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Broersen M, Frieswijk N, van Vugt M, Vermulst AA, Creemers DHM, Kroon H. Examining Youth Flexible ACT Model Implementation in the Netherlands. Community Ment Health J 2024; 60:1081-1093. [PMID: 38519800 PMCID: PMC11199218 DOI: 10.1007/s10597-024-01260-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 02/20/2024] [Indexed: 03/25/2024]
Abstract
Model adherence is a key indicator of mental health care quality. This study investigates the degree of model adherence, as well as content and staging of care, among the first Youth Flexible Assertive Community Treatment (ACT) teams in the Netherlands. Model fidelity was assessed in sixteen teams with the Youth Flexile ACT model fidelity scale (2014 version). Mental health workers completed a 'content of care questionnaire' to map the interventions applied in the teams. Model fidelity scores revealed that twelve teams adhered to the Youth Flexible ACT standard with 'optimal implementation' (≥ 4.1 on a 5 point scale) and four teams with 'adequate implementation'. Most disciplines were well integrated within the teams; however, several items regarding the involvement of specific disciplines and the availability of treatment interventions (peer support worker, employment and education specialist and programs, family interventions, integrated dual disorder treatment) scored below the optimum. Frequency of contact during ACT and the use of Routine Outcome Monitoring instruments scored below the optimum as well. The 'content of care' data showed that most clients received an individual psychological intervention, and nearly half of the client sample received scaled-up / intensified ACT care. The findings indicate a predominantly successful translation of care from the theoretical Flexible ACT framework into practice, covering both ACT and non-ACT functions. Further room for improvement lies in the incorporation of specialized disciplines in the personal and social recovery domains, including the peer support worker and employment and education specialist, as well as in specific protocolled interventions.
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Affiliation(s)
- Marieke Broersen
- GGZ Oost Brabant, Oss, The Netherlands.
- Tranzo - Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands.
| | | | | | | | | | - Hans Kroon
- Tranzo - Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Trimbos Institute, Utrecht, The Netherlands
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Engelsbel F, Keet R, Nugter A. A pre-post study design: evaluating the effectiveness of a new community-based integrated service model on patient outcomes. Int J Ment Health Syst 2024; 18:20. [PMID: 38725081 PMCID: PMC11084129 DOI: 10.1186/s13033-024-00636-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 04/25/2024] [Indexed: 05/12/2024] Open
Abstract
This study aimed to evaluate a new service model, Specialists Together In the Community (STIC), in terms of patient outcomes. This model integrates Flexible Assertive Community Treatment (FACT)-principles with expertise of specialized teams that offer diagnosis-related outpatient treatment. In a pre-post design, symptoms and quality of life of 930 former FACT-patients were measured repeatedly pre- and post-STIC. Regarding patients in former specialized teams, pre- and post-treatment social functioning and symptoms were measured for the pre- (n = 944) and post-STIC (n = 544) groups. Against expectation, symptoms of former FACT-patients remained stable post-STIC compared to a slight decrease pre-STIC. According to expectation, pre- and post-STIC groups had an equal symptom reduction. Unexpectedly, the post-STIC group did not improve more on social functioning than the pre-STIC group. Explorative analysis showed less treatment contacts in the post-STIC group. The highly similar patient outcomes post-STIC could be improved by monitoring process outcomes and prolonging study duration.
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Affiliation(s)
- Fabiana Engelsbel
- GGZ Noord-Holland-Noord Research Department, Heerhugowaard, The Netherlands.
| | - René Keet
- GGZ Noord-Holland-Noord FIT-Academy, Heerhugowaard, The Netherlands
| | - Annet Nugter
- GGZ Noord-Holland-Noord Research Department, Heerhugowaard, The Netherlands
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Roosenschoon BJ, van Weeghel J, Deen ML, van Esveld EW, Kamperman AM, Mulder CL. Fidelity and Clinical Competence in Providing Illness Management and Recovery: An Explorative Study. Community Ment Health J 2023; 59:1508-1520. [PMID: 37253901 PMCID: PMC10598171 DOI: 10.1007/s10597-023-01137-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 05/07/2023] [Indexed: 06/01/2023]
Abstract
Illness Management and Recovery (IMR) is a psychosocial intervention supporting people with serious mental illnesses. In this study, 15 IMR groups were assessed for fidelity and clinician competency to establish the implementation level of all IMR elements and explore complementarity of the IMR Treatment Integrity Scale (IT-IS) to the standard IMR Fidelity Scale. Use of the IT-IS was adapted, similar to the IMR Fidelity Scale. Descriptive statistics were applied. Implementation success of IMR elements varied widely on the IMR Fidelity Scale and IT-IS (M = 3.94, SD = 1.13, and M = 3.29, SD = 1.05, respectively). Twelve IMR elements (60%) were well-implemented, whereas eight (40%) were implemented insufficiently, including some critical cognitive-behavioral techniques (e.g., role-playing). The scales appeared largely complementary, though strongly correlated (r (13) = 0.74, p = 0.002). Providing all IMR elements adequately requires a variety of clinical skills. Specific additional training and supervision may be necessary.
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Affiliation(s)
- Bert-Jan Roosenschoon
- Department of Psychiatry, Epidemiological and Social Psychiatric Research Institute, Erasmus MC University Medical Centre, Doctor Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands.
- Parnassia Academy, Parnassia Psychiatric Institute, Kiwistraat 32, Den Haag, 2552 DH, The Netherlands.
| | - Jaap van Weeghel
- Department of TRANZO, Tilburg School of Social and Behavioral Sciences, Tilburg University, PO Box 90153, Tilburg, 5000 LE, The Netherlands
| | - Mathijs L Deen
- Parnassia Academy, Parnassia Psychiatric Institute, Kiwistraat 32, Den Haag, 2552 DH, The Netherlands
- Faculty of Social and Behavioral Sciences, Institute of Psychology, Leiden University, Wassenaarseweg 52, Leiden, 2333 AK, The Netherlands
| | | | - Astrid M Kamperman
- Department of Psychiatry, Epidemiological and Social Psychiatric Research Institute, Erasmus MC University Medical Centre, Doctor Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands
| | - Cornelis L Mulder
- Department of Psychiatry, Epidemiological and Social Psychiatric Research Institute, Erasmus MC University Medical Centre, Doctor Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands
- ANTES Mental Health Care, Parnassia Psychiatric Institute, Albrandswaardsedijk 74, Poortugaal, 3172 AA, The Netherlands
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Indicadores de boas práticas em saúde para a população de rua: revisão de escopo. ACTA PAUL ENFERM 2022. [DOI: 10.37689/acta-ape/2022ar004766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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The Active Recovery Triad monitor: evaluation of a model fidelity scale for recovery-oriented care in long-term mental health care settings. BMC Psychiatry 2022; 22:346. [PMID: 35590299 PMCID: PMC9118770 DOI: 10.1186/s12888-022-03949-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 04/13/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The Active Recovery Triad (ART) model is a recently developed care model for people who are admitted to an institutional setting for several years and receive 24-h mental health care and support. This study focuses on the ART monitor, a model fidelity scale that measures the degree of compliance with the ART model. Our aim is to evaluate the psychometric properties of the ART monitor and to further improve the instrument. METHODS Fifteen teams at the start (n = 7, group 1) or in the process (6 months to three years) of implementing care according to the ART model (n = 8, group 2) were audited using the ART monitor. Auditors were trained care workers, peer workers, and family peer workers. Auditors and team members provided feedback on the instrument. The content validity, construct validity and inter-rater reliability of the ART monitor were investigated. Based on the outcomes of these psychometric properties, the ART monitor was finalized. RESULTS Regarding content validity, auditors and teams indicated that they perceived the ART monitor to be a useful instrument. In terms of construct validity, a significant difference (t(13) = 2.53, p < 0.05) was found between teams at the start of the implementation process (group 1, average score of 2.42 (SD = 0.44)) and teams with a longer duration of implementation (group 2, average score of 2.95 (SD = 0.37)). When allowing for a one-point difference in scores, 88% of the items had an inter-rater agreement over 65%. Items with a relatively low inter-rater reliability, in combination with feedback from auditors and teams regarding content validity, provided direction for further improvement and revision of the instrument. CONCLUSIONS We concluded that the revised ART monitor is feasible and useful in mental health care practice. However, further evaluation of its psychometric properties will be needed.
