Care, Monsterweg, The Hague, The Netherlands
| | - Hans Kroon
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, Da Costakade, The Netherlands
| | - Bert-Jan Roosenschoon
- Department of Psychiatry, Epidemiological and Social Psychiatric Research institute, Erasmus MC, PO Box 2040 Dp-0122, Rotterdam, CA 3000, The Netherlands,Parnassia Psychiatric Institute, department BavoEuropoort, Centre for Mental Health Care, Prins Constantijnweg, Rotterdam, The Netherlands
| | - Marja Depla
- Department of General Practice & Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Centre, Van der Boechorsstraat, Amsterdam, The Netherlands
| | - Cornelis L Mulder
- Department of Psychiatry, Epidemiological and Social Psychiatric Research institute, Erasmus MC, PO Box 2040 Dp-0122, Rotterdam, CA 3000, The Netherlands,Parnassia Psychiatric Institute, department BavoEuropoort, Centre for Mental Health Care, Prins Constantijnweg, Rotterdam, The Netherlands
| |
Collapse
|
28
|
Pettersen H, Ruud T, Ravndal E, Landheim A. Walking the fine line: self-reported reasons for substance use in persons with severe mental illness. Int J Qual Stud Health Well-being 2013; 8:21968. [PMID: 24369778 PMCID: PMC3871834 DOI: 10.3402/qhw.v8i0.21968] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2013] [Indexed: 11/14/2022] Open
Abstract
Many theoretical models have been proposed to explain the relationship between severe mental illness (SMI) and substance use. Because many of these are contradictory quantitative American studies, a qualitative, exploratory study of a Scandinavian sample may offer a new perspective. The aim of the study is to explore reasons for substance use through analysis of the participants' experiences. A qualitative study with semistructured interviews was used. Purposeful sampling (N=11) of patients with substance use disorder (SUD) and SMI, who were included in assertive community treatment teams, was completed. Inclusion criteria are increased quality of life or increased general functioning, and decreased substance use, after a minimum of 12 months in treatment. Reasons given for using substances were categorized as (a) controlling the symptoms of mental illness, (b) counteracting medication side effects, or (c) balancing the ambiguity. The conclusion is that the study findings mainly support secondary substance use models in explaining the comorbidity of SMI and substance use. However, there is some support for the traditional self-medication hypothesis (SMH), iatrogenic vulnerability, and the supersensitivity model. This may be because the majority of the study participants reported having a mental illness with subsequent substance use. The expressed ambivalence to substance use also lends some support to bidirectional models.
Collapse
Affiliation(s)
- Henning Pettersen
- National Centre for Dual Diagnosis, Innlandet Hospital Trust, Brumunddal, Norway; SERAF - Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway;
| | - Torleif Ruud
- Division Mental Health Services, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Edle Ravndal
- SERAF - Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | - Anne Landheim
- National Centre for Dual Diagnosis, Innlandet Hospital Trust, Brumunddal, Norway
| |
Collapse
|
29
|
Wilk P, Vingilis E, Bishop JEH, He W, Braun J, Forchuk C, Seeley J, Mitchell B. Distinctive trajectory groups of mental health functioning among assertive community treatment clients: an application of growth mixture modelling analysis. Can J Psychiatry 2013; 58:670-8. [PMID: 24331286 DOI: 10.1177/070674371305801204] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Assertive community treatment (ACT) studies that have used conventional, statistical growth modelling methods have not examined different trajectories of outcomes or covariates that could influence different trajectories, even though heterogeneity in outcomes has been established in other research on severe mental illness. The purpose of our study was to examine the general trend in mental health functioning of ACT clients over a 2-year follow-up time period, to discover groups of ACT clients with distinctive longitudinal trajectories of mental health functioning, and to examine if some of the key sociodemographic and illness-related factors influence group membership. METHOD A 2-year, prospective, within-subjects study of 216 ACT clients within southern Ontario, collected functional outcome data at baseline and 12 and 24 months using the Colorado Client Assessment Record. Baseline covariates included sex, primary diagnosis, number of comorbidities, hospitalization history, and duration of illness. Growth mixture modelling (GMM) was used to examine trajectories. RESULTS Clinical staff assessments of ACT clients showed a statistically significant improvement in functioning and 84% achieved successful community tenure. GMM analysis identified 2 classes of ACT clients: class 1 (79.63% of clients) experienced lower and stable overall functioning, and class 2 (20.37%) showed a better baseline functioning score and improvement in the overall functioning over time. Class membership was predicted by the number of comorbidities and diagnosis. CONCLUSIONS Our study suggests general stability in overall functioning for the sampled ACT clients over 2 years, but significant heterogeneity in trajectories of functioning.
