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McClanahan A, Adams CN, Hackman AL, Cotes RO, Minkoff K. Postcrisis Follow-Up and Linkage to Community Services. Psychiatr Clin North Am 2024; 47:531-546. [PMID: 39122344 DOI: 10.1016/j.psc.2024.04.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2024]
Abstract
During the postcrisis period, many individuals struggle to transition to available care, often falling through the cracks. This article discusses effective postcrisis approaches that provide rapid access to transitional team-based care using critical time intervention strategies. It also highlights the development of state, county, and funder models for "care-traffic control" to ensure swift linkage to follow-up services, along with new funding models that support intensive community crisis stabilization during the postcrisis period. Emerging crisis systems can leverage these emerging services and approaches to facilitate successful transitions for individuals in need.
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Affiliation(s)
- Alexander McClanahan
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, 67 President Street, MSC 865, Charleston, SC 29425, USA
| | - Curtis N Adams
- Department of Psychiatry, University of Maryland School of Medicine, 701 W Pratt Street, 5th Floor, Baltimore, MD 21201, USA
| | - Ann L Hackman
- Department of Psychiatry, University of Maryland School of Medicine, 701 W Pratt Street, 5th Floor, Baltimore, MD 21201, USA
| | - Robert O Cotes
- Department of Psychiatry and Sciences, Emory University School of Medicine, 10 Park Place SE, Suite 620, Atlanta, GA 30303, USA
| | - Kenneth Minkoff
- ZiaPartners, Inc, 15270 North Oracle Road, Suite 124-308, Catalina, AZ 85739, USA.
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Samosh J, Agha A, Pettey D, Sylvestre J, Aubry T. Community Mental Health Services for Frequent Emergency Department Users: A Qualitative Study of Outcomes Perceived by Program Clients and Case Managers. Prof Case Manag 2024; 29:139-148. [PMID: 38037223 DOI: 10.1097/ncm.0000000000000692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
PURPOSE OF STUDY This study aimed to investigate the perceived outcomes and mechanisms of change of a community mental health service combining system navigation and intensive case management supports for frequent emergency department users presenting with mental illness or addiction. PRIMARY PRACTICE SETTING The study setting was a community mental health agency receiving automated referrals directly from hospitals in a midsize Canadian city for all individuals attending an emergency department two or more times within 30 days for mental illness or addiction. METHODOLOGY AND SAMPLE Qualitative interviews with 15 program clients. Focus groups with six program case managers. Data were analyzed using pragmatic qualitative thematic analysis. RESULTS Participants generally reported perceiving that the program contributed to reduced emergency department use, reduced mental illness symptom severity, and improved quality of life. Perceived outcomes were more mixed for outcomes related to addiction. Reported mechanisms of change emphasized the importance of positive working relationships between program clients and case managers, as well as focused efforts to develop practical skills. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE Community mental health services including intensive case management for frequent emergency department users presenting with mental illness or addiction were perceived to effectively address client needs while reducing emergency department resource burden. Similar programs should emphasize the development of consistent and warm working relationships between program clients and case managers, as well as practical skills development to support client health and well-being.
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Affiliation(s)
- Jonathan Samosh
- Jonathan Samosh, MSc, is a PhD candidate in Clinical Psychology at the University of Ottawa's School of Psychology and Centre for Research on Educational and Community Services. His research interests include community mental health and homelessness
- Ayda Agha, MScCH, is a PhD candidate in Experimental Psychology at the University of Ottawa's School of Psychology and Centre for Research on Educational and Community Services. Her research interests include community mental health and homelessness
- Donna Pettey, PhD, RSW, is Director of Integration, Research, and Evaluation at the Canadian Mental Health Association's Ottawa Branch. She provides research leadership to the agency to support clinical decision-making in the provision of community mental health services
- John Sylvestre, PhD, is Full Professor at the School of Psychology and Senior Researcher at the Centre for Research on Educational and Community Services at the University of Ottawa. His research interests include community mental health and homelessness
- Tim Aubry, PhD, CPsych, is Full Professor at the School of Psychology and Senior Researcher at the Centre for Research on Educational and Community Services at the University of Ottawa. His research interests include community mental health and homelessness
| | - Ayda Agha
- Jonathan Samosh, MSc, is a PhD candidate in Clinical Psychology at the University of Ottawa's School of Psychology and Centre for Research on Educational and Community Services. His research interests include community mental health and homelessness
- Ayda Agha, MScCH, is a PhD candidate in Experimental Psychology at the University of Ottawa's School of Psychology and Centre for Research on Educational and Community Services. Her research interests include community mental health and homelessness
- Donna Pettey, PhD, RSW, is Director of Integration, Research, and Evaluation at the Canadian Mental Health Association's Ottawa Branch. She provides research leadership to the agency to support clinical decision-making in the provision of community mental health services
- John Sylvestre, PhD, is Full Professor at the School of Psychology and Senior Researcher at the Centre for Research on Educational and Community Services at the University of Ottawa. His research interests include community mental health and homelessness
- Tim Aubry, PhD, CPsych, is Full Professor at the School of Psychology and Senior Researcher at the Centre for Research on Educational and Community Services at the University of Ottawa. His research interests include community mental health and homelessness
| | - Donna Pettey
- Jonathan Samosh, MSc, is a PhD candidate in Clinical Psychology at the University of Ottawa's School of Psychology and Centre for Research on Educational and Community Services. His research interests include community mental health and homelessness
- Ayda Agha, MScCH, is a PhD candidate in Experimental Psychology at the University of Ottawa's School of Psychology and Centre for Research on Educational and Community Services. Her research interests include community mental health and homelessness
- Donna Pettey, PhD, RSW, is Director of Integration, Research, and Evaluation at the Canadian Mental Health Association's Ottawa Branch. She provides research leadership to the agency to support clinical decision-making in the provision of community mental health services
- John Sylvestre, PhD, is Full Professor at the School of Psychology and Senior Researcher at the Centre for Research on Educational and Community Services at the University of Ottawa. His research interests include community mental health and homelessness
- Tim Aubry, PhD, CPsych, is Full Professor at the School of Psychology and Senior Researcher at the Centre for Research on Educational and Community Services at the University of Ottawa. His research interests include community mental health and homelessness
| | - John Sylvestre
- Jonathan Samosh, MSc, is a PhD candidate in Clinical Psychology at the University of Ottawa's School of Psychology and Centre for Research on Educational and Community Services. His research interests include community mental health and homelessness
- Ayda Agha, MScCH, is a PhD candidate in Experimental Psychology at the University of Ottawa's School of Psychology and Centre for Research on Educational and Community Services. Her research interests include community mental health and homelessness
- Donna Pettey, PhD, RSW, is Director of Integration, Research, and Evaluation at the Canadian Mental Health Association's Ottawa Branch. She provides research leadership to the agency to support clinical decision-making in the provision of community mental health services
- John Sylvestre, PhD, is Full Professor at the School of Psychology and Senior Researcher at the Centre for Research on Educational and Community Services at the University of Ottawa. His research interests include community mental health and homelessness
- Tim Aubry, PhD, CPsych, is Full Professor at the School of Psychology and Senior Researcher at the Centre for Research on Educational and Community Services at the University of Ottawa. His research interests include community mental health and homelessness
| | - Tim Aubry
- Jonathan Samosh, MSc, is a PhD candidate in Clinical Psychology at the University of Ottawa's School of Psychology and Centre for Research on Educational and Community Services. His research interests include community mental health and homelessness
- Ayda Agha, MScCH, is a PhD candidate in Experimental Psychology at the University of Ottawa's School of Psychology and Centre for Research on Educational and Community Services. Her research interests include community mental health and homelessness
- Donna Pettey, PhD, RSW, is Director of Integration, Research, and Evaluation at the Canadian Mental Health Association's Ottawa Branch. She provides research leadership to the agency to support clinical decision-making in the provision of community mental health services
- John Sylvestre, PhD, is Full Professor at the School of Psychology and Senior Researcher at the Centre for Research on Educational and Community Services at the University of Ottawa. His research interests include community mental health and homelessness
- Tim Aubry, PhD, CPsych, is Full Professor at the School of Psychology and Senior Researcher at the Centre for Research on Educational and Community Services at the University of Ottawa. His research interests include community mental health and homelessness
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Herinckx H, Gubrud P, Kerlinger A, Cellarius K. Identifying Competencies of the ACT Program Nurse Using the DACUM Method. Issues Ment Health Nurs 2024; 45:607-616. [PMID: 38593458 DOI: 10.1080/01612840.2024.2328255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
The nurse role on an Assertive Community Treatment (ACT) team requires a specialized set of skills in psychiatric community-based care. While the ACT model has existed for fifty years, no nationally recognized standard curriculum to train ACT nurses has been developed. The ACT Nursing Project described in this paper aimed to create a competency-based on-board training program using the Developing a Curriculum (DACUM) method. Eight ACT nurses from three states served as the expert panel to create a DACUM chart detailing the full set of nine duties and 127 tasks required of ACT nurses. To verify the DACUM results, 57 ACT nurses from four states completed a survey and confirmed that 80% of the tasks identified by the expert panel were also performed by the validation sample of ACT nurses. This paper describes how the DACUM duties and tasks provided the framework to develop onboard training curriculum for ACT program nurses. The next step is to pilot the onboard training curriculum to newly hired ACT nurses to ensure they are equipped to meet the complex needs of people living with serious mental illness, and to increase their competency, job satisfaction and decrease the high annual turnover rate among ACT nurses.
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Affiliation(s)
- Heidi Herinckx
- Oregon Centers of Excellence, Options for Southern Oregon, Grants Pass, Oregon, USA
| | - Paula Gubrud
- Nursing Education Connections and OHSU School of Nursing, Portland, Oregon, USA
| | - Alyssa Kerlinger
- Oregon Center of Excellence for Assertive Community Treatment, Options for Southern Oregon, Grants Pass, Oregon, USA
| | - Karen Cellarius
- School of Social Work, Human Services Implementation Lab at the Portland State University Regional Research Institute, Portland, Oregon, USA
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Reardon B, Toles M, Cuddeback G, Travers D. Perceptions of ACT Team Members on the Implementation of Physical Health Services: A Qualitative Study. J Am Psychiatr Nurses Assoc 2024; 30:108-120. [PMID: 35220783 DOI: 10.1177/10783903221079800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Adults with severe mental illnesses have mortality rates 2.5 to 3 times higher than the general population, largely due to medical illnesses. Those with the most profound mental illnesses are served by assertive community treatment (ACT) teams that provide intensive mental health care; however, there are no clearly established models to integrate physical health treatment into ACT and this is a critical gap in the literature. AIMS To describe perceptions of ACT team members regarding services provided for their clients to treat physical health, how those services can be improved, and what implementation strategies would likely be needed to promote uptake and sustainability of those services on ACT teams. METHOD Qualitative interviews were conducted via Zoom using a semistructured interview guide with 19 employees from three ACT teams in a southeastern state. Interview transcripts were analyzed, using manifest content analysis, a form of qualitative analysis, to identify key themes in the interview transcripts. RESULTS ACT team members described limited physical health services for their clients. They reported (1) system-level barriers to improving physical health care, such as inadequate tools and training; and (2) patient-level barriers, such as limited awareness of physical care needs. ACT team members reported the need for additional medical staff and strengthened relationships with primary care providers. They also recommended changes in policy, education, and quality monitoring to implement new physical health care services. CONCLUSIONS Findings suggest intervention components and implementation strategies for improving physical health care of ACT consumers.
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Affiliation(s)
- Brandy Reardon
- Brandy Reardon, PhD, RN, University of North Carolina at Chapel Hill, NC, USA
| | - Mark Toles
- Mark Toles, PhD, RN, FAAN, University of North Carolina at Chapel Hill, NC, USA
| | - Gary Cuddeback
- Gary Cuddeback, PhD, MSW, MPH, University of North Carolina at Chapel Hill, NC, USA
| | - Debbie Travers
- Debbie Travers, PhD, RN, FAEN, Duke University, Chapel Hill, NC, USA
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Arahanthabailu P, Praharaj SK, Purohith AN, Yesodharan R, Bhandary RP, Sharma PSVN. Madison to Manipal: A narrative review of modified assertive community treatment programs. Asian J Psychiatr 2023; 88:103746. [PMID: 37625329 DOI: 10.1016/j.ajp.2023.103746] [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: 04/02/2023] [Revised: 07/22/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Assertive community treatment (ACT) is a multidisciplinary, team-based approach providing comprehensive individualized care for the patients with various mental illness, has been adapted variably across the world in terms of patient-staff ratio, selection of patients, the pattern of service delivery and frequency of contact. We aim to review the extant literature on the modifications of ACT programs for severe mental disorders and their effectiveness. METHODS Studies on modified ACT approaches for mental illnesses were searched in multiple databases. We adopted a rapid appraisal approach. The searches were restricted to articles published in English. We appraised the fidelity assessment of the ACT studies wherever available. In addition, we assessed the study quality using a grading tool based on ten practice components of ACT. RESULTS We found 23 reports (10 RCTs and 13 non-controlled studies) on modified ACT. The extant literature on modified ACT programs is heterogeneous. The modifications in ACT included changes in patient-to-staff ratio, team composition, service hours, and interventions carried out. Most controlled studies were conducted in high-income settings and had inconsistent outcome, possibly due to the comprehensive nature of the 'usual care.' In contrast, modified ACT services from low and middle-income countries reduced hospitalization rates and improved treatment adherence. CONCLUSIONS Modifications in ACT programs were done to cater to specific subpopulation and the changes in program structure to suit the resources and setting. The outcome of modified ACT appears heterogenous, though the findings from low and middle-income countries are promising.
