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Gary R. Bond - One of the best experts on this subject based on the ideXlab platform.
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the critical ingredients of Assertive Community Treatment
World Psychiatry, 2015Co-Authors: Gary R. Bond, Robert E DrakeAbstract:In their paradigm-shifting study, Stein and Test (1) developed and evaluated a Community mental health Treatment model for people with serious mental illness that became known as Assertive Community Treatment (ACT). Their approach challenged many standard practices and beliefs in psychiatry. Based on earlier work, they had concluded (2) that hospital training programs to prepare patients for Community living after discharge were ineffective, and that providing training and support within Community settings after discharge was far superior. The principle of in vivo assessment, training and support became a cornerstone of the ACT model. With the locus of contact in the Community, ACT used Assertive outreach to engage clients who were reluctant to keep appointments at a clinic. Another critical ingredient of the ACT model was a holistic approach to services, helping with illness management, medication management, housing, finances, and anything else critical to an individual's Community adjustment. ACT services included assistance in routine practical problems in living, such as shopping and using public transportation. Along with the focus on the client's immediate needs and personal goals, the shift in service delivery to Community settings dramatically increased client engagement in and satisfaction with mental health services (3). Drawing on their experience on hospital Treatment teams, Stein and Test formulated the ACT model as requiring a multidisciplinary team of mental health professionals, providing intensive, timely, and personalized services, facilitated through frequent team meetings to review Treatment plans and services. ACT was also conceived as a direct service model, with clinicians providing most needed services themselves rather than referring to other providers. Another feature of the model with far-reaching influence was integration of services, which has demonstrated advantages over brokered approaches (i.e., referring clients to other programs for many services). ACT teams integrated mental health Treatment, housing, rehabilitation, and many other services, and tailored them to the needs and goals of each client. Another core feature of the ACT model was a low client-staff ratio of approximately 10 clients per full-time ACT practitioner. This staffing pattern permitted multiple contacts each week with clients needing intensive support. In addition, teams provided continuous coverage, responding quickly to client emergencies, 24 hours per day, seven days per week. Finally, ACT teams committed to long-term and continuous care. Initially, the model promised lifelong care.
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program fidelity and beyond multiple strategies and criteria for ensuring quality of Assertive Community Treatment
Psychiatric Services, 2012Co-Authors: Maria Monroedevita, Gary A Morse, Gary R. BondAbstract:Assertive Community Treatment (ACT) is an evidence-based practice with robust research support. But ACT services have been shown to lose their effectiveness over time. This review of 57 research reports offers practical recommendations on how to safeguard the quality of ACT programs with a blend of multiple strategies in the areas of policy and administration, training and consultation, team operation, and program evaluation.
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integrating Assertive Community Treatment and illness management and recovery for consumers with severe mental illness
Community Mental Health Journal, 2010Co-Authors: Michelle P Salyers, Gary R. Bond, Kim T. Mueser, Angela L Rollins, Alan B Mcguire, Veronica R MacyAbstract:This study examined the integration of two evidence-based practices for adults with severe mental illness: Assertive Community Treatment (ACT) and illness management and recovery (IMR) with peer specialists as IMR practitioners. Two of four ACT teams were randomly assigned to implement IMR. Over 2 years, the ACT-IMR teams achieved moderate fidelity to the IMR model, but low penetration rates: 47 (25.7%) consumers participated in any IMR sessions and 7 (3.8%) completed the program during the study period. Overall, there were no differences in consumer outcomes at the ACT team level; however, consumers exposed to IMR showed reduced hospital use over time.