Collapse
Affiliation(s)
- Piotr Wilk
- Assistant Professor, Departments of Epidemiology and Biostatistics, The University of Western Ontario, London, Ontario; Scientist, Children's Health Research Institute, London, Ontario
| | - Evelyn Vingilis
- Professor, Departments of Family Medicine and Epidemiology and Biostatistics, The University of Western Ontario, London, Ontario; Director, Population and Community Health Unit, Department of Family Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario
| | - Joan E H Bishop
- Psychiatrist, Psychosocial Rehabilitation Program, Waypoint Centre for Mental Health Care, Penetanguishene, Ontario; Professor Emeritus, Department of Psychiatry, The University of Western Ontario, London, Ontario
| | - Wenqing He
- Associate Professor, Statistical and Actuarial Sciences, The University of Western Ontario, London, Ontario
| | - John Braun
- Professor, Statistical and Actuarial Sciences, The University of Western Ontario, London, Ontario
| | - Cheryl Forchuk
- Associate Director Nursing Research, Arthur Labatt Family School of Nursing, The University of Western Ontario, London, Ontario; Assistant Director, Lawson Health Research Institute, London, Ontario
| | - Jane Seeley
- Project Coordinator, Department of Family Medicine, The University of Western Ontario, London, Ontario
| | - Beth Mitchell
- Director, Mental Health Care Program, London Health Sciences Centre, London, Ontario
| |
Collapse
|
30
|
Abstract
The extent to which explicit and implicit stigma are endorsed by mental health practitioners using evidence-based practices is unknown. The purposes of the current study were to a) examine implicit and explicit biases among Assertive Community Treatment (ACT) staff and b) explore the extent to which biases predicted the use of treatment control mechanisms. Participants were 154 ACT staff from nine states. Overall, the participants exhibited positive explicit and implicit attitudes toward people with mental illness. When modeled using latent factors, greater implicit, but not explicit, bias significantly predicted greater endorsement of restrictive or controlling clinical interventions. Thus, despite overall positive attitudes toward those with mental illness for the sample as a whole, individual differences in provider stigma were related to clinical care. Mental health professionals, and specifically ACT clinicians, should be educated on types of bias and ways in which biases influence clinical interventions.
Collapse
Affiliation(s)
- Laura G Stull
- *Department of Psychology, Anderson University, Anderson, IN; and †Department of Psychology, Indiana University Purdue University Indianapolis (IUPUI)
| | | | | | | |
Collapse
|
31
|
Wiley-Exley E, Domino ME, Ricketts TC, Cuddeback G, Burns BJ, Morrissey J. The impact of Assertive Community Treatment on utilization of primary care and other outpatient health services: the North Carolina experience. J Am Psychiatr Nurses Assoc 2013; 19:195-204. [PMID: 23824135 DOI: 10.1177/1078390313494170] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND A number of states have implemented Assertive Community Treatment (ACT) teams statewide. The extent to which team-based care in ACT programs substitutes or complements primary care and other types of health services is relatively unknown outside of clinical trials. OBJECTIVE To analyze whether investments in ACT yield savings in primary care and other outpatient health services. DESIGN Patterns of medical and mental health service use and costs were examined using Medicaid claims files from 2000 to 2002 in North Carolina. Two-part models and negative binomial models compared individuals on ACT (n = 1,065 distinct individuals) with two control groups of Medicaid enrollees with severe mental illness not receiving ACT services (n = 1,426 and n = 41,717 distinct individuals). RESULTS We found no evidence that ACT affected utilization of other outpatient health services or primary care; however, ACT was associated with a decrease in other outpatient health expenditures (excluding ACT) through a reduction in the intensity with which these services were used. Consistent with prior literature, ACT also decreased the likelihood of emergency room visits and inpatient psychiatric stays. CONCLUSIONS Given the increasing emphasis and efforts toward integrating physical health and behavioral health care, it is likely that ACT will continue to be challenged to meet the physical health needs of its consumers. To improve primary care receipt, this may mean a departure from traditional staffing patterns (e.g., the addition of a primary care doctor and nurse) and expansion of the direct services ACT provides to incorporate physical health treatments.