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Affiliation(s)
- Praveen Arahanthabailu
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Samir Kumar Praharaj
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India.
| | - Abhiram N Purohith
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India.
| | - Renjulal Yesodharan
- Department of Psychiatric (Mental Health) Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Rajeshkrishna P Bhandary
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
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Ramonet M, Genest P. [Can intensive home care solve the problem of overcrowded psychiatric beds?]. Soins Psychiatr 2023; 44:39-43. [PMID: 37479357 DOI: 10.1016/j.spsy.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023]
Abstract
The growing demand for psychiatric care raises questions about the place and value of alternatives to hospitalization. Community-based intensive care, such as home-based intensive care teams, are models that have been extensively studied and precisely described in international literature. They make it possible to avoid or shorten hospital stays, and have interesting variations for providing access to care in rural areas.
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Affiliation(s)
- Marianne Ramonet
- Secteur 4, Pôle de psychiatrie, CHRU de Brest, CH Bohars, route de Ploudalmézeau, 29820 Bohars, France.
| | - Philippe Genest
- Secteur 4, Pôle de psychiatrie, CHRU de Brest, CH Bohars, route de Ploudalmézeau, 29820 Bohars, France
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Choy-Brown M, Williams NJ, Ramirez N, Esp S. Psychometric evaluation of a pragmatic measure of clinical supervision as an implementation strategy. Implement Sci Commun 2023; 4:39. [PMID: 37024945 PMCID: PMC10080877 DOI: 10.1186/s43058-023-00419-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 03/16/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Valid and reliable measurement of implementation strategies is essential to advancing implementation science; however, this area lags behind the measurement of implementation outcomes and determinants. Clinical supervision is a promising and highly feasible implementation strategy in behavioral healthcare for which pragmatic measures are lacking. This research aimed to develop and psychometrically evaluate a pragmatic measure of clinical supervision conceptualized in terms of two broadly applicable, discrete clinical supervision techniques shown to improve providers' implementation of evidence-based psychosocial interventions-(1) audit and feedback and (2) active learning. METHODS Items were generated based on a systematic review of the literature and administered to a sample of 154 outpatient mental health clinicians serving youth and 181 community-based mental health providers serving adults. Scores were evaluated for evidence of reliability, structural validity, construct-related validity, and measurement invariance across the two samples. RESULTS In sample 1, confirmatory factor analysis (CFA) supported the hypothesized two-factor structure of scores on the Evidence-Based Clinical Supervision Strategies (EBCSS) scale (χ2=5.89, df=4, p=0.208; RMSEA=0.055, CFI=0.988, SRMR=0.033). In sample 2, CFA replicated the EBCSS factor structure and provided discriminant validity evidence relative to an established supervisory alliance measure (χ2=36.12, df=30, p=0.204; RMSEA=0.034; CFI=0.990; SRMR=0.031). Construct-related validity evidence was provided by theoretically concordant associations between EBCSS subscale scores and agency climate for evidence-based practice implementation in sample 1 (d= .47 and .55) as well as measures of the supervision process in sample 2. Multiple group CFA supported the configural, metric, and partial scalar invariance of scores on the EBCSS across the two samples. CONCLUSIONS Scores on the EBCSS provide a valid basis for inferences regarding the extent to which behavioral health providers experience audit and feedback and active learning as part of their clinical supervision in both clinic- and community-based behavioral health settings. TRIAL REGISTRATION ClinicalTrials.gov NCT04096274 . Registered on 19 September 2019.
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Affiliation(s)
- Mimi Choy-Brown
- University of Minnesota, Twin Cities, 1404 Gortner Avenue, St. Paul, MN 55108 USA
| | - Nathaniel J. Williams
- Boise State University, 1910 University Drive, Education Suite 717, Boise, ID 83725-1940 USA
| | - Nallely Ramirez
- Boise State University, 1910 University Drive, Education Suite 717, Boise, ID 83725-1940 USA
| | - Susan Esp
- Boise State University, 1910 University Drive, Education Suite 717, Boise, ID 83725-1940 USA
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Munch Nielsen C, Hjorthøj C, Arnfred BT, Nordentoft M. Patient Outcomes of Flexible Assertive Community Treatment Compared With Assertive Community Treatment. Psychiatr Serv 2022:appips20220235. [PMID: 36475824 DOI: 10.1176/appi.ps.20220235] [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] [Indexed: 12/12/2022]
Abstract
OBJECTIVE In many European countries, flexible assertive community treatment (FACT) has replaced assertive community treatment (ACT) despite limited evidence for FACT's effectiveness in improving functional and patient-reported outcomes. This study evaluated the effectiveness of FACT relative to ACT in improving functioning, client satisfaction, and the working alliance. METHODS The authors used a nonblinded, quasi-experimental controlled study design to compare outcomes of patients treated by ACT teams that were reconfigured to FACT teams with those of patients treated by a remaining ACT team. Patients from nine ACT teams in the Capital Region of Denmark were included. Six of the nine ACT teams were reconfigured to FACT in 2018 and 2019 by integrating them with community mental health teams. The remaining three ACT teams were used as control groups. Assignment to treatment was based solely on administrative considerations. RESULTS The study included 131 patients (FACT, N=74; ACT, N=57). Patients treated by FACT teams had poorer personal and social functioning than patients assigned to ACT teams (adjusted difference in means=-2.9, 95% CI=-5.8 to -0.1). No between-group differences were found in client satisfaction or working alliance. CONCLUSIONS Patients treated by FACT teams had significantly lower functioning than patients treated by ACT teams, but the clinical relevance or causality of this finding remains unclear. Given the reconfiguration of the FACT teams during follow-up, along with substantial drop-out rates and baseline differences between the two groups, these results must be interpreted with caution. The findings require further examination in a randomized controlled trial that includes fidelity measures of the treatment models.
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Affiliation(s)
- Camilla Munch Nielsen
- Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen (all authors); Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen (Hjorthøj)
| | - Carsten Hjorthøj
- Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen (all authors); Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen (Hjorthøj)
| | - Benjamin Thorup Arnfred
- Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen (all authors); Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen (Hjorthøj)
| | - Merete Nordentoft
- Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen (all authors); Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen (Hjorthøj)
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Akiba CF, Powell BJ, Pence BW, Muessig K, Golin CE, Go V. "We start where we are": a qualitative study of barriers and pragmatic solutions to the assessment and reporting of implementation strategy fidelity. Implement Sci Commun 2022; 3:117. [PMID: 36309715 PMCID: PMC9617230 DOI: 10.1186/s43058-022-00365-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Fidelity measurement of implementation strategies is underdeveloped and underreported, and the level of reporting is decreasing over time. Failing to properly measure the factors that affect the delivery of an implementation strategy may obscure the link between a strategy and its outcomes. Barriers to assessing and reporting implementation strategy fidelity among researchers are not well understood. The aims of this qualitative study were to identify barriers to fidelity measurement and pragmatic pathways towards improvement. METHODS We conducted in-depth interviews among researchers conducting implementation trials. We utilized a theory-informed interview approach to elicit the barriers and possible solutions to implementation strategy fidelity assessment and reporting. Reflexive-thematic analysis guided coding and memo-writing to determine key themes regarding barriers and solutions. RESULTS Twenty-two implementation researchers were interviewed. Participants agreed that implementation strategy fidelity was an essential element of implementation trials and that its assessment and reporting should improve. Key thematic barriers focused on (1) a current lack of validated fidelity tools with the need to assess fidelity in the short term, (2) the complex nature of some implementation strategies, (3) conceptual complications when assessing fidelity within mechanisms-focused implementation research, and (4) structural issues related to funding and publishing. Researchers also suggested pragmatic solutions to overcome each barrier. Respondents reported using specification and tracking data in the short term until validated tools become available. Participants suggested that researchers with strategy-specific content expertise lead the way in identifying core components and setting fidelity requirements for them. Addressing the third barrier, participants provided examples of what pragmatic prospective and retrospective fidelity assessments might look like along a mechanistic pathway. Finally, researchers described approaches to minimize costs of data collection, as well as more structural accountability like adopting and enforcing reporting guidelines or changing the structure of funding opportunities. DISCUSSION We propose short- and long-term priorities for improving the assessment and reporting of implementation strategy fidelity and the quality of implementation research. CONCLUSIONS A better understanding of the barriers to implementation strategy fidelity assessment may pave the way towards pragmatic solutions.
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Affiliation(s)
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, St. Louis, MO, USA
- Division of Infectious Diseases, John T. Milliken Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
- Center for Dissemination & Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, MO, USA
| | - Brian W Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kate Muessig
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Carol E Golin
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Vivian Go
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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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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11
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McGuire AB, Kukla M, Rollins AL, Garabrant J, Henry N, Eliacin J, Myers LJ, Flanagan ME, Hunt MG, Iwamasa GY, Bauer SM, Carter JL, Salyers MP. Recovery-oriented acute inpatient mental health care: Operationalization and measurement. Psychiatr Rehabil J 2021; 44:318-326. [PMID: 34323532 PMCID: PMC8664980 DOI: 10.1037/prj0000494] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The current article describes efforts to develop and test a measure of recovery-oriented inpatient care. METHOD The Recovery-oriented Acute INpatient (RAIN) scale was based on prior literature and current Veterans Health Administration (VHA) policy and resources and further revised based on data collection from 34 VHA acute inpatient units. RESULTS A final scale of 23, behaviorally anchored items demonstrated a four-factor structure including the following factors: inpatient treatment planning, outpatient treatment planning, group programming, and milieu. While several items require additional revision to address psychometric concerns, the scale demonstrated adequate model fit and was consistent with prior literature on recovery-oriented inpatient care. Conclusions and Implementations for Practice: The RAIN scale represents an important tool for future implementation and empirical study of recovery-oriented inpatient care. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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The Psychometric Properties of the Assertive Community Treatment Transition Readiness Scale (ATR). Community Ment Health J 2021; 57:1301-1309. [PMID: 33723735 DOI: 10.1007/s10597-021-00806-9] [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: 08/12/2020] [Accepted: 02/17/2021] [Indexed: 10/21/2022]
Abstract
Assertive community treatment (ACT) is an evidence-based practice for individuals living with severe mental illnesses. Originally conceptualized as a lifetime service, there is a need for standardized measures to help ACT teams identify clients who are potentially ready for a transition to less intensive services. Here, to address this gap in the literature, the psychometric properties of the Assertive Community Treatment Transition Readiness Scale (ATR) were examined. Data on the ATR were collected from ACT staff from across the country who had experience transitioning ACT clients to less intensive services. Results from an exploratory factor analysis suggested a one-factor solution and that items on the ATR demonstrated excellent internal consistency reliability as well as predictive criterion validity and known-groups validity. The ATR is an easy-to-use, 18-item measure that has the potential, in combination with clinical judgment and practice wisdom, to be a useful tool for identifying ACT clients who could transition to a less intensive level of care.
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Fukui S, Salyers MP, Morse G, Rollins AL. Factors that affect quality of care among mental health providers: Focusing on job stress and resources. Psychiatr Rehabil J 2021; 44:204-211. [PMID: 33539113 PMCID: PMC8376230 DOI: 10.1037/prj0000469] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Objective: High-quality, person-centered care is a priority for mental health services. The current study conducted secondary data analysis to examine the impact of job stress (i.e., interaction with high-risk consumer cases, increased caseload, emotional exhaustion) and resources (i.e., increased organizational and supervisory support, autonomy, role clarity) on providers' perceived quality of care. Methods: Data consisted of 145 direct care providers from an urban community mental health center. Structural equation modeling was used for testing the hierarchical regression model, sequentially adding job stress and resource variables in the prediction models for the quality of care (i.e., person-centered care, discordant care [conflict with consumers and tardiness]). Results: Person-centered care was positively associated with increased role clarity, organizational support, and larger caseload size, while a lower level of discordant care was associated with lower emotional exhaustion, smaller caseload size, less interaction with high-risk consumer cases, and with increased role clarity. Conclusions and Implications for Practice: Resources on the job may be particularly important for improved person-centered care, and lowering job stress may help reduce discordant care. The current study suggests the need for the mental health organizations to attend to both job stress and resources for providers to improve the quality of care. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | - Michelle P Salyers
- Department of Psychology, Indiana University-Purdue University Indianapolis
| | | | - Angela L Rollins
- Department of Psychology, Indiana University-Purdue University Indianapolis
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Stanhope V, Baslock D, Tondora J, Jessell L, Ross AM, Marcus SC. Developing a Tool to Measure Person-Centered Care in Service Planning. Front Psychiatry 2021; 12:681597. [PMID: 34408678 PMCID: PMC8365091 DOI: 10.3389/fpsyt.2021.681597] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 07/07/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Delivering person-centered care is a key component of health care reform. Despite widespread endorsement, medical and behavioral health settings struggle to specify and measure person-centered care objectively. This study presents the validity and reliability of the Person-Centered Care Planning Assessment Measure (PCCP-AM), an objective measure of the extent to which service planning is person-centered. Methods: Based upon the recovery-oriented practice of person-centered care planning, the 10-item PCCP-AM tool rates service plans on the inclusion of service user strengths, personal life goals, natural supports, self-directed actions and the promotion of community integration. As part of a large randomized controlled trial of person-centered care planning, service plans completed by community mental health clinic providers were rated using the PCCP-AM. Reliability was tested by calculating inter-rater reliability across 168 plans and internal consistency across 798 plans. To test concurrent validity, PCCP-AM scores for 84 plans were compared to expert rater scores on a separate instrument. Results: Interrater reliability for each of the 10 PCCP-AM items as measured by Kendall's W ranged from W = 0.77 to W = 0.89 and percent of scores within ± 1 point of each other ranged from 85.7 to 100%. Overall internal consistency as measured by Cronbach's alpha across 798 plans was α = 0.72. Concurrent validity as measured by Kendall's W ranged from W = 0.55 to W = 0.74 and percent of item scores within ± 1 point of expert rater scores ranged from 73.8 to 86.8%. Conclusions: Findings demonstrated that the 10-item PCCP-AM was a valid and reliable objective measure of person-centered care. Using the service plan as an indicator of multiple domains of person-centered care, the measure provides a valuable tool to inform clinical supervision and quality improvement across programs. More psychometric testing is needed to strengthen the measure for research purposes.