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Westen K, Boyle P, Kroon H. An observational comparison of FACT and ACT in the Netherlands and the US. BMC Psychiatry 2022; 22:311. [PMID: 35505332 PMCID: PMC9063161 DOI: 10.1186/s12888-022-03927-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 03/23/2022] [Indexed: 12/05/2022] Open
Abstract
Assertive Community Treatment (ACT) is a well-defined service delivery model for the care and treatment of the most severely mentally ill in the community with American origins. The Dutch have adapted the model in order to accommodate a broader range of needs and allow more flexible implementation. Functional Assertive Community Treatment (FACT) provides the intensity of care needed to help participants sustain life in the community as well as continuity of care over time for many vulnerable client populations.
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Affiliation(s)
- Koen Westen
- grid.440506.30000 0000 9631 4629Avans University of Applied Sciences, Breda, The Netherlands ,CCAF, Utrecht, The Netherlands ,grid.491422.80000 0004 0546 0823Reinier van Arkel, ’s, Hertogenbosch, The Netherlands
| | - Patrick Boyle
- Center for Evidence Based Practices, Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, USA.
| | - Hans Kroon
- CCAF, Utrecht, The Netherlands ,grid.416017.50000 0001 0835 8259Department of Mental Health Care and Participation, Trimbos Institute, Utrecht, The Netherlands ,grid.12295.3d0000 0001 0943 3265Department of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, Tilburg, The Netherlands
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van Haaren M, de Jong S, Roeg DPK. The foundations of the working alliance in assertive community treatment teams. BMC Psychiatry 2021; 21:559. [PMID: 34758777 PMCID: PMC8582115 DOI: 10.1186/s12888-021-03563-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 10/18/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In this study, we aimed to identify and define the fundamental components of the working alliance in multidisciplinary (Flexible) Assertive Community Treatment teams with shared caseloads, in order to support their daily practice and further research. METHODS After reviewing the literature, concept mapping with professionals and clients was used to define the working alliance in (F) ACT teams. The resulting concept maps formed the basis for the working alliance assessment instrument, which was pilot tested with professionals and clients through cognitive interviews with a think-aloud procedure. RESULTS The study led to the development of a twenty five-item assessment instrument to evaluate working alliances in multidisciplinary teams (WAM) that was comprised of three subscales: bond, task/goal and team. Two different versions were developed for clients and professionals. CONCLUSIONS The WAM instrument was developed to determine the quality of the working alliance in (F) ACT teams. Future research will focus on testing its psychometric properties and predictive value.
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Affiliation(s)
- M. van Haaren
- grid.491104.9Department of Outpatient Psychiatry/Department of Forensic Psychiatry, GGzE Direct/De Woenselse Poort, GGzE, Eindhoven, the Netherlands
| | - S. de Jong
- grid.468630.f0000 0004 0631 9338Research Department, Lentis Groningen, the Netherlands
| | - D. P. K. Roeg
- grid.12295.3d0000 0001 0943 3265Tilburg University, Tilburg, the Netherlands/Tranzo & Kwintes Supported Housing, PO Box 90153, 5000 LE Tilburg, Zeist, the Netherlands
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Muusse C, Kroon H, Mulder CL, Pols J. Frying eggs or making a treatment plan? Frictions between different modes of caring in a community mental health team. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:1581-1597. [PMID: 34250614 PMCID: PMC8456910 DOI: 10.1111/1467-9566.13346] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/14/2021] [Accepted: 06/14/2021] [Indexed: 06/13/2023]
Abstract
In this article, we conduct an empirical ethics approach to unravel the different perspectives on good care that are present in a community mental health team (CMHT) in Utrecht. With the deinstitutionalisation of mental health care, the importance of a close collaboration between the social and medical domains of care on the level of the local community is put in the foreground. Next to organisational thresholds or incentives, this collaboration is shaped by different notions of what good mental health care should entail. Using the concept of modes of ordering care (Moser 2005), we describe five modes of ordering mental health care that are present in the practice of the CMHT: the medical specialist, the juridical, the community, the relational and the bureaucratic perspective. These different modes of ordering care lead to frictions and misunderstandings, but are mutually enhancing at other times. Unravelling these different modes of ordering care can facilitate collaboration between professionals of different care domains and support a mutual understanding of what needs to be done. More so, the analysis foregrounds that ordering care from a relational approach is important in daily practice, but is in need of stronger legitimation.
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Affiliation(s)
- Christien Muusse
- Trimbos InstituteNetherlands Institute of Mental Health and AddictionUtrechtThe Netherlands
- Department Ethics, Law & HumanitiesAmsterdam UMCAmsterdamThe Netherlands
| | - Hans Kroon
- Trimbos InstituteNetherlands Institute of Mental Health and AddictionUtrechtThe Netherlands
- Tranzo, School of Social and Behavioural SciencesTilburg UniversityTilburgThe Netherlands
| | - Cornelis L. Mulder
- Department of PsychiatryErasmus MCRotterdamThe Netherlands
- Parnassia Psychiatric InstituteThe HagueThe Netherlands
| | - Jeannette Pols
- Department Ethics, Law & HumanitiesAmsterdam UMCAmsterdamThe Netherlands
- Department of AnthropologyUniversity of AmsterdamAmsterdamThe Netherlands
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Abstract
LEARNING OBJECTIVE After participating in this activity, learners should be better able to:• Assess characteristics of forensic assertive community treatment programs. ABSTRACT Forensic assertive community treatment (FACT) has emerged internationally as an intervention strategy for people with serious mental disorders who are involved with the criminal justice system. Studies to date have shown marked variability, however, in FACT program design and operation. Based upon a literature review and relevant experience, the authors present their perspective on the essential elements of FACT. Given that FACT is an adaptation of the evidence-based assertive community treatment (ACT) model, it is recommended that FACT programs maintain a high-fidelity ACT component. FACT programs should also have both mental health and criminal justice admission criteria because service recipients are involved in both service systems. For optimal effectiveness, FACT team clinicians must partner with criminal justice agencies that provide community-based supervision to their patients. Prospective FACT enrollees should receive a clear explanation of the program, including how their respective mental health and criminal justice service providers will work collaboratively with them to prevent incarceration. FACT programs should also use risk/need assessment to inform treatment planning, evidence-based mental health and community correctional practices to promote both wellness and public safety, and shared training to promote effective collaboration. Additional elements to consider include housing, medical care, and transitional services. These elements are presented and discussed, including a rationale and evidence to support each component. The article concludes with introduction of a FACT fidelity scale, the Rochester Forensic Assertive Community Treatment Scale (R-FACTS). By operationalizing essential FACT elements, the R-FACTS is designed to support FACT program development, implementation, and dissemination in a more consistent and measurable manner.