Collapse
|
32
|
Ruggeri M, Bonetto C, Lasalvia A, De Girolamo G, Fioritti A, Rucci P, Santonastaso P, Neri G, Pileggi F, Ghigi D, Miceli M, Scarone S, Cocchi A, Torresani S, Faravelli C, Zimmermann C, Meneghelli A, Cremonese C, Scocco P, Leuci E, Mazzi F, Gennarelli M, Brambilla P, Bissoli S, Bertani ME, Tosato S, De Santi K, Poli S, Cristofalo D, Tansella M. A multi-element psychosocial intervention for early psychosis (GET UP PIANO TRIAL) conducted in a catchment area of 10 million inhabitants: study protocol for a pragmatic cluster randomized controlled trial. Trials 2012; 13:73. [PMID: 22647399 PMCID: PMC3464965 DOI: 10.1186/1745-6215-13-73] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Accepted: 05/30/2012] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Multi-element interventions for first-episode psychosis (FEP) are promising, but have mostly been conducted in non-epidemiologically representative samples, thereby raising the risk of underestimating the complexities involved in treating FEP in 'real-world' services. METHODS/DESIGN The Psychosis early Intervention and Assessment of Needs and Outcome (PIANO) trial is part of a larger research program (Genetics, Endophenotypes and Treatment: Understanding early Psychosis - GET UP) which aims to compare, at 9 months, the effectiveness of a multi-component psychosocial intervention versus treatment as usual (TAU) in a large epidemiologically based cohort of patients with FEP and their family members recruited from all public community mental health centers (CMHCs) located in two entire regions of Italy (Veneto and Emilia Romagna), and in the cities of Florence, Milan and Bolzano. The GET UP PIANO trial has a pragmatic cluster randomized controlled design. The randomized units (clusters) are the CMHCs, and the units of observation are the centers' patients and their family members. Patients in the experimental group will receive TAU plus: 1) cognitive behavioral therapy sessions, 2) psycho-educational sessions for family members, and 3) case management. Patient enrollment will take place over a 1-year period. Several psychopathological, psychological, functioning, and service use variables will be assessed at baseline and follow-up. The primary outcomes are: 1) change from baseline to follow-up in positive and negative symptoms' severity and subjective appraisal; 2) relapse occurrences between baseline and follow-up, that is, episodes resulting in admission and/or any case-note records of re-emergence of positive psychotic symptoms. The expected number of recruited patients is about 400, and that of relatives about 300. Owing to the implementation of the intervention at the CMHC level, the blinding of patients, clinicians, and raters is not possible, but every effort will be made to preserve the independency of the raters. We expect that this study will generate evidence on the best treatments for FEP, and will identify barriers that may hinder its feasibility in 'real-world' clinical settings, patient/family conditions that may render this intervention ineffective or inappropriate, and clinical, psychological, environmental, and service organization predictors of treatment effectiveness, compliance, and service satisfaction.
Collapse
Affiliation(s)
- Mirella Ruggeri
- Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
- Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Chiara Bonetto
- Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Antonio Lasalvia
- Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Giovanni De Girolamo
- Agenzia Sanitaria e Sociale Regionale, Regione Emilia Romagna, Verona, Italy
- IRCCS Centro S.Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Angelo Fioritti
- Agenzia Sanitaria e Sociale Regionale, Regione Emilia Romagna, Verona, Italy
- Department of Mental Health, Azienda ULSS, Bologna, Italy
| | - Paola Rucci
- Agenzia Sanitaria e Sociale Regionale, Regione Emilia Romagna, Verona, Italy
| | | | - Giovanni Neri
- Agenzia Sanitaria e Sociale Regionale, Regione Emilia Romagna, Verona, Italy
| | | | - Daniela Ghigi
- Department of Mental Health, Azienda ULSS, Rimini, Italy
| | | | - Silvio Scarone
- Department of Mental Health, Azienda ULSS S. Paolo, Milan, Italy
| | - Angelo Cocchi
- Department of Mental Health, Azienda Ospedaliera Ospedale Niguarda Ca’ Granda, Milan Programma 2000, Italy
| | | | - Carlo Faravelli
- Department of Psychology, University of Firenze, Florence, Italy
| | - Christa Zimmermann
- Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Anna Meneghelli
- Department of Mental Health, Azienda Ospedaliera Ospedale Niguarda Ca’ Granda, Milan Programma 2000, Italy
| | - Carla Cremonese
- Department of Psychiatry, University of Padova, Padova, Italy
| | - Paolo Scocco
- Department of Psychiatry, University of Padova, Padova, Italy
| | | | - Fausto Mazzi
- Department of Mental Health, Azienda ULSS, Modena, Italy
| | | | - Paolo Brambilla
- Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
- DISM, Inter-University Center for Behavioural Neurosciences, University of Udine, Udine, Italy
| | - Sarah Bissoli
- Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Maria Elena Bertani
- Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Sarah Tosato
- Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Katia De Santi
- Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Sara Poli
- Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Doriana Cristofalo
- Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Michele Tansella
- Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| |
Collapse
|
33
|
Gilburt H, Burns T, Copello A, Coulton S, Crawford M, Day E, Deluca P, Godfrey C, Parrott S, Rose AK, Sinclair JMA, Wright C, Drummond C. Assertive Community Treatment for alcohol dependence (ACTAD): study protocol for a randomised controlled trial. Trials 2012; 13:19. [PMID: 22348423 PMCID: PMC3305428 DOI: 10.1186/1745-6215-13-19] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Accepted: 02/20/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Alcohol dependence is a significant and costly problem in the UK yet only 6% of people a year receive treatment. Current service provision based on the treatment of acute episodes of illness and emphasising personal choice and motivation results in a small proportion of these patients engaging with alcohol treatment. There is a need for interventions targeted at the population of alcohol dependent patients who are hard to engage in conventional treatment. Assertive Community Treatment (ACT), a model of care based on assertive outreach, has been used for treating patients with severe mental illnesses and presents a promising avenue for engaging patients with primary alcohol dependence. So far there has been little research on this. METHODS/DESIGN In this single blind exploratory randomised controlled trial, a total of 90 alcohol dependent participants will be recruited from community addiction services. After completing a baseline assessment, they will be assigned to one of two conditions: (1) ACT plus care as usual, or (2) care as usual. Those allocated to the ACT plus care as usual will receive the same treatment that is routinely provided by services, plus a trained key worker who will provide ACT. ACT comprises intensive and assertive contact at least once a week, over 50% of contacts in the participant's home or local community, and comprehensive case management across social and health care, for a period of one year. All participants will be followed up at 6 months and 12 months to assess outcome post randomisation. The primary outcome measures will be alcohol consumption: mean drinks per drinking day and percentage of days abstinent measured by the Time Line Follow Back interview. Secondary outcome measures will include severity of alcohol dependence, alcohol related problems, motivation to change, social network involvement, quality of life, therapeutic relationship and service use. Other outcome variables are treatment engagement including completion of assessment, detoxification and aftercare. DISCUSSION Results of this trial will help clarify the potential beneficial effects of ACT for people with alcohol dependence and provide information to design a definitive trial. TRIAL REGISTRATION NUMBER ISRCTN: ISRCTN22775534.
Collapse
Affiliation(s)
- Helen Gilburt
- Department of Addictions, Institute of Psychiatry, Kings College London, London, UK
| | - Tom Burns
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Alex Copello
- School of Psychology, University of Birmingham, Birmingham, UK
| | - Simon Coulton
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | | | - Ed Day
- School of Psychiatry, University of Birmingham, Birmingham, UK
| | - Paolo Deluca
- Department of Addictions, Institute of Psychiatry, Kings College London, London, UK
| | | | - Steve Parrott
- Department of Health Sciences, University of York, York, UK
| | - Abigail K Rose
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | | | - Christine Wright
- Department of Mental Health, St George's, University of London, London, UK
| | - Colin Drummond
- Department of Addictions, Institute of Psychiatry, Kings College London, London, UK
| |
Collapse
|
34
|
Abstract
BACKGROUND Processes underlying success and failure in assertive community treatment (ACT), a widely investigated treatment model for persons with severe mental illness, are poorly understood. AIMS The purpose of the current study was to examine processes in ACT by (1) understanding how consumers and staff describe the processes underlying treatment success and failure and (2) comparing processes identified by staff and consumers. METHOD Investigators conducted semi-structured interviews with 25 staff and 23 consumers from four ACT teams. RESULTS Both staff and consumers identified aspects of the ACT team itself as the most critical in the process of consumer success. For failure, consumers identified consumer characteristics as most critical and staff identified lack of social relationships. Processes underlying failure were not viewed as merely the opposite of processes underlying success. In addition, there was notable disagreement between staff and consumers on important processes. CONCLUSIONS Findings overlap with critical ingredients identified in previous studies, including aspects of the ACT team, social involvement and employment. In contrast to prior studies, there was little emphasis on hospitalizations and greater emphasis on not abusing substances, obtaining wants and desires, and consumer characteristics.