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Affiliation(s)
- Victoria Stanhope
- Silver School of Social Work, New York University, New York, NY, United States
| | - Daniel Baslock
- Silver School of Social Work, New York University, New York, NY, United States
| | - Janis Tondora
- Program of Recovery and Community Health, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Lauren Jessell
- Silver School of Social Work, New York University, New York, NY, United States
| | - Abigail M Ross
- Graduate School of Service, Fordham University, New York, NY, United States
| | - Steven C Marcus
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, United States
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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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Clausen H, Ruud T, Odden S, Benth JŠ, Heiervang KS, Stuen HK, Landheim A. Improved Rehabilitation Outcomes for Persons With and Without Problematic Substance Use After 2 Years With Assertive Community Treatment-A Prospective Study of Patients With Severe Mental Illness in 12 Norwegian ACT Teams. Front Psychiatry 2020; 11:607071. [PMID: 33424668 PMCID: PMC7785822 DOI: 10.3389/fpsyt.2020.607071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/11/2020] [Indexed: 12/04/2022] Open
Abstract
Background: Persons with severe mental illness often face difficulties in accessing and receiving adequate services enabling them to live independently. Many have co-occurring substance use problems that increase the risk of adverse outcomes. Community-based service models have been implemented around the world, including assertive community treatment (ACT), but the knowledge of rehabilitation outcomes in different subgroups is limited. We aimed to explore rehabilitation outcomes among patients suffering severe mental illness with and without substance use problems who had received ACT services for at least 2 years. Additionally, we compared differences in changes between the two groups. Methods: A total of 142 patients who received services for 2 years from the first 12 Norwegian ACT teams were included. Eighty-four (59%) had problematic substance use, while 58 (41%) did not. Data regarding housing, activity, symptoms, functioning, and subjective quality of life were collected upon enrollment into ACT and at 2 years of follow-up. Clinician-rated scales and self-report questionnaires were used. Changes within the two groups and differences in change between the groups were assessed using generalized linear mixed models. Results: Both groups were more likely to have good housing, higher level of functioning, and less anxiety and depressive symptoms after 2 years. The odds of good housing among participants with problematic substance use increased only after adjusting for age and gender. Participants with problematic substance use had less severe symptoms, particularly negative and manic symptoms, while participants without problematic substance use reported improved satisfaction with life in general. Neither group experienced a change in having a meaningful daily activity, positive symptoms, practical and social functioning, or subjective quality of life. The reduction of manic symptoms in the substance use group was the only difference between the groups. Conclusion: After 2 years, patients with and without problematic substance use experienced improvements in several important domains. Furthermore, the improvements were similar in both groups for most outcomes. This may suggest that ACT has a place in the continued effort toward integrated and comprehensive community services empowering patients with severe mental illness to achieve and sustain an independent life, including marginalized groups with severe substance use.
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Affiliation(s)
- Hanne Clausen
- Department of Research and Development, Division of Mental Health Services, Akerhus University Hospital, Lørenskog, Norway.,Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway
| | - Torleif Ruud
- Department of Research and Development, Division of Mental Health Services, Akerhus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Sigrun Odden
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Kristin Sverdvik Heiervang
- Department of Research and Development, Division of Mental Health Services, Akerhus University Hospital, Lørenskog, Norway.,Centre for Medical Ethics, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Hanne Kilen Stuen
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway.,Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Anne Landheim
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway.,Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
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ROCHEFORT DAVIDA. Innovation and Its Discontents: Pathways and Barriers in the Diffusion of Assertive Community Treatment. Milbank Q 2019; 97:1151-1199. [PMID: 31680353 PMCID: PMC6904263 DOI: 10.1111/1468-0009.12429] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Policy Points Widespread diffusion of policy innovation is the exception rather than the rule, depending as it does on the convergence of a variety of intellectual, political, economic, and organizational forces. The history of Assertive Community Treatment (ACT) provides a compelling case study of this process while also showing how conditions may shift over time, altering the scenarios for continued program expansion. Diffusion of a program like ACT challenges government to play a nuanced role in which public endorsement and resources are used to strengthen a worthwhile service, but without suppressing flexibility and ongoing experimentation as core program values. Acceptance as a proven form of "evidence-based practice" is a critical element in the validation of ACT and other community mental health interventions that combine clinical and social features in novel ways. However, the use of conventional evidence-based research as a singular gold standard of program value narrows the range of stakeholder input, as well as the evaluation methodologies and forms of data deemed worthy of attention. CONTEXT Originating at the county level in Wisconsin in the early 1970s, Assertive Community Treatment is one of the most influential mental health programs ever developed. The subject of hundreds of research studies and recipient of enthusiastic backing from private advocacy organizations and government agencies, the program has spread widely across the United States and internationally as a package of resources and management techniques for supporting individuals with severe and chronic mental illness in the community. Today, however, ACT is associated with a rising tide of criticism challenging the program's practices and philosophy while alternative service models are advancing. METHODS To trace the history of the Assertive Community Treatment movement, a diffusion-of-innovation framework was applied based on relevant concepts from public policy analysis, organizational behavior, implementation science, and other fields. In-depth review of the literature on ACT design, management, and performance also provided insight into the program's creation and subsequent evolution across different settings. FINDINGS A number of factors have functioned to fuel and to constrain ACT diffusion. The former category includes policy learning through research; the role of policy entrepreneurs; ACT's acceptance as a normative standard; and a thriving international epistemic community. The latter category includes cost concerns, fidelity demands, shifting norms, research contradictions and gaps, and a multifactorial context affecting program adoption. Currently, the program stands at a crossroads, strained by the principle of adherence to a long-standing operational framework, on the one hand, and calls to adjust to an environment of changing demands and opportunities, on the other. CONCLUSIONS For nearly 50 years, Assertive Community Treatment has been a mainstay of community mental health programming in the United States and other parts of the world. This presence will continue, but not in any static sense. A growing number of hybrid and competing versions of the program are likely to develop to serve specialized clientele groups and to respond to consumer demands and the recovery paradigm in behavioral health care.
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Receipt and targeting of evidence-based psychosocial interventions for people living with psychoses: findings from the second Australian national survey of psychosis. Epidemiol Psychiatr Sci 2019; 28:613-629. [PMID: 29893656 PMCID: PMC6998989 DOI: 10.1017/s2045796018000288] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AIMS. Clinical Practice Guidelines (CPGs) recommend evidence-based psychosocial interventions (EBPIs) to improve consumer recovery; however, availability appears limited. We describe receipt of six EBPIs, reported by people with psychoses, and associations with service and consumer characteristics, including indicators of need (eligibility) and benefit (suitability). METHODS. Participants in the 2010 Australian national survey of psychosis (n = 1825) were interviewed to assess demographic, functional, mental and physical health characteristics and service use in the previous year. Six EBPIs (Cognitive Behaviour Therapy for psychosis; Family Psycho-Education (FPE); Relapse Prevention Planning (RPP); Skills Training; Supported Employment; and Assertive Community Treatment) were chosen, based on the strength and consistency of CPG recommendations. Associations between receipt of interventions and eligibility and suitability indicators were examined via correlations and χ2. Logistic regression was used to predict receipt of one or more EBPIs and to identify predictors of each individual EBPI. RESULTS. Less than one-quarter of the sample reported receipt of an evidence-based level of any intervention: rates ranged from 3.4% (FPE) to 21.1% (RPP). The model predicting receipt of one or more EBPIs was statistically significant (χ2 (20, n = 1746) = 216.12, p < 0.01) and marginally useful. Nine variables contributed uniquely, of which six were service characteristics. The strongest predictors of receipt were being assigned a psychologist as a case manager (p < 0.01, OR(CI) = 2.36(1.50-3.72)) and accessing a non-clinical mental health support service in the past year (p < 0.01, OR(CI) = 2.01(1.60-2.51)). CONCLUSIONS. Prior reports of limited receipt of EBPIs are reinforced. There is patchy evidence for targeting of EBPIs to those who might benefit most. Service characteristics contribute more to the prediction of receipt than clinical characteristics. Greater implementation effort and better targeting are required to bridge evidence-practice gaps, including improved evidence-based practice literacy among professionals and needs-based service re-design to improve provision and optimise consumer outcomes.
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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: 56] [Impact Index Per Article: 11.2] [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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20
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Odden S, Landheim A, Clausen H, Stuen HK, Heiervang KS, Ruud T. Model fidelity and team members' experiences of assertive community treatment in Norway: a sequential mixed-methods study. Int J Ment Health Syst 2019; 13:65. [PMID: 31636700 PMCID: PMC6796407 DOI: 10.1186/s13033-019-0321-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 10/10/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Assertive community treatment (ACT) is an evidence-based treatment for people with severe mental illness, and this model is used widely throughout the world. Given the various adaptations in different contexts, we were interested in studying the implementation and adaptation of the ACT model in Norway. The first 12 Norwegian ACT teams were established between 2009 and 2011, and this study investigated the teams' model fidelity and the team members' experiences of working with ACT. METHODS To investigate implementation of the ACT model, fidelity assessments were performed 12 and 30 months after the teams started their work using the Tool for Measurement of Assertive Community Treatment (TMACT). Means and standard deviations were used to describe the ACT teams' fidelity scores. Cohen's effect size d was used to assess the changes in TMACT scores from the first to second assessment. Qualitative focus group interviews were conducted in the 12 teams after 30 months to investigate the team members' experiences of working with the ACT model. RESULTS The fidelity assessments of the Norwegian teams showed high implementation of the structural and organizational parts of the ACT model. The newer parts of the model, the recovery and evidence-based practices, were less implemented. Four of the six subscales in TMACT improved from the first to the second assessment. The team members experienced the ACT model to be a good service model for the target population: people with severe mental illness, significant functional impairment, and continuous high service needs. Team members perceived some parts of the model difficult to implement and that it was challenging to find effective ways to collaborate with existing health and social services. CONCLUSION The first 12 Norwegian ACT teams implemented the ACT model to a moderate degree. The ACT model could be implemented in Norway without extensive adaptations. Although the team members were satisfied with the ACT model, especially the results for their service users, inclusion of the ACT team to the existing service system was perceived as challenging.
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Affiliation(s)
- Sigrun Odden
- Norwegian National Advisory Unit On Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway
| | - Anne Landheim
- Norwegian National Advisory Unit On Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway
- Department of Public Health, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Hanne Clausen
- Norwegian National Advisory Unit On Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway
- Dept. of Research & Development, Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | - Hanne Kilen Stuen
- Norwegian National Advisory Unit On Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway
| | - Kristin Sverdvik Heiervang
- Dept. of Research & Development, Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | - Torleif Ruud
- Mental Health Services, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Harvey C, Brophy L, Tibble H, Killaspy H, Spittal MJ, Hamilton B, Ennals P, Newton R, Cruickshank P, Hall T, Fletcher J. Prevention and Recovery Care Services in Australia: Developing a State-Wide Typology of a Subacute Residential Mental Health Service Model. Front Psychiatry 2019; 10:383. [PMID: 31244691 PMCID: PMC6580196 DOI: 10.3389/fpsyt.2019.00383] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 05/15/2019] [Indexed: 01/15/2023] Open
Abstract
Aims: Community-based residential alternatives to hospitalization are an emerging service model. Evidence for their acceptability and effectiveness is promising but limited. Prevention and Recovery Care (PARC) services are one such residential model, offering short-term subacute treatment and care (usually between 7 and 28 days). PARC services in Victoria, Australia, are designed to support consumers with severe mental illness to either avoid a psychiatric hospital admission (step-up care) or transition from hospital back into the community (step-down care). As a precursor to a series of studies investigating the appropriateness, effectiveness and efficiency of PARC services, we aimed to investigate whether a typology of PARC services can be developed. Methods: A manager or other appropriately knowledgeable staff member from each of the 19 adult PARC services included in the study completed a tool based on PARC operational guidelines (the Victorian PARC service mapping questionnaire) and a validated instrument measuring the quality of care in residential mental health settings (the Quality Indicator for Rehabilitative Care, QuIRC). Thirty (of 42) stakeholders participated in a modified Delphi study to select 23 from the available 230 variables for entry into a hierarchical cluster analysis. Results: Cluster analysis produced three clusters of equal dissimilarity. At the 90% confidence level, there were four variables which were significantly different between clusters. These were the year the PARC was opened, the QuIRC Living Environment domain score, the proportion of all admissions that were a step-down admission from an inpatient unit, and how often families were invited to care meetings. Sensitivity analyses suggested the findings were robust to the method used to identify clusters. Conclusions: Although PARC services were broadly similar, their identified differences suggest there is variable model implementation across Victoria sufficient to generate a PARC service typology. This typology may prove important for interpreting differences in outcomes experienced by consumers and carers using PARC services, when applied in our analyses of service effectiveness. The value of conducting service mapping and typology studies is underscored. Further research to characterize subacute residential services, including recovery-promoting features of the built environment, is warranted.