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Roosenschoon BJ, van Weeghel J, Deen ML, van Esveld EW, Kamperman AM, Mulder CL. Effects of Illness Management and Recovery: A Multicenter Randomized Controlled Trial. Front Psychiatry 2021; 12:723435. [PMID: 34970161 PMCID: PMC8712643 DOI: 10.3389/fpsyt.2021.723435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 11/22/2021] [Indexed: 11/25/2022] Open
Abstract
There have been inconsistent findings in the literature with respect to the efficacy of Illness Management and Recovery (IMR) in the psychosocial treatment of people with schizophrenia or other severe mental illnesses. This study aimed to comprehensively investigate the effectiveness of IMR, including the impact of completion and fidelity. In this randomized controlled trial (RCT), 187 outpatients received either IMR plus care as usual (CAU) or only CAU. Multilevel modeling was implemented to investigate group differences over an 18-month period, comprising 12 months of treatment and six months of follow-up. The primary outcome was overall illness management, which was assessed using the client version of the IMR scale. Secondary outcomes included measures regarding illness management, clinical, personal, and functional recovery, and hospitalizations. The interviewers were blinded to group allocation. This clinical trial was registered with the Netherlands Trial Register (NL4931, NTR5033). Patients who received IMR showed statistically significant improvement in self-reported overall illness management (the primary outcome). Moreover, they showed an improvement in self-esteem, which is a component of personal recovery. There were no effects within the other questionnaires. There were also no statistically significant between-group differences in terms of hospitalizations. Patients in both groups showed statistically significant improvement in clinician-rated overall illness management, social support, clinical and functional recovery, and self-stigma over time. IMR completion was associated with stronger effects. High IMR fidelity was associated with self-esteem. This study confirms the efficacy of IMR in overall illness self-management. To our knowledge, this is the first RCT on IMR to explore the impact of fidelity on treatment efficacy. Future studies should further establish efficacy in personal recovery. To improve efficacy, it appears important to promote IMR completion and fidelity.
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Affiliation(s)
- Bert-Jan Roosenschoon
- Department of Psychiatry, Epidemiological and Social Psychiatric Research Institute, Erasmus MC University Medical Centre, Rotterdam, Netherlands.,Parnassia Academy, Parnassia Psychiatric Institute, Den Haag, Netherlands
| | - Jaap van Weeghel
- Parnassia Academy, Parnassia Psychiatric Institute, Den Haag, Netherlands.,Department of TRANZO, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | - Mathijs L Deen
- Parnassia Academy, Parnassia Psychiatric Institute, Den Haag, Netherlands.,Faculty of Social and Behavioral Sciences, Institute of Psychology, Leiden University, Leiden, Netherlands
| | | | - Astrid M Kamperman
- Department of Psychiatry, Epidemiological and Social Psychiatric Research Institute, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - Cornelis L Mulder
- Department of Psychiatry, Epidemiological and Social Psychiatric Research Institute, Erasmus MC University Medical Centre, Rotterdam, Netherlands.,Antes Mental Health Care, Parnassia Psychiatric Institute, Rotterdam, Netherlands
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Smelson D, Shaffer PM, Posada Rodriguez C, Gaba A, Harter J, Pinals DA, Casey SC. A co-occurring disorders intervention for drug treatment court: 12-month pilot study outcomes. ADVANCES IN DUAL DIAGNOSIS 2020. [DOI: 10.1108/add-08-2020-0016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeMany individuals in drug treatment courts (DTCs) have co-occurring mental health and substance use disorders (COD), which can negatively impact treatment engagement, behavioral health and criminal justice outcomes. This paper aims to report results of DTC participants with a COD, who received a 12-month wraparound treatment intervention called MISSION-Criminal Justice (MISSION-CJ) alongside DTC to improve treatment engagement and behavioral health outcomes and reduce reincarcerations.Design/methodology/approachIn this pre-post, single-group pilot, 48 clients enrolled and 81% completed 12-month follow-up assessments (N = 39) and weekly MISSION-CJ fidelity for type and intensity of services delivered. Generalized linear mixed models (GLMMs) were computed with a fixed term for fidelity (e.g. high or low MISSION-CJ), time and a fidelity x time interaction term.FindingsAmong participants, at 12 months, 81% of the participants remained engaged in treatment at study completion, and 89% had high MISSON-CJ fidelity. Clients demonstrated significant reductions from baseline to 12 months in average nights in jail (B = −0.1849511, p < 0.0344), mental health symptoms via the Behavior and Symptom Identification Scale (BASIS) total and subscale scores (B = −0.121613,p< 0.0186) and trauma symptoms on the PTSD Checklist-5 (PCL-5) (B = −0.928791, p < 0.0138). High MISSION-CJ fidelity further improved criminal justice, and behavioral health outcomes.Originality/valueThis was the first reported 12-month MISSION-CJ trial. While feasible to implement, given the design limitations, future research should include a large randomized controlled trial.
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van Weeghel J. Fidelity Scale: From Black Box to Holy Grail. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 47:927-931. [PMID: 32500430 PMCID: PMC7547993 DOI: 10.1007/s10488-020-01057-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Fidelity scales are indispensable in the pursuit of evidence-based mental healthcare. Without fidelity checks, treatment remains a mysterious black box. The aim of this article is to comment on the studies in this special section, and to discuss some general issues with regard to fidelity assessment. Despite all of their supposed benefits, resistance to fidelity scales persists among mental health practitioners. One way to overcome this resistance is to conduct fidelity assessments in the context of a well-guided learning community. The predictive validity of fidelity scales is considered the single most valuable attribute of these instruments. Research on predictive validity requires large sample sizes, which is difficult to achieve. It should nevertheless not prevent us from rigorously searching for this Holy Grail of fidelity assessment. In addition, fidelity assessment should be placed in a broader perspective. The quality of care for people with severe mental illness cannot be assessed conclusively according to the extent to which separate interventions have been applied with good fidelity. These individuals need access to high-quality treatment and support systems within the community, which can enable them to live their lives as valued citizens. In conclusion, fidelity assessment, both at the level of interventions and systems, contributes to a highly desirable transparency in practice variations within the field of mental healthcare.
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Affiliation(s)
- Jaap van Weeghel
- Tranzo Scientific Center for Care and Welfare, Department of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands. .,Parnassia Psychiatric Institute, The Hague, The Netherlands. .,Phrenos Center of Expertise, Da Costakade 45, 3521 VS, Utrecht, The Netherlands.
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Broersen M, Creemers DHM, Frieswijk N, Vermulst AA, Kroon H. Investigating the critical elements and psychosocial outcomes of Youth Flexible Assertive Community Treatment: a study protocol for an observational prospective cohort study. BMJ Open 2020; 10:e035146. [PMID: 32265243 PMCID: PMC7245379 DOI: 10.1136/bmjopen-2019-035146] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION When adolescents experience complex psychiatric and social problems, numerous healthcare services usually become involved. In these cases, fragmentation of care services is a risk that often results in both ineffective care and in patients disengaging from care services. To address these issues, Youth Flexible Assertive Community Treatment (Youth Flexible ACT) was developed in the Netherlands. This client-centred service delivery model aims to tackle the fragmented care system by providing psychiatric treatment and support in a flexible and integrated manner. While Youth Flexible ACT is gaining in popularity, the effectiveness of the care model remains largely unexamined. METHODS AND ANALYSIS Here, we present an observational prospective cohort (2017-2021) in which a broad range of treatment outcomes will be monitored. The primary aim of the study is to examine change in treatment outcomes over the course of the Flexible ACT care. The secondary aim is to examine the association between (elements of) Youth Flexible ACT model fidelity and treatment outcomes. An estimated total number of 200 adolescents who receive care from one of the 16 participating Youth Flexible ACT teams will be included in the study. Participants will be asked to complete assessments at four time points in 6-month intervals, resulting in a study duration of 18 months. Latent growth curve analysis will be conducted to examine change in psychosocial functioning over time and its relation to model fidelity. ETHICS AND DISSEMINATION This study received ethical approval from Trimbos Ethics Committee (201607_75-FACT2). This approval applies for all participating institutions. The results of the study will be reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology statement. Results will be disseminated via peer-reviewed academic journals and presentations at conferences. In addition, results will be made available for participating sites, funders and researchers.