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scope of agency control Assertive Community Treatment teams supervision of consumers
Psychiatric Services, 2009Co-Authors: Lorna L Moser, Gary R. BondAbstract:Objective: Assertive Community Treatment teams have been criticized as being inherently coercive; however, base rates of control practices used by teams have not been well documented. The purpose of this study was to assess the rates at which different forms of agency control, such as involuntary outpatient commitment, representative payeeship, intensive medication monitoring, and agency-supervised housing, were used by Assertive Community Treatment teams. Also examined were program, practitioner, and consumer correlates of agency control practices. Methods: A statewide survey was conducted of 23 Assertive Community Treatment teams serving consumers with severe mental illness. Data were collected on both team attributes and practitioner attributes. Results: Extent of agency control was highly variable across sites. Intensive medication monitoring and representative payeeship were the most frequently used agency control practices. The strongest predictor of agency control was having a higher percentage of consumers on the caseload who were diagnosed as having a schizophrenia-spectrum disorder. Fidelity to the Assertive Community Treatment model was not associated with agency control. However, lower quality of basic clinical services (for example, assessment and Treatment planning) was associated with greater use of agency-supervised housing. Pessimistic practitioner attitudes were not significantly associated with agency control, but practitioner education was negatively associated with both representative payeeship and intensive medication monitoring. Conclusions: Assertive Community Treatment teams differed widely in their scope of agency control, and this variation was not associated with fidelity to the model. Consumer characteristics, such as a schizophrenia spectrum disorder and active substance use, were most closely associated with agency control. (Psychiatric Services 60:922–928, 2009)
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Assertive Community Treatment facilitators and barriers to implementation in routine mental health settings
Psychiatric Services, 2009Co-Authors: Anthony D Mancini, Gary R. Bond, Lorna L Moser, Gregory J Mchugo, Rob Whitley, Molly T Finnerty, Barbara J BurnsAbstract:Objective: This study identified barriers and facilitators to the high-fidelity implementation of Assertive Community Treatment. Methods: As part of a multistate implementation project for evidence-based practices, training and consultation were provided to 13 newly implemented Assertive Community Treatment teams in two states. Model fidelity was assessed at baseline and at six, 12, 18, and 24 months. Key informant interviews, surveys, and monthly on-site visits were used to monitor implementation processes related to barriers and facilitators. Results: Licensing processes of the state mental health authority provided critical structural supports for implementation. These supports included a dedicated Medicaid billing structure, start-up funds, ongoing fidelity monitoring, training in the model, and technical assistance. Higher-fidelity sites had effective administrative and program leadership, low staff turnover, sound personnel practices, and skilled staff, and they allocated sufficient resources in terms of staffing, office space, and cars. Lower-fidelity sites were associated with insufficient resources, prioritization of fiscal concerns in implementation, lack of change culture, poor morale, conflict among staff, and high staff turnover. In cross-state comparisons, the specific nature of fiscal policies, licensing processes, and technical assistance appeared to influence implementation. Conclusions: State mental health authorities can play a critical role in Assertive Community Treatment implementation but should carefully design billing mechanisms, promote technical assistance centers, link program requirements to fidelity models, and limit bureaucratic requirements. Successful implementation at the organizational level requires committed leadership, allocation of sufficient resources, and careful hiring procedures. (Psychiatric Services 60:189–195, 2009)
Robert E Drake - One of the best experts on this subject based on the ideXlab platform.
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the critical ingredients of Assertive Community Treatment
World Psychiatry, 2015Co-Authors: Gary R. Bond, Robert E DrakeAbstract:In their paradigm-shifting study, Stein and Test (1) developed and evaluated a Community mental health Treatment model for people with serious mental illness that became known as Assertive Community Treatment (ACT). Their approach challenged many standard practices and beliefs in psychiatry. Based on earlier work, they had concluded (2) that hospital training programs to prepare patients for Community living after discharge were ineffective, and that providing training and support within Community settings after discharge was far superior. The principle of in vivo assessment, training and support became a cornerstone of the ACT model. With the locus of contact in the Community, ACT used Assertive outreach to engage clients who were reluctant to keep appointments at a clinic. Another critical ingredient of the ACT model was a holistic approach to services, helping with illness management, medication management, housing, finances, and anything else critical to an individual's Community adjustment. ACT services included assistance in routine practical problems in living, such as shopping and using public transportation. Along with the focus on the client's immediate needs and personal goals, the shift in service delivery to Community settings dramatically increased client engagement in and satisfaction with mental health services (3). Drawing on their experience on hospital Treatment teams, Stein and Test formulated the ACT model as requiring a multidisciplinary team of mental health professionals, providing intensive, timely, and personalized services, facilitated through frequent team meetings to review Treatment plans and services. ACT was also conceived as a direct service model, with clinicians providing most needed services themselves rather than referring to other providers. Another feature of the model with far-reaching influence was integration of services, which has demonstrated advantages over brokered approaches (i.e., referring clients to other programs for many services). ACT teams integrated mental health Treatment, housing, rehabilitation, and many other services, and tailored them to the needs and goals of each client. Another core feature of the ACT model was a low client-staff ratio of approximately 10 clients per full-time ACT practitioner. This staffing pattern permitted multiple contacts each week with clients needing intensive support. In addition, teams provided continuous coverage, responding quickly to client emergencies, 24 hours per day, seven days per week. Finally, ACT teams committed to long-term and continuous care. Initially, the model promised lifelong care.