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Affiliation(s)
- Carol Harvey
- Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
- Psychosocial Research Centre, NorthWestern Mental Health, Coburg, VIC, Australia
| | - Lisa Brophy
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
- Mind Australia Ltd, Heidelberg, VIC, Australia
- La Trobe University School of Allied Health, Human Services and Sport, Bundoora, VIC, Australia
| | - Holly Tibble
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Helen Killaspy
- Division of Psychiatry, University College London, London, United Kingdom
| | - Matthew J. Spittal
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Bridget Hamilton
- School of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia
| | | | - Richard Newton
- Peninsula Mental Health Service, Frankston, VIC, Australia
| | | | - Teresa Hall
- Nossal Institute for Global Health, and Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Justine Fletcher
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
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Melau M, Albert N, Nordentoft M. Development of a fidelity scale for Danish specialized early interventions service. Early Interv Psychiatry 2019; 13:568-573. [PMID: 29193743 DOI: 10.1111/eip.12523] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 04/11/2017] [Accepted: 09/30/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND The efficacy of the Specialized Early Intervention (SEI) treatment in Denmark, the OPUS treatment, has in a randomized clinical trial proved to be very effective compared to treatment as usual, and the dissemination of SEI services is increasing in Denmark. A prerequisite for upholding positive effects along with creating new teams and preserving critical components is to ensure fidelity to the model. Currently there is no Danish fidelity scale for SEI services. AIM To establish a fidelity scale for SEI teams, in a brief and easily manageable form, for the use of evaluating and assessing the critical components in Danish SEI services. METHOD We identified essential evidence-based components of SEI services internationally and interviewed experts from five Danish SEI teams, using an adapted version of the Delphi Consensus method. RESULTS An 18-point fidelity scale was constructed. The scale was divided into two dimensions: one relating to the structure of the SEI team and one relating to the character and content of the SEI treatment. Each component can be rated either 1 or 0 (1 point = fulfilling the requirements for the components; and 0 point = the requirements were not met). The maximum score was a total of 18 points with 5 of the components being mandatory. CONCLUSION The development of the fidelity scale is an important tool for securing the quality of SEI treatment in Denmark.
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Affiliation(s)
- Marianne Melau
- Mental Health Centre, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nikolai Albert
- Mental Health Centre, Copenhagen University Hospital, Copenhagen, Denmark
| | - Merete Nordentoft
- Mental Health Centre, Copenhagen University Hospital, Copenhagen, Denmark
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Abstract
AIM Specialized early intervention (SEI) treatment in meta-analysis has proven to be effective, compared to usual treatment, in treating first-episode psychosis, and the dissemination of SEI services is increasing. A prerequisite for upholding positive effects is to ensure fidelity to the treatment concept once tested. The aim of this study was to map programme fidelity of SEI teams in Denmark by testing a newly developed fidelity scale. METHODS The 18-item SEI fidelity scale was assessed by visiting SEI teams in person. The scale is divided into 2 dimensions: one concerning the structure and the other concerning the character and content of the treatment. Interviews were conducted with team leaders, patients and members of the staff, and team conferences were observed. Satisfactory fidelity can be obtained at 2 levels: an elite level and an adequate level. RESULTS In total, 96% (n = 22) of the Danish SEI teams participated in the fidelity study. An elite fidelity score was achieved by 32% of the teams, scoring 15 or 16 on the 18-point scale; 27% reached adequate level. With regard to the structural domain of the scale, we found variation among the teams. CONCLUSIONS The multimodal approach was found to be very efficient in evaluating elements critical to SEI teams in Denmark. A low score on the structural domain could, in the long term, lead to an inability to maintain a well-functioning team and provide high-quality treatment.
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Affiliation(s)
- Marianne Melau
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Hellerup, Denmark
| | - Nikolai Albert
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Hellerup, Denmark
| | - Merete Nordentoft
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Hellerup, Denmark
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Spivak S, Mojtabai R, Green C, Firth T, Sater H, Cullen BA. Distribution and Correlates of Assertive Community Treatment (ACT) and ACT-Like Programs: Results From the 2015 N-MHSS. Psychiatr Serv 2019; 70:271-278. [PMID: 30602345 DOI: 10.1176/appi.ps.201700561] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study examined the availability and characteristics of assertive community treatment (ACT) programs across mental health treatment facilities in the United States. METHODS Prevalence and correlates of facilities that reported offering ACT, broadly defined as intensive community services for serious mental illness provided by multidisciplinary teams in the clients' natural settings and including both ACT and "ACT-like" programs, were examined by using data from the National Mental Health Services Survey. Availability of services essential to the ACT model in these facilities was also examined. RESULTS Of the 12,826 surveyed facilities, 13.4% reported offering ACT, with significant variability among states. Of the facilities with ACT, 19.2% reported offering all core ACT services. Few facilities offered peer support, employment, and housing services. Compared with programs at facilities that did not offer all core ACT services, facilities with ACT programs that offered these services had higher odds of being publicly owned (odds ratio [OR]=2.12, 95% confidence interval [CI]=1.64-2.74) and of receiving federal (OR=3.60, CI=2.17-5.98) or grant funding (OR=1.87, CI=1.45-2.41). Facilities with ACT that offered all core services also had higher odds of offering other services important to individuals with serious mental disorders. CONCLUSIONS Substantial differences existed in availability of ACT and ACT-like programs among states, with evidence of a large unmet need overall, even when a very broad and inclusive definition of ACT was used. Few ACT programs offered all core services. Legislative, administrative, and funding differences may explain some of the variability.
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Affiliation(s)
- Stanislav Spivak
- Johns Hopkins University School of Medicine and Johns Hopkins University Bloomberg School of Public Health (Spivak, Mojtabai, Cullen); Johns Hopkins Medical Systems (Green, Firth, Sater)
| | - Ramin Mojtabai
- Johns Hopkins University School of Medicine and Johns Hopkins University Bloomberg School of Public Health (Spivak, Mojtabai, Cullen); Johns Hopkins Medical Systems (Green, Firth, Sater)
| | - Charee Green
- Johns Hopkins University School of Medicine and Johns Hopkins University Bloomberg School of Public Health (Spivak, Mojtabai, Cullen); Johns Hopkins Medical Systems (Green, Firth, Sater)
| | - Tyler Firth
- Johns Hopkins University School of Medicine and Johns Hopkins University Bloomberg School of Public Health (Spivak, Mojtabai, Cullen); Johns Hopkins Medical Systems (Green, Firth, Sater)
| | - Holly Sater
- Johns Hopkins University School of Medicine and Johns Hopkins University Bloomberg School of Public Health (Spivak, Mojtabai, Cullen); Johns Hopkins Medical Systems (Green, Firth, Sater)
| | - Bernadette A Cullen
- Johns Hopkins University School of Medicine and Johns Hopkins University Bloomberg School of Public Health (Spivak, Mojtabai, Cullen); Johns Hopkins Medical Systems (Green, Firth, Sater)
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25
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Luo X, Law SF, Wang X, Shi J, Zeng W, Ma X, Chow W, Liu S, Zhao W, Liu X, Yao S, Phillips MR. Effectiveness of an Assertive Community Treatment program for people with severe schizophrenia in mainland China - a 12-month randomized controlled trial. Psychol Med 2019; 49:969-979. [PMID: 29962366 DOI: 10.1017/s0033291718001629] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Assertive Community Treatment (ACT) is an evidence-based treatment program for people with severe mental illness developed in high-income countries. We report the first randomized controlled trial of ACT in mainland China. METHODS Sixty outpatients with schizophrenia with severe functional impairments or frequent hospitalizations were randomly assigned to ACT (n = 30) or standard community treatment (n = 30). The severity of symptoms and level of social functioning were assessed at baseline and every 3 months during the 1-year study. The primary outcome was the duration of hospital readmission. Secondary outcomes included a pre-post change in symptom severity, the rates of symptom relapse and gainful employment, social and occupational functioning, and quality of life of family caregivers. RESULTS Based on a modified intention-to-treat analysis, the outcomes for ACT were significantly better than those of standard community treatment. ACT patients were less likely to be readmitted [3.3% (1/30) v. 25.0% (7/28), Fisher's exact test p = 0.023], had a shorter mean readmission time [2.4 (13.3) v. 30.7 (66.9) days], were less likely to relapse [6.7% (2/30) v. 28.6% (8/28), Fisher's exact test p = 0.038], and had shorter mean time in relapse [3.5 (14.6) v. 34.4 (70.6) days]. The ACT group also had significantly longer times re-employed and greater symptomatic improvement and their caregivers experienced a greater improvement in their quality of life. CONCLUSION Our results show that culturally adapted ACT is both feasible and effective for individuals with severe schizophrenia in urban China. Replication studies with larger samples and longer duration of follow up are warranted.
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Affiliation(s)
- Xingwei Luo
- Medical Psychological Center, The Second Xiangya Hospital, Central South University,Changsha, Hunan 410011,China
| | - Samuel F Law
- Department of Psychiatry,University of Toronto,Toronto, Ontario,Canada
| | - Xiang Wang
- Medical Psychological Center, The Second Xiangya Hospital, Central South University,Changsha, Hunan 410011,China
| | - Jingzheng Shi
- Xiangya School of Public Health, Central South University,Changsha, Hunan410078,China
| | - Wu Zeng
- Brandeis University,Waltham MA, 02454,USA
| | - Xiaoqian Ma
- Medical Psychological Center, The Second Xiangya Hospital, Central South University,Changsha, Hunan 410011,China
| | - Wendy Chow
- Department of Psychiatry,University of Toronto,Toronto, Ontario,Canada
| | - Shiyan Liu
- Medical Psychological Center, The Second Xiangya Hospital, Central South University,Changsha, Hunan 410011,China
| | - Wei Zhao
- Medical Psychological Center, The Second Xiangya Hospital, Central South University,Changsha, Hunan 410011,China
| | - Xiaoli Liu
- Xiangya School of Public Health, Central South University,Changsha, Hunan410078,China
| | - Shuqiao Yao
- Medical Psychological Center, The Second Xiangya Hospital, Central South University,Changsha, Hunan 410011,China
| | - Michael R Phillips
- Suicide Research and Prevention Center, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine,Shanghai,China
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Lloyd-Evans B, Christoforou M, Osborn D, Ambler G, Marston L, Lamb D, Mason O, Morant N, Sullivan S, Henderson C, Hunter R, Pilling S, Nolan F, Gray R, Weaver T, Kelly K, Goater N, Milton A, Johnston E, Fullarton K, Lean M, Paterson B, Piotrowski J, Davidson M, Forsyth R, Mosse L, Leverton M, O’Hanlon P, Mundy E, Mundy T, Brown E, Fahmy S, Burgess E, Churchard A, Wheeler C, Istead H, Hindle D, Johnson S. Crisis resolution teams for people experiencing mental health crises: the CORE mixed-methods research programme including two RCTs. PROGRAMME GRANTS FOR APPLIED RESEARCH 2019. [DOI: 10.3310/pgfar07010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background
Crisis resolution teams (CRTs) seek to avert hospital admissions by providing intensive home treatment for people experiencing a mental health crisis. The CRT model has not been highly specified. CRT care is often experienced as ending abruptly and relapse rates following CRT discharge are high.
Aims
The aims of CORE (Crisis resolution team Optimisation and RElapse prevention) workstream 1 were to specify a model of best practice for CRTs, develop a measure to assess adherence to this model and evaluate service improvement resources to help CRTs implement the model with high fidelity. The aim of CORE workstream 2 was to evaluate a peer-provided self-management programme aimed at reducing relapse following CRT support.