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Affiliation(s)
- Marieke Broersen
- GGZ Oost Brabant, Oss, The Netherlands
- Tranzo - Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | | | | | | | - Hans Kroon
- Tranzo - Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Trimbos Institute, Utrecht, The Netherlands
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High and Intensive Care in Psychiatry: Validating the HIC Monitor as a Tool for Assessing the Quality of Psychiatric Intensive Care Units. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 46:34-43. [PMID: 30120618 PMCID: PMC6326958 DOI: 10.1007/s10488-018-0890-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This study aims to validate the HIC monitor as a model-fidelity scale to the High and Intensive Care (HIC) model, a recently developed model for acute psychiatric wards. To assess the psychometric properties of the HIC monitor, 37 audits were held on closed inpatient wards at 20 psychiatric hospitals in the Netherlands. Interrater reliability, construct validity and content validity were examined. Our results suggest that the HIC monitor has good psychometric properties. It can be used as a tool for assessing the implementation of the HIC model on acute psychiatric wards in the Netherlands, and for quality assessment and improvement.
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Neijmeijer L, Kuiper C, Kroon H, Didden R. Experiences of service users with a mild intellectual disability or borderline intellectual functioning with Flexible Assertive Community Treatment: A qualitative study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 33:1005-1015. [PMID: 32141154 PMCID: PMC7496458 DOI: 10.1111/jar.12723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 02/14/2020] [Accepted: 02/17/2020] [Indexed: 11/27/2022]
Abstract
Background In the Netherlands, Flexible Assertive Community Treatment (FACT) teams have been established for people with mild intellectual disability (MID) or borderline intellectual functioning (BIF) and mental health problems or challenging behaviour. Little is known yet about service users’ experiences with FACT. Method An inductive grounded theory approach was used to explore how service users valued the treatment and their own functioning, and which factors were perceived as supportive. Semi‐structured interviews were held with 15 service users. Results Most service users highly appreciated the contact with the staff and the practical and emotional support. Persistent involvement, availability and humanity, and respect for autonomy were distinguished as core values in the relationship with the staff. Most service users experienced improvement in time and attributed this to intrapersonal changes and/or less stress in life. Conclusions From the perspective of service users with MID/BIF, FACT appears to have an added value.
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Affiliation(s)
- Laura Neijmeijer
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands.,Trajectum, Zwolle, The Netherlands
| | - Chris Kuiper
- University of Applied Sciences Leiden, Leiden, The Netherlands
| | - Hans Kroon
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.,Tranzo, School of Social and Behavioural Sciences, Tilburg University, Tilburg, The Netherlands
| | - Robert Didden
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands.,Trajectum, Zwolle, The Netherlands
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16
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Bond GR, Drake RE. Assessing the Fidelity of Evidence-Based Practices: History and Current Status of a Standardized Measurement Methodology. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2019; 47:874-884. [PMID: 31691055 DOI: 10.1007/s10488-019-00991-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Evidence-based practices are effective only when implemented faithfully. This paper explicates the history, standardization, and methods for developing and validating measures of fidelity. We overviewed the past 20 years of developing fidelity measures, summarized standardization of the development procedures, and described needed psychometric assessments. Fidelity assessment has become the sine qua non of implementation, technical assistance, and research on evidence-based practices. Researchers have established standardized procedures for scale development and psychometric testing. Widescale use of fidelity measurement remains challenging. The implementation of evidence-based practice and the development and validation of fidelity measures are interdependent. International improvements of mental health care will require attention to both.
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Affiliation(s)
- Gary R Bond
- Westat, Rivermill Commercial Center, 85 Mechanic Street, Suite C3-1, Lebanon, NH, 03766, USA.
| | - Robert E Drake
- Westat, Rivermill Commercial Center, 85 Mechanic Street, Suite C3-1, Lebanon, NH, 03766, USA
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Neijmeijer LJ, Didden R, Nijman HLI, Kroon H. Assertive Community Treatment for People With Mild Intellectual Disability or Borderline Intellectual Functioning and Mental Health Problems or Challenging Behavior: State of the Art and Implementation in the Netherlands. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2018. [DOI: 10.1111/jppi.12254] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Laura J. Neijmeijer
- Radboud University Nijmegen, Behavioural Science Institute; Nijmegen
- Trajectum; Zwolle
| | - Robert Didden
- Radboud University Nijmegen, Behavioural Science Institute; Nijmegen
| | - Henk L. I. Nijman
- Radboud University Nijmegen, Behavioural Science Institute; Nijmegen
| | - Hans Kroon
- Trimbos-Institute; Netherlands Institute of Mental Health and Addiction; Utrecht the Netherlands
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Kido Y, Kawakami N, Kayama M. Comparison of hospital admission rates for psychiatric patients cared for by multidisciplinary outreach teams with and without peer specialist: a retrospective cohort study of Japanese Outreach Model Project 2011-2014. BMJ Open 2018; 8:e019090. [PMID: 30121587 PMCID: PMC6104750 DOI: 10.1136/bmjopen-2017-019090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study examined whether having peer specialists (PS) in psychiatric multidisciplinary outreach teams was associated with a lower risk of hospitalisation, improved social functioning and decreased problem behaviours. DESIGN AND SETTING This study was a retrospective cohort study based on medical records. This study was conducted as a part of the Japanese Outreach Model Project 2011-2014, which provides services for persons diagnosed mainly as ICD-10 F0, F2 and F3, who have a high possibility of hospital admission/readmission with regular Japanese outpatient care. PARTICIPANTS A total of 292 participants (clients) from 31 multidisciplinary outreach teams with and without PS (n=108 and 184, respectively) fulfilled the inclusion criteria and were included in the analysis. OUTCOME MEASURES The primary outcome measure was hospitalisation during follow-up. The difference in hospitalisation during the follow-up between teams with and without PS was analysed by Kaplan-Meier survival curves and a Cox proportional hazards model. The secondary outcome measures were social functioning (Global Assessment of Functioning, GAF) and problem behaviours (Social Behaviour Schedule, SBS) of clients, and were assessed at baseline and at 6-month follow-up. Changes in social functioning and problem behaviours were compared between clients cared for by the two team types. Amount and content of the service were also compared. RESULTS The clients cared by teams with PS had a significantly decreased probability of hospitalisation in Cox proportional hazards models adjusting for baseline characteristics (HR=0.53, 95% CI 0.31 to 0.89). The 6-month change in GAF or SBS was not significantly different between the two groups. CONCLUSION This is an observational study in which the presence of a PS appeared to be associated with a reduced rate of hospitalisation. A randomised study would be required to demonstrate a causal relationship.
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Affiliation(s)
- Yoshifumi Kido
- Department of Psychiatric and Mental Health Nursing, Mie Prefectural College of Nursing, Mie, Japan
| | - Norito Kawakami
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mami Kayama
- Department of Psychiatric and Mental Health Nursing, Graduate School of Nursing, St Luke’s International University, Tokyo, Japan
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Cornelis J, Barakat A, Dekker J, Schut T, Berk S, Nusselder H, Ruhl N, Zoeteman J, Van R, Beekman A, Blankers M. Intensive home treatment for patients in acute psychiatric crisis situations: a multicentre randomized controlled trial. BMC Psychiatry 2018; 18:55. [PMID: 29486741 PMCID: PMC6389203 DOI: 10.1186/s12888-018-1632-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 02/12/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Hospitalization is a common method to intensify care for patients experiencing a psychiatric crisis. A short-term, specialised, out-patient crisis intervention by a Crisis Resolution Team (CRT) in the Netherlands, called Intensive Home Treatment (IHT), is a viable intervention which may help reduce hospital admission days. However, research on the (cost-)effectiveness of alternatives to hospitalisation such as IHT are scarce. In the study presented in this protocol, IHT will be compared to care-as-usual (CAU) in a randomized controlled trial (RCT). CAU comprises low-intensity outpatient care and hospitalisation if necessary. In this RCT it is hypothesized that IHT will reduce inpatient days by 33% compared to CAU while safety and clinical outcomes will be non-inferior. Secondary hypotheses are that treatment satisfaction of patients and their relatives are expected to be higher in the IHT condition compared to CAU. METHODS A 2-centre, 2-arm Zelen double consent RCT will be employed. Participants will be recruited in the Amsterdam area, the Netherlands. Clinical assessments will be carried out at baseline and at 6, 26 and 52 weeks post treatment allocation. The primary outcome measure is the number of admission days. Secondary outcomes include psychological well-being, safety and patients' and their relatives' treatment satisfaction. Alongside this RCT an economic evaluation will be carried out to assess the cost-effectiveness and cost-utility of IHT compared to CAU. DISCUSSION RCTs on the effectiveness of crisis treatment in psychiatry are scarce and including patients in studies performed in acute psychiatric crisis care is a challenge due to the ethical and practical hurdles. The Zelen design may offer a feasible opportunity to carry out such an RCT. If our study finds that IHT is a safe and cost-effective alternative for CAU it may help support a further decrease of in-patient bed days and may foster the widespread implementation of IHT by mental health care organisations internationally. TRIAL REGISTRATION The trial is registered in the Netherlands Trial Register as # NTR-6151 . Registered 23 November 2016.