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Assertive Community Treatment across the atlantic comparison of model fidelity in the uk and usa
British Journal of Psychiatry, 2003Co-Authors: Matthew Fiander, Gregory J Mchugo, Tom Burns, Robert E DrakeAbstract:Background The significant reductions in hospital admission demonstrated in US Assertive Community Treatment (ACT) studies have not been replicated in the UK. Explanations cite poor UK ‘model fidelity’ and/or better UK standard care. No international model-fidelity comparisons exist. Aims To compare high-fidelity US ACT teams with a UK team. Method The UK 700's ACT team ( n =97) was compared with high-fidelity US ACT teams ( n =73) by using two measures: a forerunner of the Dartmouth Assertive Community Treatment schedule (to assess adherence to ACT principles) and 2-year prospective activity data. Results The UK and US teams had similar high-fidelity scores. Although significant differences were found in the amount and type of activity, practice differences in areas central to ACT were not great. Conclusions The failure of UK ACT studies to demonstrate the outcome differences of early US studies cannot be attributed entirely to the lack of ACT fidelity.
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moving Assertive Community Treatment into standard practice
Psychiatric Services, 2001Co-Authors: Susan D Phillips, Robert E Drake, Kim T. Mueser, Barbara J Burns, Elizabeth R Edgar, Karen W Linkins, Robert A Rosenheck, Elizabeth Mcdonel C HerrAbstract:This article describes the Assertive Community Treatment model of comprehensive Community-based psychiatric care for persons with severe mental illness and discusses issues pertaining to implementation of the model. The Assertive Community Treatment model has been the subject of more than 25 randomized controlled trials. Research has shown that this type of program is effective in reducing hospitalization, is no more expensive than traditional care, and is more satisfactory to consumers and their families than standard care. Despite evidence of the efficacy of Assertive Community Treatment, it is not uniformly available to the individuals who might benefit from it.
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Assertive Community Treatment for people with severe mental illness
Disease Management & Health Outcomes, 2001Co-Authors: Gary R. Bond, Robert E Drake, Kim T. Mueser, Eric LatimerAbstract:This article describes the critical ingredients of the Assertive Community Treatment (ACT) model for people with severe mental illness and then reviews the evidence regarding its effectiveness and cost effectiveness. ACT is an intensive mental health program model in which a multidisciplinary team of professionals serves patients who do not readily use clinic-based services, but who are often at high risk for psychiatric hospitalization. Most ACT contacts occur in Community settings. ACT teams have a holistic approach to services, helping with medications, housing, finances and everyday problems in living. ACT differs conceptually and empirically from traditional case management approaches.
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Assertive Community Treatment for People with Severe Mental Illness
Disease Management and Health Outcomes, 2001Co-Authors: Gary R. Bond, Robert E Drake, Kim T. Mueser, Eric LatimerAbstract:This article describes the critical ingredients of the Assertive Community Treatment (ACT) model for people with severe mental illness and then reviews the evidence regarding its effectiveness and cost effectiveness. ACT is an intensive mental health program model in which a multidisciplinary team of professionals serves patients who do not readily use clinic-based services, but who are often at high risk for psychiatric hospitalization. Most ACT contacts occur in Community settings. ACT teams have a holistic approach to services, helping with medications, housing, finances and everyday problems in living. ACT differs conceptually and empirically from traditional case management approaches. ACT is one of the best-researched mental health Treatment models, with 25 randomized controlled trials evaluating its effectiveness. ACT substantially reduces psychiatric hospital use, increases housing stability, and moderately improves symptoms and subjective quality of life. In addition, ACT is highly successful in engaging patients in Treatment. Research also suggests that the more closely case management programs follow ACT principles, the better the outcomes. ACT services are costly. However, studies have shown the costs of ACT services to be offset by a reduction in hospital use in patients with a history of extensive hospital use. The ACT model has been hugely influential in the mental health services field. ACT is significant because it offers a clearly defined model, and is clinically appealing to practitioners, financially appealing to administrators and scientifically appealing to researchers.