Methods
Workstream 1 was based on a systematic review, national CRT manager survey and stakeholder qualitative interviews to develop a CRT fidelity scale through a concept mapping process with stakeholders (n = 68). This was piloted in CRTs nationwide (n = 75). A CRT service improvement programme (SIP) was then developed and evaluated in a cluster randomised trial: 15 CRTs received the SIP over 1 year; 10 teams acted as controls. The primary outcome was service user satisfaction. Secondary outcomes included CRT model fidelity, catchment area inpatient admission rates and staff well-being. Workstream 2 was a peer-provided self-management programme that was developed through an iterative process of systematic literature reviewing, stakeholder consultation and preliminary testing. This intervention was evaluated in a randomised controlled trial: 221 participants recruited from CRTs received the intervention and 220 did not. The primary outcome was re-admission to acute care at 1 year of follow-up. Secondary outcomes included time to re-admission and number of days in acute care over 1 year of follow-up and symptoms and personal recovery measured at 4 and 18 months’ follow-up.
Results
Workstream 1 – a 39-item CRT fidelity scale demonstrated acceptability, face validity and promising inter-rater reliability. CRT implementation in England was highly variable. The SIP trial did not produce a positive result for patient satisfaction [median Client Satisfaction Questionnaire score of 28 in both groups at follow-up; coefficient 0.97, 95% confidence interval (CI) –1.02 to 2.97]. The programme achieved modest increases in model fidelity. Intervention teams achieved lower inpatient admission rates and less inpatient bed use. Qualitative evaluation suggested that the programme was generally well received. Workstream 2 – the trial yielded a statistically significant result for the primary outcome, in which rates of re-admission to acute care over 1 year of follow-up were lower in the intervention group than in the control group (odds ratio 0.66, 95% CI 0.43 to 0.99; p = 0.044). Time to re-admission was lower and satisfaction with care was greater in the intervention group at 4 months’ follow-up. There were no other significant differences between groups in the secondary outcomes.
Limitations
Limitations in workstream 1 included uncertainty regarding the representativeness of the sample for the primary outcome and lack of blinding for assessment. In workstream 2, the limitations included the complexity of the intervention, preventing clarity about which were effective elements.
Conclusions
The CRT SIP did not achieve all its aims but showed potential promise as a means to increase CRT model fidelity and reduce inpatient service use. The peer-provided self-management intervention is an effective means to reduce relapse rates for people leaving CRT care.
Study registration
The randomised controlled trials were registered as Current Controlled Trials ISRCTN47185233 and ISRCTN01027104. The systematic reviews were registered as PROSPERO CRD42013006415 and CRD42017043048.
Funding
The National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
| | | | - David Osborn
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Gareth Ambler
- Department of Statistical Science, University College London, London, UK
| | - Louise Marston
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Danielle Lamb
- Division of Psychiatry, University College London, London, UK
| | - Oliver Mason
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Nicola Morant
- Division of Psychiatry, University College London, London, UK
| | - Sarah Sullivan
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Claire Henderson
- Health Service and Population Research, King’s College London, London, UK
| | - Rachael Hunter
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Stephen Pilling
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Fiona Nolan
- School of Health and Social Care, University of Essex, Colchester, UK
| | - Richard Gray
- Department of Nursing and Midwifery, La Trobe University, Melbourne, VIC, Australia
| | - Tim Weaver
- Mental Health Social Work and Interprofessional Learning, Middlesex University London, London, UK
| | | | | | - Alyssa Milton
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Elaine Johnston
- Division of Psychiatry, University College London, London, UK
| | - Kate Fullarton
- Division of Psychiatry, University College London, London, UK
| | - Melanie Lean
- Division of Psychiatry, University College London, London, UK
| | - Beth Paterson
- Division of Psychiatry, University College London, London, UK
| | | | | | - Rebecca Forsyth
- Division of Psychiatry, University College London, London, UK
| | - Liberty Mosse
- Division of Psychiatry, University College London, London, UK
| | - Monica Leverton
- Division of Psychiatry, University College London, London, UK
| | - Puffin O’Hanlon
- Division of Psychiatry, University College London, London, UK
| | - Edward Mundy
- Division of Psychiatry, University College London, London, UK
| | - Tom Mundy
- Division of Psychiatry, University College London, London, UK
| | - Ellie Brown
- Psychiatric Health Strategic Research Centre, Deakin University, Geelong, VIC, Australia
| | - Sarah Fahmy
- Division of Psychiatry, University College London, London, UK
| | - Emma Burgess
- Division of Psychiatry, University College London, London, UK
| | | | - Claire Wheeler
- Division of Psychiatry, University College London, London, UK
| | - Hannah Istead
- Division of Psychiatry, University College London, London, UK
| | - David Hindle
- Division of Psychiatry, University College London, London, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
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27
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Affiliation(s)
- Samuel F Law
- Department of Psychiatry,University of Toronto,Toronto, Ontario,Canada
| | - Xingwei Luo
- Medical Psychological Center, The Second Xiangya Hospital, Central South University,Changsha, Hunan 410011,China
| | - Shuqiao Yao
- Medical Psychological Center, The Second Xiangya Hospital, Central South University,Changsha, Hunan 410011,China
| | - Xiang Wang
- Medical Psychological Center, The Second Xiangya Hospital, Central South University,Changsha, Hunan 410011,China
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Complex Interventions and Interorganisational Relationships: Examining Core Implementation Components of Assertive Community Treatment. Int J Integr Care 2018; 18:11. [PMID: 30532665 PMCID: PMC6284138 DOI: 10.5334/ijic.3547] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction: There is increasing interest in implementing evidence-based integrated models of care in community-based mental health service systems. Assertive Community Treatment (ACT) is seen as an attractive, and at the same time challenging, model to implement in sectored service settings. This study investigates the implementation process of such an initiative. Methods: Interviews were conducted with ACT team members, the process leader, steering group members, and collaboration partners. The “Sustainable Implementation Scale” helped to identify critical implementation components, and these were further explored using the qualitative interview data. The “Tool for Measuring Assertive Community Treatment” addressed programme fidelity, and the initiative’s sustainability was assessed. Results: High-fidelity implementation of ACT in a sectored service setting is possible. Prominent components that facilitated implementation were careful preparations, team members’ characteristics, and efforts by the process leader and the steering group to improve networking. Implementation was hampered by conflicting goals among the involved authorities and a mismatch between the ACT model’s characteristics and existing organisational traditions and regulations. Discussion and Conclusions: Reducing the uncertainty caused by conflicting goals is an important step in improving the implementation of ACT. In order to facilitate implementation, the goals, regulations, and availability of resources should be aligned horizontally and vertically through the involved organisations.
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Sommerfeld DH, Aarons GA, Naqvi JB, Holden J, Perivoliotis D, Mueser KT, Granholm E. Stakeholder Perspectives on Implementing Cognitive Behavioral Social Skills Training on Assertive Community Treatment Teams. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 46:188-199. [PMID: 30406858 DOI: 10.1007/s10488-018-0904-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study examined stakeholder perceptions of the "fit" between cognitive-behavioral social skills training (CBSST) and assertive community treatment (ACT) when implementing CBSST into existing community-based ACT teams. Focus group feedback was collected from a diverse set of stakeholders (i.e., clients, providers, supervisors, agency administrators, public sector representatives, and intervention developers). Results identified perceived client and provider benefits for integrating CBSST into ACT while highlighting the importance of purposeful adaptations, training, and implementation tools to facilitate structural and values fit between CBSST and ACT. Study findings will inform future endeavors to implement CBSST and other relevant EBPs into ACT. Trial Registry: ClinicalTrials.gov #NCT02254733.
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Affiliation(s)
- David H Sommerfeld
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, San Diego, CA, 92093-0812, USA.
| | - Gregory A Aarons
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, San Diego, CA, 92093-0812, USA
| | - Jeanean B Naqvi
- Department of Psychology, Carnegie Mellon University, Pittsburgh, USA
| | - Jason Holden
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, San Diego, CA, 92093-0812, USA
| | - Dimitri Perivoliotis
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, San Diego, CA, 92093-0812, USA.,Psychology Service, Veterans Affairs San Diego Healthcare System, San Diego, USA
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation, Boston University, Boston, USA
| | - Eric Granholm
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, San Diego, CA, 92093-0812, USA.,Psychology Service, Veterans Affairs San Diego Healthcare System, San Diego, USA
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30
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Johne J, von Peter S, Schwarz J, Timm J, Heinze M, Ignatyev Y. Evaluation of new flexible and integrative psychiatric treatment models in Germany- assessment and preliminary validation of specific program components. BMC Psychiatry 2018; 18:278. [PMID: 30176836 PMCID: PMC6122621 DOI: 10.1186/s12888-018-1861-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 08/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Flexible and integrative treatment (FIT) models are rather novel in German mental health care. This study aimed at identifying and evaluating empirically based, practicable, and quantifiable program components that describe the specific treatment structures and processes of German FIT models. METHODS A multi-step, iterative research process, based on Grounded Theory Methodology (GTM), was used to identify and operationalise components. A complex algorithm and expert-interviews were applied to quantify the relative weight of each component and to develop a sum score. Face and content validity were examined and internal consistency was tested by Cronbach's α coefficient. RESULTS Ten of eleven FIT components could be operationalised, quantified and united in the total score. All operationalised components showed sufficient face and content validity and eight components had a good reliability. CONCLUSIONS The components are a first step in the process of operationally defining German FIT models. They considerably overlap with various critical ingredients of international FIT models and may serve as a theoretical basis for constructing fidelity tools and research guides to enable process and outcome evaluation of German FIT models.
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Affiliation(s)
- Jakob Johne
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Sebastian von Peter
- Brandenburg Medical School Theodor Fontane, Department of Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Rüdersdorf bei Berlin, Germany
| | - Julian Schwarz
- Brandenburg Medical School Theodor Fontane, Department of Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Rüdersdorf bei Berlin, Germany
| | - Jürgen Timm
- Biometry Section, Competence Center for Clinical Trials, University of Bremen, Bremen, Germany
| | - Martin Heinze
- Brandenburg Medical School Theodor Fontane, Department of Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Rüdersdorf bei Berlin, Germany
| | - Yuriy Ignatyev
- Brandenburg Medical School Theodor Fontane, Department of Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Rüdersdorf bei Berlin, Germany
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31
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Hand BN, Darragh AR, Persch AC. Thoroughness and Psychometrics of Fidelity Measures in Occupational and Physical Therapy: A Systematic Review. Am J Occup Ther 2018; 72:7205205050p1-7205205050p10. [PMID: 30157017 DOI: 10.5014/ajot.2018.025510] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This study evaluated the thoroughness and psychometric properties of fidelity measures used by or of relevance to occupational or physical therapy. METHOD A systematic review of the literature was completed. Assessments used to measure occupational or physical therapy intervention fidelity were evaluated for thoroughness, reliability, validity, and clinical utility. RESULTS Eight fidelity measures met inclusion criteria for this systematic review. Most of the measures had moderate levels of thoroughness in the coverage of key aspects of fidelity, reported adequate to excellent reliability and validity, and were highly variable in clinical utility. CONCLUSION Additional research is recommended to validate existing occupational or physical therapy fidelity measures and to develop novel measures for other occupational therapy and physical therapy interventions. Clinicians and researchers must place greater emphasis on the development and implementation of fidelity measures to ensure uniformity in intervention delivery and high-quality, evidence-based care.
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Affiliation(s)
- Brittany N Hand
- Brittany N. Hand, PhD, OTR/L, is Assistant Professor, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus. At the time of the study, she was Student, Division of Occupational Therapy, The Ohio State University, Columbus;
| | - Amy R Darragh
- Amy R. Darragh, PhD, OTR/L, is Division Director and Associate Professor, Division of Occupational Therapy, The Ohio State University, Columbus
| | - Andrew C Persch
- Andrew C. Persch, PhD, OTR/L, is Assistant Professor, Department of Occupational Therapy, Colorado State University, Fort Collins. At the time of the study, he was Assistant Professor, Division of Occupational Therapy, The Ohio State University, Columbus
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32
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Csillag C, Nordentoft M, Mizuno M, McDaid D, Arango C, Smith J, Lora A, Verma S, Di Fiandra T, Jones PB. Early intervention in psychosis: From clinical intervention to health system implementation. Early Interv Psychiatry 2018; 12:757-764. [PMID: 29143456 DOI: 10.1111/eip.12514] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 09/06/2017] [Accepted: 09/13/2017] [Indexed: 12/20/2022]
Abstract
AIM Early intervention in psychosis (EIP) is a well-established approach with the intention of early detection and treatment of psychotic disorders. Its clinical and economic benefits are well documented. This paper presents basic aspects of EIP services, discusses challenges to their implementation and presents ideas and strategies to overcome some of these obstacles. METHODS This paper is a narrative review about the evidence supporting EIP, with examples of successful implementation of EIP and of cases where major obstacles still need to be overcome. RESULTS Experience from successfully implemented EIP services into the mental healthcare system have generated evidence, concepts and specific strategies that might serve as guidance or inspiration in other countries or systems where EIP is less well developed or not developed at all. Previous experience has made clear that evidence of clinical benefits alone is not enough to promote implementation, as economic arguments and political and social pressure have shown to be important elements in efforts to achieve implementation. CONCLUSIONS Users' narratives, close collaboration with community organizations and support from policy-makers and known people within the community championing early intervention (EI) services are just a few of the approaches that should be considered in campaigns for implementation of EI services. Fast progress in implementation is possible.