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Affiliation(s)
- Jurgen Cornelis
- Department of Research, Arkin Mental Health Care, Klaprozenweg 111, 1033, NN, Amsterdam, The Netherlands. .,Department of Emergency Psychiatry, Arkin Mental Health Care, Amsterdam, The Netherlands.
| | - Ansam Barakat
- Department of Research, Arkin Mental Health Care, Klaprozenweg 111, 1033 NN Amsterdam, The Netherlands
| | - Jack Dekker
- Department of Research, Arkin Mental Health Care, Klaprozenweg 111, 1033 NN Amsterdam, The Netherlands ,0000 0004 1754 9227grid.12380.38Department Clinical Psychology, VU University, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
| | - Tessy Schut
- Department of Emergency Psychiatry, Arkin Mental Health Care, Amsterdam, The Netherlands
| | - Sandra Berk
- 0000 0004 0546 0540grid.420193.dDepartment of Emergency Psychiatry, GGZ inGeest Mental Health Care, Amsterdam, The Netherlands
| | - Hans Nusselder
- Department of Emergency Psychiatry, Arkin Mental Health Care, Amsterdam, The Netherlands
| | - Nikander Ruhl
- 0000 0004 0546 0540grid.420193.dDepartment of Emergency Psychiatry, GGZ inGeest Mental Health Care, Amsterdam, The Netherlands
| | - Jeroen Zoeteman
- Department of Emergency Psychiatry, Arkin Mental Health Care, Amsterdam, The Netherlands
| | - Rien Van
- Department of Research, Arkin Mental Health Care, Klaprozenweg 111, 1033 NN Amsterdam, The Netherlands
| | - Aartjan Beekman
- 0000 0004 0435 165Xgrid.16872.3aGGZ inGeest and Department of Psychiatry, Amsterdam Public Health research institute, VU University Medical Center, A.J. Ernststraat 1187, 1081 HL Amsterdam, The Netherlands
| | - Matthijs Blankers
- Department of Research, Arkin Mental Health Care, Klaprozenweg 111, 1033 NN Amsterdam, The Netherlands ,0000000084992262grid.7177.6Academic Medical Center, Department of Psychiatry, University of Amsterdam, Amsterdam, The Netherlands ,0000 0001 0835 8259grid.416017.5Trimbos Institute – The Netherlands Institute of Mental Health and Addiction, Da Costakade 45, 3521 VS Utrecht, The Netherlands
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Apantaku-Olajide T, Ducray K, Byrne P, Smyth BP. Perception of unmet needs and association with benzodiazepine misuse among patients on a methadone maintenance treatment programme. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/pb.bp.111.036616] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and methodTo examine patients' perceptions of unmet needs during methadone maintenance treatment (MMT), and to explore the relationship between co-occurring benzodiazepine misuse and severity of needs. A cross-sectional survey was carried out at an MMT programme in Dublin, Ireland. All patients were invited to participate on a voluntary basis. Of the 191 eligible patients, 107 agreed to participate and completed the Camberwell Assessment of Need questionnaire.ResultsUnmet needs for substance misuse treatments, daytime activities, socialisation, money management and psychological distress were high. Fifty-two respondents (49%) reported using non-prescribed benzodiazepines during the past month. Compared with non-users of benzodiazepines, benzodiazepine users reported higher ratings of total and unmet needs (P < 0.05). The number of days using benzodiazepines predicted the severity of needs.Clinical implicationsThe findings highlight the importance of addressing coexisting psychological needs, and further support enhancing treatment interventions for benzodiazepine misuse or dependence among patients on MMT.
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Rollins AL, Kukla M, Salyers MP, McGrew JH, Flanagan ME, Leslie DL, Hunt MG, McGuire AB. Comparing the Costs and Acceptability of Three Fidelity Assessment Methods for Assertive Community Treatment. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2017; 44:810-816. [DOI: 10.1007/s10488-016-0785-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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22
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Roosenschoon BJ, van Weeghel J, Bogaards M, Deen ML, Mulder CL. Illness Management & Recovery (IMR) in the Netherlands; a naturalistic pilot study to explore the feasibility of a randomized controlled trial. BMC Psychiatry 2016; 16:391. [PMID: 27829392 PMCID: PMC5103352 DOI: 10.1186/s12888-016-1096-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 10/30/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Illness Management & Recovery (IMR) is a curriculum-based program for people with severe and persistent mental illness. To date, four randomized controlled trials (RCTs) have been published on it. As these produced mixed results, we conducted a pilot study to test the feasibility of conducting a new RCT in a Dutch psychiatric institute. Because our primary objective was to evaluate support for implementing IMR on a broader scale, we examined participant recruitment, client outcomes, and clients' and clinicians' satisfaction. Secondary objectives were to evaluate fidelity, trainers' training and supervision, and to explore program duration, dropout, and client characteristics related to dropout. For reporting, we used the checklist for pilot studies adopted from the CONSORT Statement. METHODS This program evaluation included a process-evaluation and an outcome evaluation with a One Group Pre-Posttest Design (N = 81). Interviews and internal reports were used to monitor participant numbers, program duration, dropout, and completers' characteristics. Clients' and clinicians' satisfaction and provision of trainers' training and supervision were assessed through interviews. Fidelity was assessed on the IMR Fidelity Scale; client outcomes were assessed on the IMR scale (client and clinician versions) and the Recovery Markers Questionnaire (RMQ). RESULTS Eighty-one participants were recruited of 167 people who were assessed for eligibility. Completers and clinicians were satisfied, and scores for completers improved significantly on the IMR scale (clinician version) (d = 0.84) and RMQ (d = 0.52), and not significantly on the IMR scale client version (d = 0.41). Mean fidelity was good, but three groups had only moderate fidelity. Our feasibility criterion for trainers' education and supervision was partly attained. Dropout from treatment was 51 %; female participants and people who scored higher on both IMR-scales at baseline had a significantly lower chance of dropping out. The duration of IMR varied (M = 12.7 months, SD = 2.87). CONCLUSIONS Results suggested that feasibility of conducting an RCT on IMR was good. Special attention is required to fidelity, IMR duration, trainers' education and supervision, and dropout, especially of men. One study limitation was our inability to conduct follow-up measurements of non-completers.