Collapse
Affiliation(s)
- Laura G Stull
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA.
| | | | | |
Collapse
|
35
|
Abstract
The compatibility of recovery work with the Assertive Community Treatment (ACT) model has been debated; and little is known about how to best measure the work of recovery. Two ACT teams with high and low recovery orientation were identified by expert consensus and compared on a number of dimensions. Using an interpretive, qualitative approach to analyze interview and observation data, teams differed in the extent to which the environment, team structure, staff attitudes, and processes of working with consumers supported principles of recovery orientation. We present a model of recovery work and discuss implications for research and practice.
Collapse
Affiliation(s)
- Michelle P Salyers
- VA HSR&D Center on Implementing Evidence-Based Practice, Roudebush VAMC and Regenstrief Institute, Inc, Indianapolis, IN 46202, USA.
| | | | | | | |
Collapse
|
36
|
Cuddeback GS, Morrissey JP. Program planning and staff competencies for forensic assertive community treatment: ACT-eligible versus FACT-eligible consumers. J Am Psychiatr Nurses Assoc 2011; 17:90-7. [PMID: 21659299 PMCID: PMC3653310 DOI: 10.1177/1078390310392374] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Forensic assertive community treatment (FACT) is a recent adaptation of the assertive community treatment (ACT) model; however, more information is needed about how FACT and ACT consumers differ and how FACT should be modified to accommodate these differences. METHOD Linked, multisystem administrative data from King County, Washington, were used to compare the demographic, clinical, and criminal justice characteristics of ACT- and FACT-eligible consumers. RESULTS FACT consumers were more likely to be male, persons of color, and had more complex clinical profiles. Also, some FACT consumers were incarcerated for sex offenses, and more than half had violent offenses. CONCLUSIONS Traditionally, ACT teams avoid serving consumers with personality disorders, violent consumers, and sex offenders; however, given increased use of mandated outpatient treatment and mental health courts, FACT teams may have less discretion to choose whom they serve. The addition of clinical interventions and other modifications may be particularly important for FACT teams.
Collapse
Affiliation(s)
- Gary S Cuddeback
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | | |
Collapse
|
37
|
Wright-Berryman JL, McGuire AB, Salyers MP. A review of consumer-provided services on assertive community treatment and intensive case management teams: implications for future research and practice. J Am Psychiatr Nurses Assoc 2011; 17:37-44. [PMID: 21659293 PMCID: PMC3117264 DOI: 10.1177/1078390310393283] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Assertive community treatment (ACT) is an evidence-based practice that provides intensive, in vivo services for adults with severe mental illness. Some ACT and intensive case management teams have integrated consumers as team members with varying results. METHODS The authors reviewed the literature examining the outcomes of having consumer providers on case management teams, with attention devoted to randomized controlled trials (RCTs). RESULTS Sixteen published studies were identified, including eight RCTs. Findings were mixed, with evidence supporting consumer-provided services for improving engagement and limited support for reduced hospitalizations. However, evidence was lacking for other outcomes areas such as symptom reduction or improved quality of life. CONCLUSION Including a consumer provider on an ACT team could enhance the outreach mechanisms of ACT, using a more recovery-focused approach to bring consumers into services and help engage them over time. More rigorous research is needed to further evaluate integrating consumer providers on teams.
Collapse
|
38
|
Kortrijk HE, Mulder CL, Roosenschoon BJ, Wiersma D. Treatment outcome in patients receiving assertive community treatment. Community Ment Health J 2010; 46:330-6. [PMID: 19847646 PMCID: PMC2910892 DOI: 10.1007/s10597-009-9257-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Accepted: 10/02/2009] [Indexed: 11/30/2022]
Abstract
In an observational study of severely mentally ill patients treated in assertive community treatment (ACT) teams, we investigated how treatment outcome was associated with demographic factors, clinical factors, and motivation for treatment. To determine psychosocial outcome, patients were routinely assessed using the Health of the Nation Outcome Scales (HoNOS). Trends over time were analyzed using a mixed model with repeated measures. The HoNOS total score was modeled as a function of treatment duration and patient-dependent covariates. Data comprised 637 assessments of 139 patients; mean duration of follow-up was 27.4 months (SD = 5.4). Substance abuse, higher age, problems with motivation, and lower educational level were associated with higher HoNOS total scores (i.e., worse outcome). To improve treatment outcome, we recommend better implementation of ACT, and also the implementation of additional programs targeting subgroups which seem to benefit less from ACT.
Collapse
Affiliation(s)
- H E Kortrijk
- Parnassia Bavo Group, BavoEuropoort, Westersingel 94, 3015 LC, Rotterdam, The Netherlands.
| | | | | | | |
Collapse
|