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Affiliation(s)
- Claudio Csillag
- Mental Health Centre North Zealand, University of Copenhagen, Hilleroed, Denmark
| | | | - Masafumi Mizuno
- Department of Neuropsychiatry, Toho University School of Medicine, Tokyo, Japan
| | - David McDaid
- Personal Social Services Research Unit, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Celso Arango
- Hospital General Universitario Gregorio Marañón, Universidad Complutense, School of Medicine, CIBERSAM, IiSGM, Madrid, Spain
| | - Jo Smith
- Institute of Health and Society, University of Worcester, Worcester, UK
| | | | - Swapna Verma
- Department of Early Psychosis Intervention, Institute of Mental Health, Singapore, Singapore
| | | | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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Abstract
BACKGROUND One goal within positive psychiatry is to support the personal recovery of persons with mental illness and providing opportunities for well-being. AIM The current article aims to introduce readers to the concept of personal recovery and the potential and importance of recovery-oriented services and measures. METHODS A literature review was conducted to help consider the domains of 'personal recovery', 'recovery-oriented services/interventions', and 'measures'. A database search was complemented with a web-based search. Both medical subject heading (MESH) terms and free-text search terms were used. RESULTS Literature from research journals, grey literature, and websites were included. Within this context, recovery does not refer to a cure but involves a process in which a person acts as an agent to develop new goals and meaning in life, despite and beyond limitations posed by the illness and its consequences. A positive focus on recovery is in sharp contrast to historical deterministic and pessimistic concepts of mental illnesses. Recovery-oriented services such as peer support, assertive community treatment, supported employment/education/housing, illness self-management, and decreasing self-stigma are highlighted. A review of 27 measures that focus on personal recovery and promotion of well-being are also discussed. CONCLUSIONS The literature overview presents perspectives and knowledge of how to develop positive psychiatry, how mental health services and their partner organizations may become more recovery oriented and help persons reach well-being and a better quality of life. This study is limited to a narrative review and may precede future systematic reviews.
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Affiliation(s)
- Ulrika Bejerholm
- a Department of Health Sciences/Mental Health, Activity and Participation , Lund University , Lund , Sweden.,b Center for Evidence-based Psychosocial Interventions (CEPI) , Lund University , Lund , Sweden
| | - David Roe
- c Department of Community Mental Health , University of Haifa , Haifa , Israel.,d Department of Medicine , Aalborg University , Aalborg , Denmark
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Schroeder RA. Unique Practice, Unique Place: Exploring Two Assertive Community Treatment Teams in Maine. Issues Ment Health Nurs 2018; 39:499-505. [PMID: 29370560 DOI: 10.1080/01612840.2017.1413460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Assertive Community Treatment (ACT) is a model of care that provides comprehensive community-based psychiatric care for persons with serious mental illness. This model has been widely documented and has shown to be an evidence-based model of care for reducing hospitalizations for this targeted population. Critical ingredients of the ACT model are the holistic nature of their services, a team based approach to treatment and nurses who assist with illness management, medication monitoring, and provider collaboration. Although the model remains strong there are clear differences between urban and rural teams. This article describes present day practice in two disparate ACT programs in urban and rural Maine. It offers a new perspective on the evolving and innovative program of services that treat those with serious mental illness along with a review of literature pertinent to the ACT model and future recommendations for nursing practice. The success and longevity of these two ACT programs are testament to the quality of care and commitment of staff that work with seriously mentally ill consumers. Integrative care models such as these community-based treatment teams and nursing driven interventions are prime elements of this successful model.
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35
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Lofthus AM, Weimand BM, Ruud T, Rose D, Heiervang KS. "This is not a Life Anyone would want"-A Qualitative Study of Norwegian ACT Service users' Experience with Mental Health Treatment. Issues Ment Health Nurs 2018; 39:519-526. [PMID: 29370562 DOI: 10.1080/01612840.2017.1413459] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We discuss Norwegian service users' experiences with community mental health treatment in general, and the interprofessional Assertive Community Treatment (ACT) model in particular. To gain the right to treatment, service users have to accept certain limitations, such as medication and community treatment orders (CTOs). Seventy participants responded to five open-ended questions. In addition, eight of them participated in either focus group or interviews. A collaborative approach, using Stepwise-Deductive Induction (SDI) method was used to analyze the participants' experiences. The results showed that the treatment contributes to an experience of autonomy but also one of restriction. It provides service users with enhanced normalcy, but simultaneously a feeling of deviance. There needs to be an ongoing reflection and discussion about those paradoxes in treatment, and service users have to be involved.
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Affiliation(s)
- Ann-Mari Lofthus
- a Akershus Universitetssykehus HF , Department of Research and Development, Division of Mental Health Services , Lorenskog , Norway.,b National Centre for knowledge through experience in mental health , Skien , Norway.,c University of Oslo, Institute of Clinical Medicine , Oslo , Norway
| | - Bente M Weimand
- a Akershus Universitetssykehus HF , Department of Research and Development, Division of Mental Health Services , Lorenskog , Norway
| | - Torleif Ruud
- a Akershus Universitetssykehus HF , Department of Research and Development, Division of Mental Health Services , Lorenskog , Norway.,c University of Oslo, Institute of Clinical Medicine , Oslo , Norway
| | - Diana Rose
- d King's College London, Institute of Psychiatry, Psychology & Neuroscience , London , United Kingdom of Great Britain and Northern Ireland
| | - Kristin S Heiervang
- a Akershus Universitetssykehus HF , Department of Research and Development, Division of Mental Health Services , Lorenskog , Norway
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36
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Monroe-DeVita M, Morse G, Mueser KT, McHugo GJ, Xie H, Hallgren KA, Peterson R, Miller J, Akiba C, York M, Gingerich S, Stiles B. Implementing Illness Management and Recovery Within Assertive Community Treatment: A Pilot Trial of Feasibility and Effectiveness. Psychiatr Serv 2018; 69:562-571. [PMID: 29446335 PMCID: PMC6433370 DOI: 10.1176/appi.ps.201700124] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE In a pilot feasibility and effectiveness study, illness management and recovery (IMR), a curriculum-based program to help people with serious mental illness pursue personal recovery goals, was integrated into assertive community treatment (ACT) to improve participants' recovery and functioning. METHODS A small-scale cluster randomized controlled design was used to test implementation of IMR within ACT teams in two states. Eight high-fidelity ACT teams were assigned to provide IMR (ACT+IMR; four teams) or standard ACT services (ACT only; four teams). Clinical outcomes from 101 individuals with schizophrenia-spectrum or bipolar disorders were assessed at baseline, six months, and one year. RESULTS Exposure to IMR (session attendance and module completion) varied between the ACT+IMR teams, with participants on one team having significantly less exposure. Results from intent-to-treat analyses showed that participants in ACT+IMR demonstrated significantly better outcomes with a medium effect size at follow-up on clinician-rated illness self-management. A nonsignificant, medium effect size was found for one measure of functioning, and small effect sizes were observed for client-rated illness self-management and community integration. Session and module completion predicted better outcomes on four of the 12-month outcome measures. CONCLUSIONS Findings support the feasibility of implementing IMR within ACT teams. Although there were few significant findings, effect sizes on some variables in this small-scale study and the dose-response relationships within ACT+IMR teams suggest this novel approach could be promising for improving recovery for people with serious mental illness. Further large-scale studies utilizing a hybrid effectiveness-implementation design could provide a promising direction in this area.
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Affiliation(s)
- Maria Monroe-DeVita
- Dr. Monroe-DeVita, Dr. Hallgren, and Mr. Stiles are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Morse and Mr. Miller are with Places for People, St. Louis. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. McHugo and Dr. Xie are with the Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire. Ms. Peterson is with the Department of Psychology, University of Central Florida, Orlando. Mr. Akiba is with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ms. York is with the Department of Psychology, Southern Illinois University, Carbondale, Illinois. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania
| | - Gary Morse
- Dr. Monroe-DeVita, Dr. Hallgren, and Mr. Stiles are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Morse and Mr. Miller are with Places for People, St. Louis. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. McHugo and Dr. Xie are with the Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire. Ms. Peterson is with the Department of Psychology, University of Central Florida, Orlando. Mr. Akiba is with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ms. York is with the Department of Psychology, Southern Illinois University, Carbondale, Illinois. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania
| | - Kim T Mueser
- Dr. Monroe-DeVita, Dr. Hallgren, and Mr. Stiles are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Morse and Mr. Miller are with Places for People, St. Louis. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. McHugo and Dr. Xie are with the Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire. Ms. Peterson is with the Department of Psychology, University of Central Florida, Orlando. Mr. Akiba is with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ms. York is with the Department of Psychology, Southern Illinois University, Carbondale, Illinois. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania
| | - Gregory J McHugo
- Dr. Monroe-DeVita, Dr. Hallgren, and Mr. Stiles are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Morse and Mr. Miller are with Places for People, St. Louis. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. McHugo and Dr. Xie are with the Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire. Ms. Peterson is with the Department of Psychology, University of Central Florida, Orlando. Mr. Akiba is with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ms. York is with the Department of Psychology, Southern Illinois University, Carbondale, Illinois. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania
| | - Haiyi Xie
- Dr. Monroe-DeVita, Dr. Hallgren, and Mr. Stiles are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Morse and Mr. Miller are with Places for People, St. Louis. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. McHugo and Dr. Xie are with the Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire. Ms. Peterson is with the Department of Psychology, University of Central Florida, Orlando. Mr. Akiba is with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ms. York is with the Department of Psychology, Southern Illinois University, Carbondale, Illinois. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania
| | - Kevin A Hallgren
- Dr. Monroe-DeVita, Dr. Hallgren, and Mr. Stiles are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Morse and Mr. Miller are with Places for People, St. Louis. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. McHugo and Dr. Xie are with the Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire. Ms. Peterson is with the Department of Psychology, University of Central Florida, Orlando. Mr. Akiba is with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ms. York is with the Department of Psychology, Southern Illinois University, Carbondale, Illinois. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania
| | - Roselyn Peterson
- Dr. Monroe-DeVita, Dr. Hallgren, and Mr. Stiles are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Morse and Mr. Miller are with Places for People, St. Louis. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. McHugo and Dr. Xie are with the Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire. Ms. Peterson is with the Department of Psychology, University of Central Florida, Orlando. Mr. Akiba is with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ms. York is with the Department of Psychology, Southern Illinois University, Carbondale, Illinois. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania
| | - Joris Miller
- Dr. Monroe-DeVita, Dr. Hallgren, and Mr. Stiles are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Morse and Mr. Miller are with Places for People, St. Louis. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. McHugo and Dr. Xie are with the Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire. Ms. Peterson is with the Department of Psychology, University of Central Florida, Orlando. Mr. Akiba is with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ms. York is with the Department of Psychology, Southern Illinois University, Carbondale, Illinois. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania
| | - Christopher Akiba
- Dr. Monroe-DeVita, Dr. Hallgren, and Mr. Stiles are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Morse and Mr. Miller are with Places for People, St. Louis. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. McHugo and Dr. Xie are with the Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire. Ms. Peterson is with the Department of Psychology, University of Central Florida, Orlando. Mr. Akiba is with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ms. York is with the Department of Psychology, Southern Illinois University, Carbondale, Illinois. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania
| | - Mary York
- Dr. Monroe-DeVita, Dr. Hallgren, and Mr. Stiles are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Morse and Mr. Miller are with Places for People, St. Louis. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. McHugo and Dr. Xie are with the Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire. Ms. Peterson is with the Department of Psychology, University of Central Florida, Orlando. Mr. Akiba is with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ms. York is with the Department of Psychology, Southern Illinois University, Carbondale, Illinois. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania
| | - Susan Gingerich
- Dr. Monroe-DeVita, Dr. Hallgren, and Mr. Stiles are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Morse and Mr. Miller are with Places for People, St. Louis. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. McHugo and Dr. Xie are with the Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire. Ms. Peterson is with the Department of Psychology, University of Central Florida, Orlando. Mr. Akiba is with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ms. York is with the Department of Psychology, Southern Illinois University, Carbondale, Illinois. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania
| | - Bryan Stiles
- Dr. Monroe-DeVita, Dr. Hallgren, and Mr. Stiles are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Morse and Mr. Miller are with Places for People, St. Louis. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. McHugo and Dr. Xie are with the Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire. Ms. Peterson is with the Department of Psychology, University of Central Florida, Orlando. Mr. Akiba is with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ms. York is with the Department of Psychology, Southern Illinois University, Carbondale, Illinois. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania
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Stuen HK, Landheim A, Rugkåsa J, Wynn R. Responsibilities with conflicting priorities: a qualitative study of ACT providers' experiences with community treatment orders. BMC Health Serv Res 2018; 18:290. [PMID: 29669558 PMCID: PMC5907185 DOI: 10.1186/s12913-018-3097-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 04/05/2018] [Indexed: 11/21/2022] Open
Abstract
Background Patients with severe mental illness may be subjected to Community Treatment Orders (CTOs) in order to secure that the patients adhere to treatment. Few studies have investigated the use of CTOs within an Assertive Community Treatment (ACT) setting, and little is known about how the tension between the patients’ autonomy and the clinicians’ responsibility to act in the patients’ best interest are resolved in practice. The aim of this study was to explore the service providers’ experiences with CTOs within an ACT setting. Methods The study was based on reviews of case files of 15 patients, eight individual qualitative in depth interviews and four focus group interviews with service providers involved in ACT and decisions related to CTOs. A modified grounded theory approach was used to analyze the data. Results The main theme ‘responsibility with conflicting priorities’ emerged from data analysis (case file reviews, individual interviews and focus group interviews). The balance between coercive approaches and the emphasis on promoting patient autonomy was seen as problematic. The participants saw few alternatives to CTOs as long-term measures to secure ongoing treatment for some of the patients. However, participants perceived the ACT model’s comprehensive scope as an opportunity to build rapport with patients and thereby better meet their needs. The team approach, the ACT providers’ commitment to establish supportive relationships and the frequent meetings with patients in their home environment were highlighted. The ACT approach gave them insight into patients’ everyday lives and, in some cases a greater sense of security when considering whether to take patients off CTOs. Conclusions Many of the participants viewed CTOs as helpful in securing long-term treatment for patients. CTO decision-making was described as challenging and complex and presented the providers with many dilemmas. The ACT approach was considered as helpful in that it afforded comprehensive, patient-centered support and opportunities to build rapport. Electronic supplementary material The online version of this article (10.1186/s12913-018-3097-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hanne Kilen Stuen
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brummundal, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Anne Landheim
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brummundal, Norway.,Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | - Jorun Rugkåsa
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway.,Centre for Care Research, University College of Southeast Norway, Porsgrunn, Norway
| | - Rolf Wynn
- Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway. .,Divison of Mental Health and Addictions, University Hospital of North Norway, Tromsø, Norway.