Michael King - One of the best experts on this subject based on the ideXlab platform.
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ten year outcomes of participants in the react randomised evaluation of Assertive Community Treatment in north london study
BMC Psychiatry, 2014Co-Authors: Helen Killaspy, Laia Masexposito, Louise Marston, Michael KingAbstract: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.
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randomised evaluation of Assertive Community Treatment 3 year outcomes
British Journal of Psychiatry, 2009Co-Authors: Helen Killaspy, Stella Kingett, Paul Bebbington, Robert Blizard, Sonia Johnson, Fiona Nolan, Stephen Pilling, Michael KingAbstract:The only randomised controlled trial to test high-fidelity Assertive Community Treatment (ACT) in the UK (the Randomised Evaluation of Assertive Community Treatment (REACT) study) found no advantage over usual care from Community mental health teams in reducing the need for inpatient care and in other clinical outcomes, but participants found ACT more acceptable and engaged better with it. One possible reason for the lack of efficacy of ACT might be the short period of follow-up (18 months in the REACT study). This paper reports on participants' service contact, in-patient service use and adverse events 36 months after randomisation.
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successful engagement a mixed methods study of the approaches of Assertive Community Treatment and Community mental health teams in the react trial
Social Psychiatry and Psychiatric Epidemiology, 2009Co-Authors: Helen Killaspy, Paul Bebbington, Sonia Johnson, Fiona Nolan, Stephen Pilling, Barbara Pierce, Michael KingAbstract:Background The only randomised trial of Assertive Community Treatment (ACT) carried out in England (the “REACT” study: randomised evaluation of Assertive Community Treatment in North London) found no clinically significant advantage over usual care from Community mental health teams (CMHTs). However, ACT clients were more satisfied and better engaged with services. To understand these findings better, we investigated the content of care and interventions offered to study participants.
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the react study cost effectiveness analysis of Assertive Community Treatment in north london
Psychiatric Services, 2009Co-Authors: Paul Mccrone, Helen Killaspy, Paul Bebbington, Sonia Johnson, Fiona Nolan, Stephen Pilling, Michael KingAbstract:Objective: Assertive Community Treatment (ACT) is a key component of mental health care, but recent information on its cost-effectiveness is limited. This article provides a cost-effectiveness analysis of Assertive Community Treatment and usual care from Community mental health teams (CMHTs) in the United Kingdom. Methods: Participants who had difficulties engaging with Community services were randomly assigned to ACT (N=127) or continued usual care from CMHTs (N=124). Costs were measured at baseline and 18 months later and compared between the two groups. In the analysis, cost data were linked to information on satisfaction, which had been shown to be significantly higher with ACT. Results: Total follow-up costs over 18 months were higher for the ACT group by L4,031 ($6,369), but this was not statistically significant (95% confidence interval of -L2,592 to L10,690 [-$4,095 to $16,890]). A one-unit improvement in satisfaction was associated with extra costs in the ACT group of L473 ($747). Conclusions: The costs of ACT were not significantly different from usual care. ACT did, however, result in greater levels of client satisfaction and engagement with services and as such may be the preferred Community Treatment option for patients with long-term serious mental health problems. (Psychiatric Services 60:908-913, 2009)
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successful engagement a mixed methods study of the approaches of Assertive Community Treatment and Community mental health teams in the react trial
Social Psychiatry and Psychiatric Epidemiology, 2009Co-Authors: Helen Killaspy, Paul Bebbington, Sonia Johnson, Fiona Nolan, Stephen Pilling, Barbara Pierce, Michael KingAbstract:The only randomised trial of Assertive Community Treatment (ACT) carried out in England (the “REACT” study: randomised evaluation of Assertive Community Treatment in North London) found no clinically significant advantage over usual care from Community mental health teams (CMHTs). However, ACT clients were more satisfied and better engaged with services. To understand these findings better, we investigated the content of care and interventions offered to study participants. Quantitative data were collected to compare team structures and processes. Qualitative interviews with care co-ordinators of 40 of the 251 REACT study participants (20 ACT, 20 CMHT clients) were carried out and thematic analysis was used to explore differences in the approaches of the two types of team. CMHTs scored low for ACT model fidelity and ACTTs scored high or ACT-like. All staff cited client engagement as their primary aim, but ACT approaches were less formal, more frequent and more successful than CMHTs’. Two aspects of ACT appeared important for engagement: small case loads and the team approach. Successful client engagement appeared to be associated with greater staff satisfaction. The findings from this study assist in understanding why the ACT approach is more acceptable to clients deemed by CMHTs as “hard to engage”. The key elements of ACT that facilitate client engagement may not be easily replicated within CMHTs due to their larger, varied caseloads.
