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Engelsbel F, Keet R, Nugter A. A pre-post study design: evaluating the effectiveness of a new community-based integrated service model on patient outcomes. Int J Ment Health Syst 2024; 18:20. [PMID: 38725081 PMCID: PMC11084129 DOI: 10.1186/s13033-024-00636-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 04/25/2024] [Indexed: 05/12/2024] Open
Abstract
This study aimed to evaluate a new service model, Specialists Together In the Community (STIC), in terms of patient outcomes. This model integrates Flexible Assertive Community Treatment (FACT)-principles with expertise of specialized teams that offer diagnosis-related outpatient treatment. In a pre-post design, symptoms and quality of life of 930 former FACT-patients were measured repeatedly pre- and post-STIC. Regarding patients in former specialized teams, pre- and post-treatment social functioning and symptoms were measured for the pre- (n = 944) and post-STIC (n = 544) groups. Against expectation, symptoms of former FACT-patients remained stable post-STIC compared to a slight decrease pre-STIC. According to expectation, pre- and post-STIC groups had an equal symptom reduction. Unexpectedly, the post-STIC group did not improve more on social functioning than the pre-STIC group. Explorative analysis showed less treatment contacts in the post-STIC group. The highly similar patient outcomes post-STIC could be improved by monitoring process outcomes and prolonging study duration.
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Affiliation(s)
- Fabiana Engelsbel
- GGZ Noord-Holland-Noord Research Department, Heerhugowaard, The Netherlands.
| | - René Keet
- GGZ Noord-Holland-Noord FIT-Academy, Heerhugowaard, The Netherlands
| | - Annet Nugter
- GGZ Noord-Holland-Noord Research Department, Heerhugowaard, The Netherlands
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de Bruijn E, Jochems EC, Wierdsma AI, Voskes Y. The Overlooked Part of Flexible Assertive Community Treatment-A Retrospective Study on Factors Related to Discharge from FACT for Clients with a Psychotic Disorder. Community Ment Health J 2023; 59:1313-1320. [PMID: 37086300 PMCID: PMC10447266 DOI: 10.1007/s10597-023-01115-z] [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] [Received: 09/28/2022] [Accepted: 03/08/2023] [Indexed: 04/23/2023]
Abstract
Flexible assertive community treatment (FACT) is a recovery-based treatment and its manual describes discharge criteria for clients who are recovered. Yet research on discharge is lacking. In this retrospective and observational study, between 2009 and 2019, we explored how sociodemographic, clinical, and treatment factors are associated with planned discharge or no discharge. We included 1734 clients with a psychotic disorder of which 38.5% were discharged after a mutual decision that FACT was no longer necessary. Logistic regression analysis was used to create a discharge profile which was more favorable for discharged clients. They were older at the start of FACT, had lower HoNOS scores, were diagnosed with another psychotic disorder, and had fewer contacts with non-FACT members. Discharge is a part of FACT and is more common than anticipated. While this study provides preliminary answers, further research is necessary to better understand discharge and its associated factors.
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Affiliation(s)
- Eva de Bruijn
- GGZ Breburg, Tilburg, The Netherlands
- Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, Tilburg, The Netherlands
| | | | | | - Yolande Voskes
- GGZ Breburg, Tilburg, The Netherlands
- Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, Tilburg, The Netherlands
- Department of Ethics, Law and Humanities, Amsterdam UMC, Amsterdam, The Netherlands
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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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Roebroek LO, Bruins J, Boonstra A, Veling W, Jörg F, Sportel BE, Delespaul PA, Castelein S. The effects of a computerized clinical decision aid on clinical decision-making in psychosis care. J Psychiatr Res 2022; 156:532-537. [PMID: 36356555 DOI: 10.1016/j.jpsychires.2022.10.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 10/07/2022] [Accepted: 10/26/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Clinicians in mental healthcare have few objective tools to identify and analyze their patient's care needs. Clinical decision aids are tools that support this process. This study examines whether 1) clinicians working with a clinical decision aid (TREAT) discuss more of their patient's care needs compared to usual treatment, and 2) agree on more evidence-based treatment decisions. METHODS Clinicians participated in consultations (n = 166) with patients diagnosed with psychotic disorders from four Dutch mental healthcare institutions (research registration number 201700763). Primary outcomes were measured with the modified Clinical Decision-making in Routine Care questionnaire and combined with psychiatric, physical and social wellbeing related care needs. A multilevel analysis compared discussed care needs and evidence-based treatment decisions between treatment as usual (TAU) before, TAU after and the TREAT condition. RESULTS First, a significant increase in discussed care needs for TREAT compared to both TAU conditions (β = 20.2, SE = 5.2, p = 0.00 and β = 15.8, SE = 5.4, p = 0.01) was found. Next, a significant increase in evidence-based treatments decisions for care needs was observed for TREAT compared to both TAU conditions (β = 16.7, SE = 4.8, p = 0.00 and β = 16.0, SE = 5.1, p = 0.01). CONCLUSION TREAT improved the discussion about physical health issues and social wellbeing related topics. It also increased evidence-based treatment decisions for care needs which are sometimes overlooked and difficult to treat. Our findings suggest that TREAT makes sense of routine outcome monitoring data and improves guideline-informed care.