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38
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Abstract
American researchers have led the world in developing, evaluating, and disseminating evidence-based psychiatric rehabilitation practices for people with serious mental illness. Paradoxically, however, the USA lags behind most industrialized nations in providing access to high-quality mental health and psychiatric services. This essay examines several evidence-based practices developed in the USA, the spread of these practices, the barriers to ensuring availability to people who could benefit from these services, and some promising directions for overcoming the barriers. Factors influencing the growth and sustainment of effective client-centred practices include the availability of adequate and stable funding, committed leadership, and the influence of vested interests. Two strategies for promoting the spread and sustainment of well-implemented evidence-based practices are the adoption of fidelity scales and learning communities.
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Affiliation(s)
- G. R. Bond
- Westat Inc, Health Studies Sector, Rivermill Commercial Center, 85 Mechanic St., Lebanon, New Hampshire 03766, USA
| | - R. E. Drake
- Westat Inc, Health Studies Sector, Rivermill Commercial Center, 85 Mechanic St., Lebanon, New Hampshire 03766, USA
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39
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Opportunities for Integrating Physical Health Within Assertive Community Treatment Teams: Results from Practitioner Focus Groups. Community Ment Health J 2017; 53:306-315. [PMID: 27401164 DOI: 10.1007/s10597-016-0043-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 07/05/2016] [Indexed: 10/21/2022]
Abstract
This qualitative study assessed the experiences of assertive community treatment (ACT) team members regarding the integration of physical and mental health self-management for persons with serious mental illness. Three focus groups elicited information from participants concerning barriers, strategies, and recommendations. Findings from inductive analyses revealed six overarching themes: (1) collaboration with primary care, (2) improvements in engagement, (3) team-focused roles, (4) education and training, (5) recommendations for system level barriers, and (6) systems collaboration. Participant recommendations suggest that ACT teams are well positioned to integrate mental and physical health treatment, but further research is needed to support integrated care.
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40
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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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41
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Ignatyev Y, Timm J, Heinze M, Indefrey S, von Peter S. Development and Preliminary Validation of the Scale for Evaluation of Psychiatric Integrative and Continuous Care-Patient's Version. Front Psychiatry 2017; 8:162. [PMID: 28912735 PMCID: PMC5583144 DOI: 10.3389/fpsyt.2017.00162] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 08/14/2017] [Indexed: 11/13/2022] Open
Abstract
This pilot study aimed to evaluate and examine an instrument that integrates relevant aspects of cross-sectoral (in- and outpatients) mental health care, is simply to use and shows satisfactory psychometric properties. The development of the scale comprised literature research, held 14 focus groups and 12 interviews with patients and health care providers, item-pool generation, content validation by a scientific expert panel, and face validation by 90 patients. The preliminary scale was tested on 385 patients across seven German hospitals with cross-sectoral mental health care (CSMHC) as part of their treatment program. Psychometric properties of the scale were evaluated using genuine and transformed data scoring. To check reliability and postdictive validity of the scale, Cronbach's α coefficient and multivariable linear regression were used. This development process led to the development of an 18-item scale called the "Scale for Evaluation of Psychiatric Integrative and Continuous Care (SEPICC)" with a two-point and five-point response options. The scale consists of two sections. The first section assesses the presence or absence of patients' experiences with various CSMHC' relevant components such as home treatment, flexibility of treatments' switching, case management, continuity of care, cross-sectoral therapeutic groups, and multidisciplinary teams. The second section evaluates the patients' opinions about these relevant components. Using raw and transformed scoring resulted into comparable results. However, data distribution using transformed scoring showed a smaller deviation from normality. For the overall scale, the Cronbach's α coefficient was 0.82. Self-reported experiences with relevant components of the CSMHC were positively associated with the patients approval of these components. In conclusion, the new scale provides a good starting point for further validation. It can be used as a tool to evaluate CSMHC. Methodologically, using transformed data scoring appeared to be preferable because of a smaller deviation from normality and a higher reliability measured by Cronbach's α.
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Affiliation(s)
- Yuriy Ignatyev
- Department of Psychiatry, Psychotherapy and Psychosomatics, Immanuel Klinik, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
| | - Jürgen Timm
- Biometry Section, Competence Center for Clinical Trials, University of Bremen, Bremen, Germany
| | - Martin Heinze
- Department of Psychiatry, Psychotherapy and Psychosomatics, Immanuel Klinik, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
| | - Sonja Indefrey
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Berlin, Germany
| | - Sebastian von Peter
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Berlin, Germany
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Csillag C, Nordentoft M, Mizuno M, Jones PB, Killackey E, Taylor M, Chen E, Kane J, McDaid D. Early intervention services in psychosis: from evidence to wide implementation. Early Interv Psychiatry 2016; 10:540-546. [PMID: 26362703 DOI: 10.1111/eip.12279] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 08/17/2015] [Indexed: 11/27/2022]
Abstract
AIM Early intervention (EI) in psychosis is a comprehensive and evidence-based approach aimed at detection and treatment of psychotic symptoms in their early stages. This paper presents core features and noteworthy aspects of the evidence basis and limitations of EI, the importance of programme fidelity, challenges for its widespread dissemination and economic perspectives related to it. METHODS This paper is a narrative review about the evidence supporting EI and the challenges to its widespread dissemination. RESULTS In spite of evidence of a wide range of benefits, widespread dissemination has been slow, and even currently implemented programmes might be threatened. This reflects in part the shortcomings of mental health care in general, such as low priority for funding, stigma and structural problems. Successful examples of advocacy, mobilization and destigmatization campaigns have overcome these difficulties. CONCLUSIONS Funding for mental health in general and for EI services appears low relative to need. One key argument for better funding for EI can be found in its favourable cost-effectiveness, but not all stakeholders beyond mental health administrators are aware of this. Positive impacts of EI programmes on excess unemployment and tax forgone suggest that social affairs and labour ministries - and not only health ministries - could be more involved in governance of mental health issues; ministries of justice and education are other sector stakeholders than can benefit. Wider dissemination of EI services will probably benefit from better integration of potential funders, promotion of joint targets and shared financial or budgetary incentives.
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Affiliation(s)
- Claudio Csillag
- Mental Health Centre North Zealand, University of Copenhagen, Copenhagen, Denmark.
| | - Merete Nordentoft
- Mental Health Centre Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Masafumi Mizuno
- Department of Neuropsychiatry, Toho University School of Medicine, Tokyo, Japan
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Eóin Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health and The Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Matthew Taylor
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - Eric Chen
- Department of Psychiatry, University of Hong Kong, Hong Kong
| | - John Kane
- Department of Psychiatry, Hofstra North Shore-Long Island Jewish School of Medicine, Hempstead, New York, USA
| | - David McDaid
- Health and Social Care, London School of Economics and Political Science, London, UK
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Linz SJ, Sturm BA. Facilitating Social Integration for People With Severe Mental Illness Served by Assertive Community Treatment. Arch Psychiatr Nurs 2016; 30:692-699. [PMID: 27888961 DOI: 10.1016/j.apnu.2016.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 05/18/2016] [Accepted: 05/29/2016] [Indexed: 11/15/2022]
Abstract
PURPOSE This article explores the experience of workers on Assertive Community Treatment (ACT) teams surrounding their efforts to facilitate social integration for their clients. DESIGN AND METHODS Sixteen workers were individually interviewed and eight additional workers participated in two focus groups. FINDINGS The formation of caring relationships between worker and client was an important first step towards social integration for ACT clients. Community activities offer opportunities for social interaction. PRACTICE IMPLICATIONS The frequency of community based activities should be increased. Social integration should be a targeted focus of service by structurally embedding a social integration specialist onto the ACT model.
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Affiliation(s)
- Sheila J Linz
- The Rutgers University School of Nursing, Camden, NJ.
| | - Bonnie A Sturm
- Seton Hall University College of Nursing, South Orange, NJ
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Lloyd-Evans B, Bond GR, Ruud T, Ivanecka A, Gray R, Osborn D, Nolan F, Henderson C, Mason O, Goater N, Kelly K, Ambler G, Morant N, Onyett S, Lamb D, Fahmy S, Brown E, Paterson B, Sweeney A, Hindle D, Fullarton K, Frerichs J, Johnson S. Development of a measure of model fidelity for mental health Crisis Resolution Teams. BMC Psychiatry 2016; 16:427. [PMID: 27905909 PMCID: PMC5133753 DOI: 10.1186/s12888-016-1139-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 11/24/2016] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Crisis Resolution Teams (CRTs) provide short-term intensive home treatment to people experiencing mental health crisis. Trial evidence suggests CRTs can be effective at reducing hospital admissions and increasing satisfaction with acute care. When scaled up to national level however, CRT implementation and outcomes have been variable. We aimed to develop and test a fidelity scale to assess adherence to a model of best practice for CRTs, based on best available evidence. METHODS A concept mapping process was used to develop a CRT fidelity scale. Participants (n = 68) from a range of stakeholder groups prioritised and grouped statements (n = 72) about important components of the CRT model, generated from a literature review, national survey and qualitative interviews. These data were analysed using Ariadne software and the resultant cluster solution informed item selection for a CRT fidelity scale. Operational criteria and scoring anchor points were developed for each item. The CORE CRT fidelity scale was then piloted in 75 CRTs in the UK to assess the range of scores achieved and feasibility for use in a 1-day fidelity review process. Trained reviewers (n = 16) rated CRT service fidelity in a vignette exercise to test the scale's inter-rater reliability. RESULTS There were high levels of agreement within and between stakeholder groups regarding the most important components of the CRT model. A 39-item measure of CRT model fidelity was developed. Piloting indicated that the scale was feasible for use to assess CRT model fidelity and had good face validity. The wide range of item scores and total scores across CRT services in the pilot demonstrate the measure can distinguish lower and higher fidelity services. Moderately good inter-rater reliability was found, with an estimated correlation between individual ratings of 0.65 (95% CI: 0.54 to 0.76). CONCLUSIONS The CORE CRT Fidelity Scale has been developed through a rigorous and systematic process. Promising initial testing indicates its value in assessing adherence to a model of CRT best practice and to support service improvement monitoring and planning. Further research is required to establish its psychometric properties and international applicability.