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Affiliation(s)
- Bert-Jan Roosenschoon
- Department of Psychiatry, Epidemiological and Social Psychiatric Research Institute, Erasmus University Medical Centre, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands. .,Parnassia Psychiatric Institute, Parnassia Academy, Kiwistraat 32, 2552, DH, Den Haag, The Netherlands.
| | - Jaap van Weeghel
- Tilburg School of Social and Behavioral Sciences, Department of TRANZO, Tilburg University, Warandelaan 2, 5037 AB Tilburg, The Netherlands ,Parnassia Psychiatric Institute, Dijk en Duin, Oude Parklaan 125, 1901 ZZ Castricum, The Netherlands
| | - Moniek Bogaards
- Parnassia Psychiatric Institute, Bavo-Europoort, Prins Constantijnweg 48-54, 3066 TA Rotterdam, The Netherlands
| | - Mathijs L. Deen
- Parnassia Psychiatric Institute, Parnassia Academy, Kiwistraat 32, 2552 DH Den Haag, The Netherlands ,Faculty of Social and Behavioral Sciences, Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands
| | - Cornelis L. Mulder
- Department of Psychiatry, Epidemiological and Social Psychiatric Research Institute, Erasmus University Medical Centre, ‘s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands ,Parnassia Psychiatric Institute, Bavo-Europoort, Prins Constantijnweg 48-54, 3066 TA Rotterdam, The Netherlands
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Nugter MA, Engelsbel F, Bähler M, Keet R, van Veldhuizen R. Outcomes of FLEXIBLE Assertive Community Treatment (FACT) Implementation: A Prospective Real Life Study. Community Ment Health J 2016; 52:898-907. [PMID: 25648552 PMCID: PMC5108818 DOI: 10.1007/s10597-015-9831-2] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 01/17/2015] [Indexed: 11/30/2022]
Abstract
This study aimed to investigate social and clinical outcomes and use of care during and after implementation of FLEXIBLE Assertive Community Treatment (ACT). Three teams and 372 patients were involved. Model fidelity, clinical and social assessments were performed at baseline and after 1 and 2 years. Use of care was registered continuously. Model fidelity was good at the end of the study. Data showed much variation between patients in number and duration of ACT periods. Statistically significant improvements were found in compliance, unmet needs and quality of life. Improvement of quality of life and functioning was related to duration of ACT. The percentage of remissions increased with 9 %. The number of admissions, admission days and face to face contacts differed between ACT and non-ACT patients, but generally decreased. Findings suggest that implementation of FACT results in a more flexible adaptation of care to the needs of the patients.
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Affiliation(s)
- M Annet Nugter
- Department of Research and Monitoring, Mental Health Service Organization GGZ Noord-Holland-Noord, PO Box 18, 1850 BA, Heiloo, The Netherlands.
| | - Fabiana Engelsbel
- Department of Research and Monitoring, Mental Health Service Organization GGZ Noord-Holland-Noord, PO Box 18, 1850 BA, Heiloo, The Netherlands
| | - Michiel Bähler
- Department of Community Mental Health, Mental Health Service Organization GGZ Noord-Holland-Noord, PO Box 18, 1850 BA, Heiloo, The Netherlands
| | - René Keet
- Department of Community Mental Health, Mental Health Service Organization GGZ Noord-Holland-Noord, PO Box 18, 1850 BA, Heiloo, The Netherlands
| | - Remmers van Veldhuizen
- Centre for Certification ACT and FACT (CCAF), Praediniussingel 20/9, 9711 AG, Groningen, The Netherlands
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van Vugt MD, Kroon H, Delespaul PAEG, Mulder CL. Assertive community treatment and associations with delinquency. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2016; 49:93-97. [PMID: 27599432 DOI: 10.1016/j.ijlp.2016.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Indexed: 06/06/2023]
Abstract
This article draws on a prospective longitudinal study in which Assertive Community Treatment (ACT) model fidelity and patient outcomes were assessed in twenty outpatient treatment teams. 530 severely mentally ill patients participated in the study. Delinquency outcomes were assessed three times during a two-year follow-up period. At baseline, 49% of the patients had a recent criminal history, meaning that they had at least one reported contact with the police and/or the justice system in the past year. Patients with a recent criminal history had more serious psychosocial problems at baseline compared to those without a recent criminal history. Delinquency outcomes showed improvement over time, but this was not associated with ACT model fidelity. The study shows an association for homelessness and criminal activity. The persistent criminal activities of some of the patients showed that for this group extra interventions are needed that specifically target reduction of criminal behavior.
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Affiliation(s)
- Maaike D van Vugt
- Department of Reintegration, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, PO Box 725, 3500 AS Utrecht, The Netherlands.
| | - Hans Kroon
- Department of Reintegration, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, PO Box 725, 3500 AS Utrecht, The Netherlands
| | - Philippe A E G Delespaul
- Mental Health Services Research & Development, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands.
| | - Cornelis L Mulder
- Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
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Norlander T, Nordén T. The Hourglass Model: Are There Structural Problems with the Scarcity of Positive Results for Flexible ACT? Clin Pract Epidemiol Ment Health 2015; 11:155-7. [PMID: 26464577 PMCID: PMC4598425 DOI: 10.2174/1745017901511010155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 05/20/2015] [Accepted: 05/20/2015] [Indexed: 11/22/2022]
Abstract
The aim of the present article was to discuss the commentary by van Veldhuizen, Delespaul and Mulder (2015) regarding the review by Nordén and Norlander (2014) based on five empirical articles about Flexible Assertive Community Treatment (FACT). Veldhuizen et al. agree on that there is insufficient evidence for the effectiveness of FACT. However, van Veldhuizen et al. avoid a discussion of the lack of positive results despite extensive research during several years and therefore an analysis of why FACT did not fare better is missing. According to FACT it is an advantage that one single team spans the entire chain of care and rehabilitation, but no evidence is given for such an opinion. Instead there may be difficulties for the staff to shift between psychiatric care and psychiatric rehabilitation and the clients perhaps don’t want to encounter the same professional team during all phases of care and rehabilitation.
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Affiliation(s)
- Torsten Norlander
- Center for Research and Development, Evidens University College, Göteborg, Sweden ; Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
| | - Tommy Nordén
- Center for Research and Development, Evidens University College, Göteborg, Sweden
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van Veldhuizen R, Delespaul P, Kroon H, Mulder N. Flexible ACT & Resource-group ACT: Different Working Procedures Which Can Supplement and Strengthen Each Other. A Response. Clin Pract Epidemiol Ment Health 2015; 11:12-5. [PMID: 25767558 PMCID: PMC4353123 DOI: 10.2174/1745017901511010012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 12/22/2014] [Accepted: 12/22/2014] [Indexed: 11/25/2022]
Abstract
This article is a response to Nordén and Norlander’s ‘Absence of Positive Results for Flexible Assertive Community
Treatment. What is the next approach?’[1], in which they assert that ‘at present [there is] no evidence for Flexible
ACT and… that RACT might be able to provide new impulses and new vitality to the treatment mode of ACT’. We question
their analyses and conclusions. We clarify Flexible ACT, referring to the Flexible Assertive Community Treatment
Manual (van Veldhuizen, 2013) [2] to rectify misconceptions. We discuss Nordén and Norlander’s interpretation of research
on Flexible ACT. The fact that too little research has been done and that there are insufficient positive results cannot
serve as a reason to propagate RACT. However, the Resource Group method does provide inspiration for working
with clients to involve their networks more effectively in Flexible ACT.