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Affiliation(s)
- Lukas O Roebroek
- Lentis Psychiatric Institute, Lentis Research, Groningen, the Netherlands; University of Groningen, Faculty of Behavioural and Social Sciences, Groningen, the Netherlands; University of Groningen, University Medical Centre Groningen, Rob Giel Research Centre, Groningen, the Netherlands.
| | - Jojanneke Bruins
- Lentis Psychiatric Institute, Lentis Research, Groningen, the Netherlands; University of Groningen, University Medical Centre Groningen, Rob Giel Research Centre, Groningen, the Netherlands
| | - Albert Boonstra
- University of Groningen, Faculty of Economics and Business, Groningen, the Netherlands
| | - Wim Veling
- University of Groningen, University Medical Centre Groningen, Rob Giel Research Centre, Groningen, the Netherlands; University Center for Psychiatry, Groningen, the Netherlands
| | - Frederike Jörg
- University of Groningen, University Medical Centre Groningen, Rob Giel Research Centre, Groningen, the Netherlands; GGZ Friesland Mental Health Services, Leeuwarden, the Netherlands
| | | | - Philippe A Delespaul
- Maastricht University, Faculty of Medicine, Department of Psychiatry & Neuropsychology, Maastricht, the Netherlands; Mondriaan Mental Health Trust, Heerlen-Maastricht, the Netherlands
| | - Stynke Castelein
- Lentis Psychiatric Institute, Lentis Research, Groningen, the Netherlands; University of Groningen, Faculty of Behavioural and Social Sciences, Groningen, the Netherlands; University of Groningen, University Medical Centre Groningen, Rob Giel Research Centre, Groningen, the Netherlands
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Trane K, Aasbrenn K, Rønningen M, Odden S, Lexén A, Landheim AS. Flexible Assertive Community Treatment in Rural and Remote Areas: A Qualitative Study of the Challenges and Adaptations of the Model. Front Public Health 2022; 10:913159. [PMID: 35983354 PMCID: PMC9379540 DOI: 10.3389/fpubh.2022.913159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundFlexible assertive community treatment (FACT) is an innovative model for providing long-term treatment to people with severe mental illness. The model was developed in the Netherlands but is now used in other countries, including Norway, which has a geography different from the Netherlands, with many rural and remote areas. Implementation of innovations is context dependent. The FACT model's potential in rural and remote areas has not been studied. Therefore, we aimed to gain knowledge regarding the challenges and modifications of the model in rural and remote contexts and discuss how they can affect the model's potential in such areas. This knowledge can improve the understanding of how FACT or similar services can be adapted to function most optimally in such conditions. We sought to address the following questions: Which elements of the FACT model do team leaders of the rural FACT teams find particularly challenging due to the context, and what modifications have the teams made to the model?MethodsDigital interviews were conducted with five team leaders from five rural FACT teams in different parts of Norway. They were selected using purposive sampling to include team leaders from some of the most rural teams in Norway. The interviews were analyzed using thematic text analysis.ResultsThe following three themes described elements of the FACT model that were experienced particularly challenging in the rural and remote context: multidisciplinary shared caseload approach, intensive outreach and crisis management. The following eight themes described the modifications that the teams had made to the model: intermunicipal collaboration, context-adaptive planning, delegation of tasks to municipal services, part-time employment, different geographical locations of staff, use of digital tools, fewer FACT board meetings, and reduced caseload.ConclusionsRural and remote contexts challenge the FACT model's potential. However, modifications can be made, some of which can be considered innovative modifications that can increase the model's potential in such areas, while others might move the teams further away from the model.