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Affiliation(s)
| | - Gary R. Bond
- Department of Psychiatry, Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth, Lebanon, NH 03766 USA
| | - Torleif Ruud
- Division Mental Health Services, Akershus Unieversity Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ada Ivanecka
- Mental Health Sciences Department, University of the West of England, Coldharbour Lane, Bristol, BS16 1QY UK
| | - Richard Gray
- Mental Health Sciences Department, University of the West of England, Coldharbour Lane, Bristol, BS16 1QY UK
| | - David Osborn
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Fiona Nolan
- Research Department of Clinical, Education and Health Psychology, University College London Gower Street, London, WC1E 6BT UK
| | - Claire Henderson
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, 16 De Crespigny Park, London, SE5 8AF UK
| | - Oliver Mason
- Research Department of Clinical, Education and Health Psychology, University College London Gower Street, London, WC1E 6BT UK
- School of Psychology, University of Surrey, Guildford, Surrey GU2 7XH UK
| | - Nicky Goater
- West London Mental Health NHS Trust, Uxbridge Road, Southall, London, UB1 3EU UK
| | - Kathleen Kelly
- Oxfordshire Healthcare NHS Foundation Trust, Barnes Unit, John Radcliffe Hospital, Oxford, OX3 9DU UK
| | - Gareth Ambler
- Department of Statistical Science, UCL, Gower Street, London, WC1E 6BT UK
| | - Nicola Morant
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Steve Onyett
- Onyett Entero Ltd, care of University of the West of England, Health and Life Sciences Coldharbour Ln, Bristol, BS16 1QY UK
| | - Danielle Lamb
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Sarah Fahmy
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Ellie Brown
- Mental Health Sciences Department, University of the West of England, Coldharbour Lane, Bristol, BS16 1QY UK
| | - Beth Paterson
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Angela Sweeney
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - David Hindle
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Kate Fullarton
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Johanna Frerichs
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Sonia Johnson
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
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Lofthus AM, Westerlund H, Bjørgen D, Lindstrøm JC, Lauveng A, Clausen H, Ruud T, Heiervang KS. Are Users Satisfied with Assertive Community Treatment in Spite of Personal Restrictions? Community Ment Health J 2016; 52:891-897. [PMID: 26868646 DOI: 10.1007/s10597-016-9994-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 01/27/2016] [Indexed: 10/22/2022]
Abstract
The purpose of this explorative study was to examine satisfaction among 70 users of 12 Norwegian Assertive Community Treatment teams. The study was carried out among a group of 70 service users, and reveals generally high levels of satisfaction with the service, with satisfaction also being high in comparison to other ACT satisfaction studies. Users under a Community Treatment Order were more satisfied, while users with an alcohol use disorder were less satisfied. Younger service users were less positive than older users. There was no difference in satisfaction between the genders. This study's positive result may reflect the ACT model's focus on user involvement, recovery and building relationships, and the fact that this service has a more holistic approach than previous services that users have experienced.
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Affiliation(s)
- Ann-Mari Lofthus
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway.
| | - Heidi Westerlund
- National Centre for Knowledge through Experience in Mental Health, Skien, Norway
| | - Dagfinn Bjørgen
- National Centre for Knowledge through Experience in Mental Health, Skien, Norway
| | | | - Arnhild Lauveng
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | - Hanne Clausen
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | - Torleif Ruud
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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46
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Staff Turnover in Assertive Community Treatment (Act) Teams: The Role of Team Climate. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2016; 44:258-268. [DOI: 10.1007/s10488-016-0740-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Clausen H, Ruud T, Odden S, Šaltytė Benth J, Heiervang KS, Stuen HK, Killaspy H, Drake RE, Landheim A. Hospitalisation of severely mentally ill patients with and without problematic substance use before and during Assertive Community Treatment: an observational cohort study. BMC Psychiatry 2016; 16:125. [PMID: 27145937 PMCID: PMC4855443 DOI: 10.1186/s12888-016-0826-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 04/22/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Co-occurring substance use increases the risk of hospitalisation in people with severe mental illness, whereas Assertive Community Treatment (ACT) generally reduces hospitalisation in patients with severe mental illness and high inpatient service use. Because the superiority of ACT over standard services amongst patients with problematic substance use is uncertain, the present study examined inpatient service use amongst patients with and without problematic substance use in the 2 years before and the 2 years after they enrolled into ACT teams. METHODS This naturalistic observational study included 142 patients of 12 different ACT teams throughout Norway. The teams assessed the patients upon enrolment into ACT using clinician-rated and self-reported questionnaires. We obtained hospitalisation data from the Norwegian Patient Register for the 2 years before and the 2 years after enrolment into ACT. We used linear mixed models to assess changes in hospitalisation and to explore associations between problematic substance use and changes in hospitalisation, controlling for socio-demographic and clinical characteristics. RESULTS A total of 84 (59%) participants had problematic substance use upon enrolment into the ACT teams. In the 2 years after ACT enrolment both participants with and without problematic substance use experienced a reduction in total inpatient days. Those with problematic substance use also had fewer involuntary inpatient days. Exploratory analyses suggested that symptom severity and functioning level interacted with problematic substance use to influence change in total inpatient days. CONCLUSION These findings may suggest that ACT teams successfully support people with complex mental health problems in the community, including those with problematic substance use, and thereby contribute to a reduction in inpatient service use.
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Affiliation(s)
- Hanne Clausen
- Department of Research & Development, Mental Health Services, Akershus University Hospital, Lørenskog, Norway. .,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Torleif Ruud
- Department of Research & Development, Mental Health Services, Akershus University Hospital, Lørenskog, Norway ,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Sigrun Odden
- National Centre for Dual Diagnosis, Innlandet Hospital Trust, Brumunddal, Norway
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway ,HØKH Research Centre, Akershus University Hospital, Lørenskog, Norway
| | - Kristin Sverdvik Heiervang
- Department of Research & Development, Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | - Hanne Kilen Stuen
- National Centre for Dual Diagnosis, Innlandet Hospital Trust, Brumunddal, Norway
| | - Helen Killaspy
- Division of Psychiatry, University College London, London, UK
| | - Robert E. Drake
- Dartmouth Psychiatric Research Center, Lebanon, New Hampshire USA
| | - Anne Landheim
- National Centre for Dual Diagnosis, Innlandet Hospital Trust, Brumunddal, Norway ,Addiction Research, University of Oslo, Oslo, Norway
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Clausen H, Landheim A, Odden S, Šaltytė Benth J, Heiervang KS, Stuen HK, Killaspy H, Ruud T. Hospitalization of high and low inpatient service users before and after enrollment into Assertive Community Treatment teams: a naturalistic observational study. Int J Ment Health Syst 2016; 10:14. [PMID: 26933446 PMCID: PMC4772328 DOI: 10.1186/s13033-016-0052-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 02/24/2016] [Indexed: 11/10/2022] Open
Abstract
Background Assertive Community Treatment (ACT) is more successful in reducing hospitalization when baseline use is high. However, with a growing recovery-focus, ACT may be useful for people with severe mental illness who are difficult to engage but not high users of inpatient services. This study investigated hospitalization 2 years before and 2 years after ACT enrollment amongst patients both with and without high inpatient services use before enrollment into ACT. Methods This naturalistic observational study included 142 patients from 12 different ACT teams throughout Norway. Of these, 74 (52 %) were high users of inpatient services before ACT. The teams assessed the patients upon enrollment using clinician-rated and self-reported questionnaires. Hospitalization data from 2 years before and 2 years after enrollment into ACT were obtained from the Norwegian Patient Registry. Linear mixed models were used to assess changes in hospitalization and to explore associations between these changes and patient characteristics. Results When the participants enrolled into the ACT teams, high users of inpatient care were younger, more often living alone and more often subject to involuntary outpatient treatment than low users. The participants spent significantly fewer days in hospital during the 2 years of ACT follow-up compared to the 2 years before enrollment. The reduction was more evident amongst high users, whereas low users had an initial increase in inpatient days in the first year of ACT and a subsequent decrease in the second year. More severe negative symptoms and previous high use of inpatient care were associated with a reduction in both total and involuntary inpatient days. Additionally, a reduction in involuntary inpatient days was associated with being subject to involuntary outpatient treatment upon enrollment into ACT. Conclusion The findings in this study may suggest that ACT contributes to more appropriate use of inpatient care, possibly by reducing the presumably avoidable hospitalization of high users and increasing the presumably needed inpatient care of low users.
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Affiliation(s)
- Hanne Clausen
- Department of Research and Development, Mental Health Services, Akershus University Hospital, Lørenskog, Norway ; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anne Landheim
- National Centre for Dual Diagnosis, Innlandet Hospital Trust, Brumunddal, Norway ; Addiction Research, University of Oslo, Oslo, Norway
| | - Sigrun Odden
- National Centre for Dual Diagnosis, Innlandet Hospital Trust, Brumunddal, Norway
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway ; HØKH Research Centre, Akershus University Hospital, Lørenskog, Norway
| | - Kristin Sverdvik Heiervang
- Department of Research and Development, Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | - Hanne Kilen Stuen
- National Centre for Dual Diagnosis, Innlandet Hospital Trust, Brumunddal, Norway
| | - Helen Killaspy
- Division of Psychiatry, University College London, London, UK
| | - Torleif Ruud
- Department of Research and Development, Mental Health Services, Akershus University Hospital, Lørenskog, Norway ; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Medeiros PFP, Cruz JI, R Schneider D, Sanudo A, Sanchez ZM. Process evaluation of the implementation of the Unplugged Program for drug use prevention in Brazilian schools. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2016; 11:2. [PMID: 26739461 PMCID: PMC4704293 DOI: 10.1186/s13011-015-0047-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 12/23/2015] [Indexed: 11/10/2022]
Abstract
Background Most Brazilian schools do not have a continuous program for drug use prevention. To address this gap, the Ministry of Health adapted the European evidence-based program Unplugged to improve the drug use prevention efforts of Brazilian public schools. The aim of this study was to evaluate the process of program implementation in three Brazilian cities among middle school students between 6th and 9th grade (11 to 14 years old). Methods Mixed methods were used in this process evaluation study, including focus groups, fidelity forms, and satisfaction questionnaires. Study participants included 36 teachers, 11 school administrators, 6 coaches, 16 stakeholders, and 1267 students from 62 classes in 8 schools. Results The 12 Unplugged lessons were all implemented in 94 % of the classes. However, only 57 % of the classes were completed as described in the program's manual. The decision to exclude activities because of time constraints was made without a common rationale. Teachers reported difficulties due to the amount of time necessary to plan the lessons and implement the activities. In addition, they mentioned that the lack of support from school administrators was an obstacle to proper program implementation. The majority of students and teachers responded positively to the program, reporting changes in the classroom environment and in personal skills or knowledge. Conclusions The Unplugged program can be feasibly implemented in Brazilian public schools. However, it is necessary to reduce the number of activities per class and to restructure the format of the standard teaching schedule to ensure that the normal academic content is still taught while Unplugged is being implemented.
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Affiliation(s)
- Pollyanna F P Medeiros
- Department of Preventive Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Botucatu, 740, 4° andar, São Paulo, SP, Brazil
| | - Joselaine I Cruz
- Department of Preventive Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Botucatu, 740, 4° andar, São Paulo, SP, Brazil
| | - Daniela R Schneider
- Department of Psychology, Universidade Federal de Santa Catarina, School of Psychology, Florianopolis, Brazil
| | - Adriana Sanudo
- Department of Preventive Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Botucatu, 740, 4° andar, São Paulo, SP, Brazil
| | - Zila M Sanchez
- Department of Preventive Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Botucatu, 740, 4° andar, São Paulo, SP, Brazil.
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Stuen HK, Rugkåsa J, Landheim A, Wynn R. Increased influence and collaboration: a qualitative study of patients' experiences of community treatment orders within an assertive community treatment setting. BMC Health Serv Res 2015; 15:409. [PMID: 26400028 PMCID: PMC4581043 DOI: 10.1186/s12913-015-1083-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 09/21/2015] [Indexed: 11/24/2022] Open
Abstract
Background Since 2009, 14 assertive community treatment (ACT) teams have started up in Norway. Over 30 % of the patients treated by the ACT teams were subject to community treatment orders (CTOs) at intake. CTOs are legal mechanisms to secure treatment adherence for patients with severe mental illness. Little is known about patients’ views and experiences of CTOs within an ACT context. Methods The study was based on qualitative in depth interviews with 15 patients that were followed up by ACT teams and that were currently subjected to CTOs. The data were analyzed by using a modified grounded theory approach. Results While some participants experienced the CTO as a security net and as an important factor for staying well, others described the CTO as a social control mechanism and as a violation of their autonomy. Although experiencing difficulties and tensions, many participants described the ACT team as a different mental health arena from what they had known before, with another frame of interaction. Despite being legally compelled to receive treatment, many participants talked about how the ACT teams focused on addressing unmet needs, the management of future crises, and finding solutions to daily life problems. Assistance with housing and finances, reduced social isolation, and being able to seek help voluntarily were positive outcomes emphasized by many patients. Discussion The participants had different views of being on a CTO within an ACT setting. While some remained clearly negative to the CTO, others described a gradual transition toward regarding the CTO as an acceptablesolution as they gained experience of ACT. Many of the participants valued the supportive relationship withthe ACT team, and communication with the care providers and the care providers’ attitudes could make a significant difference. The study shows that the perception of coercion is context dependent, and that the relationship between care providers and patients is of importance to how patients interpret the providers’ behavior and the restrictive interventions. Conclusions Although some patients focused on loss of autonomy and being compelled to take medications, other patients emphasised the supportive relationships they had with the ACT teams and that they had received help with housing, finances, and other daily life problems. Thus, being on mandated community treatment could be acceptable in the opinion of several of the patients, provided that they received other services that they found beneficial.
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Affiliation(s)
- Hanne Kilen Stuen
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brummundal, Norway. .,Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway.
| | - Jorun Rugkåsa
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway. .,Departement of Psychiatry, University of Oxford, Oxford, UK.
| | - Anne Landheim
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brummundal, Norway. .,Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway.
| | - Rolf Wynn
- Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway. .,Divison of Mental Health and Addictions, University Hospital of North Norway, Tromsø, Norway.
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