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Affiliation(s)
| | - Philippe Delespaul
- Innovations in Mental Health Care, Maastricht University and Mondriaan (Mental Health Service), The Netherlands
| | - Hans Kroon
- Reintegration and Community Care, Trimbos Institute, Utrecht, The Netherlands
| | - Niels Mulder
- Public Mental Health, Epidemiological and Social Psychiatric Research institute, Erasmus MC; Parnassia Psychiatric Institute, The Netherlands
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Kayama M, Kido Y, Setoya N, Tsunoda A, Matsunaga A, Kikkawa T, Fukuda T, Noguchi M, Mishina K, Nishio M, Ito J. Community outreach for patients who have difficulties in maintaining contact with mental health services: longitudinal retrospective study of the Japanese outreach model project. BMC Psychiatry 2014; 14:311. [PMID: 25403680 PMCID: PMC4251924 DOI: 10.1186/s12888-014-0311-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 10/22/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Japan still has the highest ratio of beds devoted to psychiatric patients in the world. In 2011, in order to reduce re-hospitalization of patients who became disconnected from regular contact with outpatient medical services, the Japanese Ministry established the Japanese Outreach Model Project (JOMP). In this study, we will explicate the JOMP project protocol and investigate the rate and length of hospital admission, impairments of social function and problematic behavior at the follow-up period (6- and 12-month) and time of services provided by JOMP. METHOD This longitudinal retrospective study used survey data collected from 32 outreach teams of 21 prefectures in Japan during September 2011 to July 2013. The outcome variables were assessed at baseline, 6-month and 12-month as to whether or not participants had been admitted to the hospital. Data from 162 participants with mental illness who had difficulties in maintaining contact with mental health services were analyzed. Repeated measures analysis of variance provided a significant effect of the intervention over time. RESULTS The rate of hospital admission of JOMP participants was 24.1% at 6-months and 27.2% at the 12-month follow-up. The average length of hospital-stay at baseline and 12-months was 38.7 days (SD 84.7). Compared with the baseline, the average score of the Global Assessment Functioning and the Social Behavioral Schedule were significantly improved after the 6-month and 12-month follow-up. The activity log showed that among the most often delivered JOMP services were to "prevent exacerbation of somatic symptoms" and "care for families". CONCLUSION These results suggest that JOMP has a strong potential to both reduce readmission rates and the length of hospital stay compared with the Japanese regular outpatient care by public insurance, and improve social function and problematic behavior. The JOMP teams provided long-term support for families. As of April 2014 JOMP was included in the National Health Insurance program in a limited way therefore an evaluation of JOMP team fidelity on readmissions must be examined.
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Affiliation(s)
- Mami Kayama
- />Psychiatric and Mental Health Nursing, College of Nursing, St. Luke’s International University, 10-1 Akashi-cho, Chuo-ku, Tokyo 104-0044 Japan
| | - Yoshifumi Kido
- />Psychiatric and Mental Health Nursing, College of Nursing, St. Luke’s International University, 10-1 Akashi-cho, Chuo-ku, Tokyo 104-0044 Japan
- />Department of Psychiatric Nursing, The University of Tokyo, Tokyo, Japan
| | - Nozomi Setoya
- />Psychiatric and Mental Health Nursing, College of Nursing, St. Luke’s International University, 10-1 Akashi-cho, Chuo-ku, Tokyo 104-0044 Japan
| | - Aki Tsunoda
- />Psychiatric and Mental Health Nursing, College of Nursing, St. Luke’s International University, 10-1 Akashi-cho, Chuo-ku, Tokyo 104-0044 Japan
| | - Asami Matsunaga
- />Department of Psychiatric Nursing, The University of Tokyo, Tokyo, Japan
| | - Takahiro Kikkawa
- />Department of Nursing, School of Health Sciences, Tokai University, Kanagawa, Japan
| | | | | | - Keiko Mishina
- />Hanazono University, Clinical Psychology, Faculty of Social Welfare, Kyoto, Japan
| | - Masaaki Nishio
- />Tohoku Fukushi University, Social Welfare, Faculty of General Welfare, Miyagi, Japan
| | - Junichiro Ito
- />National Center of Neurology and Psychiatry, National Institute of Mental Health, Psychiatric Rehabilitation, Tokyo, Japan
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Roeg DPK, van de Goor IAM, Voogt MCM, van Assen MALM, Garretsen HFL. Effects of interferential care: a community-based care program for persons with severe problems on several life areas. Int J Soc Psychiatry 2014; 60:584-94. [PMID: 24221098 PMCID: PMC4230954 DOI: 10.1177/0020764013507247] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND AND AIMS Interferential care differs from the current community-based care programs in that it targets a larger, heterogeneous group and combines brokerage and full service elements in a multi-organizational care team. The team provides all the services itself, but with the aim to prepare clients within a few months for referral to regular (ambulant) healthcare services. The aim of this study was to assess the effectiveness of interferential care. METHODS In a multisite, pretest-posttest design, 523 patients of three interferential care teams were followed. Quality of life, problem severity, problems with referral and engagement were assessed at baseline, at referral and again after 6 months. Analyses were performed using linear mixed modeling. RESULTS Interferential care showed moderate to strong effects on quality of life and problem severity. These effects persisted (quality of life) or further improved (problem severity) until follow-up 6 months after referral to regular services. There were also small effects on both engagement and problems with referral. CONCLUSION Interferential care offers significant improvements in quality of life and problem severity in persons who have severe problems on several life areas and who are currently not reached by healthcare services. It is a promising community-based care program for healthcare systems in which regular care already contains many elements of home-based practice.
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Affiliation(s)
- Diana P K Roeg
- Tranzo Department, Tilburg University, Tilburg, The Netherlands Mental Health Care Institute GGz Eindhoven and the Kempen, Eindhoven, The Netherlands
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van Vugt MD, Kroon H, Delespaul PAEG, Mulder CL. Assertive community treatment and associations with substance abuse problems. Community Ment Health J 2014; 50:460-5. [PMID: 23771775 DOI: 10.1007/s10597-013-9626-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Accepted: 06/03/2013] [Indexed: 11/30/2022]
Abstract
This study examined the associations between substance abuse problems in severely mentally ill patients, outcome and Assertive Community Treatment (ACT) model fidelity. In a prospective longitudinal study, ACT model fidelity and patient outcomes were assessed in 20 outpatient treatment teams using the Health of the Nation Outcome Scales, Camberwell Assessment of Needs short appraisal schedule and measures of service use. Five hundred and thirty severely mentally ill patients participated in the study. Substance abuse problems were assessed three times during a 2-year follow-up period. This study found that among patients with severe mental illness, patients with an addiction problem had more serious psychosocial problems at baseline. Substance abuse problems showed improvement over time, but this was not associated with ACT model fidelity. The study indicates that investment by teams to improve a patient's psychosocial situation can lead to improvements on substance problems.
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Affiliation(s)
- Maaike D van Vugt
- Department of Reintegration, Trimbos-institute, Netherlands Institute of Mental Health and Addiction, PO Box 725, 3500 AS, Utrecht, The Netherlands,
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Drukker M, Laan W, Dreef F, Driessen G, Smeets H, Van Os J. Can assertive community treatment remedy patients dropping out of treatment due to fragmented services? Community Ment Health J 2014; 50:454-9. [PMID: 24178633 DOI: 10.1007/s10597-013-9652-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 10/14/2013] [Indexed: 11/30/2022]
Abstract
Previously, many patients with severe mental illness had difficulties to engage with fragmented mental health services, thus not receiving care. In a Dutch city, Assertive Community Treatment (ACT) was introduced to cater specifically for this group of patients. In a pre-post comparison, changes in mental health care consumption were examined. All mental health care contacts, ACT and non-ACT, of patients in the newly started ACT-teams were extracted from the regional Psychiatric Case Register. Analyses of mental health care usage were performed comparing the period before ACT introduction with the period thereafter. After the introduction of ACT, mental health care use increased in this group of patients, although not all patients remained under the care of ACT teams. ACT may succeed in delivering more mental health care to patients with severe mental illness and treatment needs who previously had difficulties engaging with fragmented mental health care services.