Cornelis L Mulder - One of the best experts on this subject based on the ideXlab platform.
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the effectiveness of Assertive Community Treatment for elderly patients with severe mental illness a randomized controlled trial
BMC Psychiatry, 2014Co-Authors: Cornelis L Mulder, Jolanda Stobbe, Andre I Wierdsma, Rob M Kok, Hans De Kroon, Bertjan Roosenschoon, Marja F I A DeplaAbstract: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. 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. 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. These findings suggest that ACT for elderly patients with SMI engaged patients in Treatment more successfully. NTR1620
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consumer providers in Assertive Community Treatment programs associations with client outcomes
Psychiatric Services, 2012Co-Authors: Maaike D Van Vugt, Hans De Kroon, Philippe Delespaul, Cornelis L MulderAbstract:Objective:This study examined whether employing mental health consumers as consumer-providers in Assertive Community Treatment teams can enhance outcomes for clients with severe mental illness. Methods:In a prospective longitudinal study, presence of consumer-providers and outcomes of 530 clients with severe mental illness in 20 outpatient teams were assessed at baseline and at one-year and two-year follow-ups. Measures included the Health of the Nation Outcome Scales (HoNOS), the Camberwell Assessment of Need Short Assessment Schedule (CANSAS), the Working Alliance Scale, the number of hospital days, and the number of days of homelessness. Multilevel regression was used with the independent variables consumer-provider presence, time of measurement, and their interaction. Results:A positive association was found between consumer-provider presence and improvements in functioning on the HoNOS (p=.020), met needs in relation to personal recovery (p=.044), unmet needs in relation to personal recovery (p=.008)...
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Assertive Community Treatment in the netherlands outcome and model fidelity
The Canadian Journal of Psychiatry, 2011Co-Authors: Maaike D Van Vugt, Hans De Kroon, Bertjan Roosenschoon, Philippe Delespaul, Fred G Dreef, Annet Nugter, Jaap Van Weeghel, Jeroen Zoeteman, Cornelis L MulderAbstract:Objective: The implementation of Assertive Community Treatment (ACT) varies widely. To date, the association between model fidelity and effect has not been investigated in Europe. We investigated the association between model fidelity and outcome in the Dutch mental health system. Method: In a prospective longitudinal study, ACT model fidelity and patient outcomes were assessed in 20 outpatient Treatment teams. Patients with severe mental illness (n = 530) participated in the study. Outcomes were assessed 3 times using the Health of the Nation Outcome Scales (HoNOS), the Camberwell Assessment of Need Short Assessment Schedule (CANSAS), and the number of hospital days and homeless days during a 2-year follow-up period. Data were analyzed using multilevel statistics. Results: High ACT model fidelity was associated with better outcomes on the HoNOS and less homeless days. Among all of the ACT ingredients, team structure was associated with better outcomes. No associations were found between ACT model fidelity, number of hospital days, and CANSAS scores. Conclusions: Our evidence supports the importance of model fidelity for improving patient outcomes.