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Affiliation(s)
- Marjan Drukker
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience MHeNS, Maastricht University, P.O. Box 616, Location Vijverdal, 6200 MD, Maastricht, The Netherlands,
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Fleischhacker WW, Arango C, Arteel P, Barnes TRE, Carpenter W, Duckworth K, Galderisi S, Halpern L, Knapp M, Marder SR, Moller M, Sartorius N, Woodruff P. Schizophrenia--time to commit to policy change. Schizophr Bull 2014; 40 Suppl 3:S165-94. [PMID: 24778411 PMCID: PMC4002061 DOI: 10.1093/schbul/sbu006] [Citation(s) in RCA: 134] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Care and outcomes for people with schizophrenia have improved in recent years, but further progress is needed to help more individuals achieve an independent and fulfilled life. This report sets out the current need, informs policy makers and all relevant stakeholders who influence care quality, and supports their commitment to creating a better future. The authors recommend the following policy actions, based on research evidence, stakeholder consultation, and examples of best practice worldwide. (1) Provide an evidence-based, integrated care package for people with schizophrenia that addresses their mental and physical health needs. (2) Provide support for people with schizophrenia to enter and to remain in their community, and develop mechanisms to help guide them through the complex benefit and employment systems. (3) Provide concrete support, information, and educational programs to families and carers on how to enhance care for an individual living with schizophrenia in a manner that entails minimal disruption to their lives. (4) All stakeholders, including organizations that support people living with schizophrenia, should be consulted to regularly revise, update, and improve policy on the management of schizophrenia. (5) Provide support, which is proportionate to the impact of the disease, for research and development of new treatments. (6) Establish adequately funded, ongoing, and regular awareness-raising campaigns that form an integral part of routine plans of action. Implementation of the above recommendations will require engagement by every stakeholder, but with commitment from all, change can be achieved.
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Affiliation(s)
- W. Wolfgang Fleischhacker
- Department of Psychiatry and Psychotherapy, Medical University Innsbruck, Innsbruck, Austria;,*To whom correspondence should be addressed; Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria; tel: +43-512-504-23669, fax: +43-512-504-25267, e-mail:
| | - Celso Arango
- Hospital General Universitario Gregorio Marañón, CIBERSAM, Madrid, Spain
| | | | - Thomas R. E. Barnes
- Imperial College Centre for Mental Health, Faculty of Medicine, Imperial College London and West London Mental Health NHS Trust, London, UK
| | - William Carpenter
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD
| | | | - Silvana Galderisi
- Department of Psychiatry, Second University of Naples, Naples, Italy
| | | | - Martin Knapp
- London School of Economics and the Institute of Psychiatry, King’s College London, London, UK
| | - Stephen R. Marder
- Semel Institute, UCLA, VA Desert Pacific Mental Illness Research Education and Clinical Center, Los Angeles, CA
| | - Mary Moller
- Past President, American Psychiatric Nurses Association, Yale School of Nursing, New Haven, CT
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes, Geneva, Switzerland
| | - Peter Woodruff
- Academic Faculty, Royal College of Psychiatrists, London, UK
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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] [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.
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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
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Carta MG, Angermeyer MC, Sancassiani F, Tuligi F, Pirastu R, Pisano A, Pintus E, Mellino G, Pintus M, Pisanu E, Moro MF, Massidda D, Trincas G, Bhugra D. A follow-up on patients with severe mental disorders in Sardinia after two changes in regional policies: poor resources still correlate with poor outcomes. BMC Psychiatry 2013; 13:333. [PMID: 24313930 PMCID: PMC4029176 DOI: 10.1186/1471-244x-13-333] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 12/02/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This survey followed a cohort of patients with chronic psychosis recruited from five catchment areas (DSMs) of the Sardinian community mental health services. The objective was to examine whether the amount of resources in the different sites may be a determinant of the outcomes. METHODS Naturalistic follow-up study on 309 consecutive users with diagnosis of schizophrenic disorder, schizoaffective disorder, bipolar affective disorder with psychotic symptoms (DSM-IV TR) of five Sardinian community mental health services. Mental state and clinical symptoms along with functioning were assessed using semi-structured clinical interviews (ANTAS), Clinical Global Impression Severity Scale (CGI-S), Global Assessment of Functioning Scale (GAF) and Health of the Nation Outcome Scales (HONOS). Assessments were conducted at the beginning of the study and after one year. RESULTS The proportion of professionals working in all DSMs participating in the study was found lower than the national Italian standard (0.7 vs. 1.0 per 1,500 inhabitants). Follow-up revealed significant differences between DSMs in the improvement of the Honos scores (F = 5.932, p = 0.000). These differences correlate with the improvement of resources in terms of number of professionals during, and one year prior, to the trial. CONCLUSIONS The study shows that mental health services provided in the public sector in Sardinia are still very resource-poor, at least in terms of human resources. Our findings suggest that mental health service resources influence outcomes as regards the social functioning of users. We urge policy makers to take these observations into account when planning future services.
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Affiliation(s)
- Mauro Giovanni Carta
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, via Ospedale, 117 Cagliari, Italy.
| | - Matthias C Angermeyer
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, via Ospedale, 117 Cagliari, Italy,Centre for Public Mental Health, Gösing am Wagram, Austria
| | - Federica Sancassiani
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, via Ospedale, 117 Cagliari, Italy
| | | | - Roberto Pirastu
- Department of Mental Health (DSM)- of Carbonia-Iglesias, Carbonia, Italy
| | - Anna Pisano
- Department of Mental Health (DSM)- of Cagliari, Cagliari, Italy
| | - Elisa Pintus
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, via Ospedale, 117 Cagliari, Italy
| | - Gisa Mellino
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, via Ospedale, 117 Cagliari, Italy
| | - Mirra Pintus
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, via Ospedale, 117 Cagliari, Italy
| | - Emanuele Pisanu
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, via Ospedale, 117 Cagliari, Italy
| | - Maria Francesca Moro
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, via Ospedale, 117 Cagliari, Italy
| | - Davide Massidda
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, via Ospedale, 117 Cagliari, Italy
| | - Giuseppina Trincas
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, via Ospedale, 117 Cagliari, Italy
| | - Dinesh Bhugra
- HSPRD Institute of Psychiatry (KCL) London, London, UK
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Ernest S, Nagarajan G, Jacob KS. Assessment of need of patients with schizophrenia: a study in Vellore, India. Int J Soc Psychiatry 2013; 59:752-6. [PMID: 22965297 DOI: 10.1177/0020764012456801] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND and aims: There is a dearth of studies investigating the prevalence and factors associated with unmet needs in people with schizophrenia from low- and middle-income countries. We aimed to study prevalence and risk factors for unmet need. METHOD A case-control study design was employed. One hundred and one (101) consecutive patients attending a psychiatric hospital were assessed using Camberwell Assessment of Need Short version (CANSAS) and Positive and Negative Syndrome Scale (PANSS). Multivariate analysis was employed to adjust for confounders. RESULTS The majority of patients had many unmet needs. These unmet needs were significantly associated with lower education, poverty and persistent psychopathology on multivariate analysis. CONCLUSION Unmet needs are associated with poverty, lower education and persistent psychopathology. There is a need to manage unmet needs, in addition to addressing psychopathology and poverty.
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Affiliation(s)
- Sharmila Ernest
- 1Department of Occupational Therapy, Christian Medical College, Vellore, India
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Integrated care in patients with schizophrenia: results of trials published between 2011 and 2013 focusing on effectiveness and efficiency. Curr Opin Psychiatry 2013; 26:384-408. [PMID: 23722100 DOI: 10.1097/yco.0b013e328361ec3b] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Overview on integrated care trials focusing on effectiveness and efficiency published from 2011 to 2013. RECENT FINDINGS Eight randomized controlled trials (RCTs) and 21 non-RCT studies were published from 2011 to 2013. Studies differed in several methodological aspects such as study population, psychotherapeutic approaches used, outcome parameters, follow-up times, fidelities, and implementation of the integrated care model and the nation-specific healthcare context with different control conditions. This makes it difficult to draw firm conclusions. Most studies demonstrated relevant improvements regarding symptoms (P=0.001) and functioning (P=0.01), quality of life (P=0.01), adherence (P<.05) and patient's satisfaction (P=0.01), and reduction of caregiver's stress (P<0.05). Mean total costs were favoring or at least equalizing costs but with positive effects found on subjective health favoring integrated care models. SUMMARY There is an increasing interest in the effectiveness and efficiency of integrated care models in patients with mental disorders, specifically in those with severe and persistent mental illness. To increase generalizability, future trials should exactly describe rationales and content of integrated care model and control conditions.
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