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involuntary admission may support Treatment outcome and motivation in patients receiving Assertive Community Treatment
Social Psychiatry and Psychiatric Epidemiology, 2010Co-Authors: Hans Erik Kortrijk, A B P Staring, A W B Van Baars, Cornelis L MulderAbstract:Objective Patients with severe mental illness who are treated in Assertive Community Treatment (ACT) teams are sometimes involuntarily admitted when they are dangerous to themselves or others, and are not motivated for Treatment. However, the consequences of involuntary admission in terms of psychosocial outcome and Treatment motivation are largely unknown. We hypothesized that involuntary admission would improve psychosocial outcome and not adversely affect their Treatment motivation.
Helen Killaspy - One of the best experts on this subject based on the ideXlab platform.
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ten year outcomes of participants in the react randomised evaluation of Assertive Community Treatment in north london study
BMC Psychiatry, 2014Co-Authors: Helen Killaspy, Laia Masexposito, Louise Marston, Michael KingAbstract: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.
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Specialisation and marginalisation: how the Assertive Community Treatment debate affects individuals with complex mental health needs
The Psychiatrist, 2013Co-Authors: Alan Rosen, Helen Killaspy, Carol HarveyAbstract:The growth of specialism in a field can be considered a healthy response to emerging evidence, technology and skills, yet it risks creating unhelpful barriers to collaborative working and fragmented patient pathways. Mental health services in England have experienced this tension in recent years through the national implementation of local specialist Community teams that aim to reduce the need for in-patient admission through a focus on crisis resolution, early intervention and Assertive Community Treatment (ACT). In response to the results of studies assessing its effectiveness, there has been disinvestment in ACT. This risks marginalising people with severe and complex mental health problems by depriving them and their families of the intensive support they need for successful Community living, as well as discouraging researchers from undertaking further high-quality studies that can inform the intelligent evolution of the ACT model within different contexts.
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implementation of Assertive Community Treatment in australia model fidelity patient characteristics and staff experiences
Community Mental Health Journal, 2012Co-Authors: Carol Harvey, Helen Killaspy, Salvatore Martino, Sonia JohnsonAbstract:The impact of variable implementation of the Assertive Community Treatment (ACT) model on patient outcomes is increasingly recognised. We conducted the first study of four established Australian ACT teams, examining team composition, processes and model fidelity, using previously validated questionnaires. Demographic and clinical details of patients and their own experiences of ACT were gathered from staff. Associations between burnout and work experiences were examined. All teams were ACT-like (mean DACTS score = 3.7, SD = 0.3) with few significant patient differences between teams, except diagnosis (schizophrenia 61-93%, co-morbid substance abuse 16-33%) and proportion living alone (23-72%). Clinicians were fairly satisfied, but inter-team differences in staffing profile and experience emerged and one team scored highly on emotional exhaustion. Increased burnout was associated with greater stress due to taking a team approach. Inter-team differences suggested that attention to effective team working and leadership, as well as model fidelity, may be warranted.
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randomised evaluation of Assertive Community Treatment 3 year outcomes
British Journal of Psychiatry, 2009Co-Authors: Helen Killaspy, Stella Kingett, Paul Bebbington, Robert Blizard, Sonia Johnson, Fiona Nolan, Stephen Pilling, Michael KingAbstract:The only randomised controlled trial to test high-fidelity Assertive Community Treatment (ACT) in the UK (the Randomised Evaluation of Assertive Community Treatment (REACT) study) found no advantage over usual care from Community mental health teams in reducing the need for inpatient care and in other clinical outcomes, but participants found ACT more acceptable and engaged better with it. One possible reason for the lack of efficacy of ACT might be the short period of follow-up (18 months in the REACT study). This paper reports on participants' service contact, in-patient service use and adverse events 36 months after randomisation.
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successful engagement a mixed methods study of the approaches of Assertive Community Treatment and Community mental health teams in the react trial
Social Psychiatry and Psychiatric Epidemiology, 2009Co-Authors: Helen Killaspy, Paul Bebbington, Sonia Johnson, Fiona Nolan, Stephen Pilling, Barbara Pierce, Michael KingAbstract:Background The only randomised trial of Assertive Community Treatment (ACT) carried out in England (the “REACT” study: randomised evaluation of Assertive Community Treatment in North London) found no clinically significant advantage over usual care from Community mental health teams (CMHTs). However, ACT clients were more satisfied and better engaged with services. To understand these findings better, we investigated the content of care and interventions offered to study participants.