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Affiliation(s)
- Kristin Trane
- The Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Inland Hospital Trust, Hamar, Norway
- *Correspondence: Kristin Trane
| | | | | | - Sigrun Odden
- The Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Inland Hospital Trust, Hamar, Norway
| | | | - Anne Signe Landheim
- The Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Inland Hospital Trust, Inland Norway University of Applied Sciences, Hamar, Norway
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Jørgensen K, Rasmussen T, Hansen M, Andreasson K, Karlsson B. Recovery-Oriented Network Meetings in Mental Healthcare: A Qualitative Study. Issues Ment Health Nurs 2022; 43:164-171. [PMID: 34469284 DOI: 10.1080/01612840.2021.1961178] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Recovery-oriented cross-sectoral collaboration is a cornerstone of the debate concerning health professionals and users of mental health services and constitutes an objective in government health policy in Scandinavia and other Western countries. Users do not find that professionals communicate with each other across specific sectors regarding plans that have been prepared. They often experience that they have to start over again every time they switch between treatment locations. The aim of this study is to develop a recovery-oriented model for network meetings. Health professionals and users with experience from mental health services participated in three workshops to discuss and achieve a plan for recovery-oriented network meetings. Knowledge was generated in dynamic research cycles that were experiential, presentational, propositional, and practical. Themes were developed and framed by a content analysis.Recommendations are presented as a narrative from all the participants involved. The overall theme was 'more focus on personal recovery' with subthemes such as 'CHIME as a recovery-oriented approach'. In addition, other themes were generated such as 'open dialogical meetings', with subthemes such as 'meeting structures' and 'open dialogues'. This study concludes recommendations to promote a recovery-oriented approach in cross-sectoral network meetings inspired by theoretical perspectives along with the experiences and knowledge of co-researchers.
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Affiliation(s)
- Kim Jørgensen
- The Research Collaboration, Psychiatric Centre North Zealand, Hillerød, Denmark
| | - Tonie Rasmussen
- Department of Social and Health, Center for Quality and Development, Birkerød, Denmark
| | - Morten Hansen
- FACT Team 1, Psychiatric Outpatient Clinic, Copenhagen, Denmark
| | - Kate Andreasson
- The Research Collaboration, Psychiatric Centre North Zealand, Hillerød, Denmark
| | - Bengt Karlsson
- Mental Health Care, Center for Mental Health and Substance Abuse, Department of Health, Social and Welfare Studies, Faculty of Health and Social Sciences, Universitetet I Sørøst-Norge, Notodden, Norway
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Weijers J, Ten Kate C, Viechtbauer W, Rampaart LJA, Eurelings EHM, Selten JP. Mentalization-based treatment for psychotic disorder: a rater-blinded, multi-center, randomized controlled trial. Psychol Med 2021; 51:2846-2855. [PMID: 32466811 PMCID: PMC8640364 DOI: 10.1017/s0033291720001506] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 04/29/2020] [Accepted: 05/06/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Impaired mentalizing ability - an impaired ability to understand one's own and other people's behavior in terms of mental states - is associated with social dysfunction in non-affective psychotic disorder (NAPD). We tested whether adding mentalization-based treatment for psychotic disorder (MBTp) to treatment as usual (TAU) results in greater improvement in social functioning. METHODS Multicenter, rater-blinded, randomized controlled trial. Eighty-four patients with NAPD were assigned to TAU or MBTp plus TAU. Patients in the MBTp group received 18 months of MBTp, consisting of weekly group sessions and one individual session per 2 weeks. Social functioning was measured using the Social Functioning Scale. We conducted ANCOVAs to examine the difference between treatment conditions directly after treatment and at 6-month follow-up and performed moderation and mediation analyses. RESULTS Intention-to-treat analyses showed no significant differences between groups post-treatment (p = 0.31) but revealed the MBTp group to be superior to TAU at follow-up (p = 0.03). Patients in the MBTp group also seemed to perform better on measures of mentalizing ability, although evidence of a mediation effect was limited (p = 0.06). Lastly, MBTp treatment was less effective in chronic patients than in recent-onset patients (p = 0.049) and overall symptoms at baseline were mild, which may have reduced the overall effectiveness of the intervention. CONCLUSION The results suggest that MBTp plus TAU may lead to more robust improvements in social functioning compared to TAU, especially for patients with a recent onset of psychosis.
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Affiliation(s)
- J. Weijers
- Rivierduinen Institute for Mental Health Care, Sandifortdreef 19, 2333 ZZ Leiden, The Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands
| | - C. Ten Kate
- Rivierduinen Institute for Mental Health Care, Sandifortdreef 19, 2333 ZZ Leiden, The Netherlands
| | - W. Viechtbauer
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands
| | - L. J. A. Rampaart
- Rivierduinen Institute for Mental Health Care, Sandifortdreef 19, 2333 ZZ Leiden, The Netherlands
| | - E. H. M. Eurelings
- Department of Clinical Psychology, Health, and Neuropsychology, Leiden University, Wassenaarseweg 52, 2333 AKLeiden, The Netherlands
| | - J. P. Selten
- Rivierduinen Institute for Mental Health Care, Sandifortdreef 19, 2333 ZZ Leiden, The Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands
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Tjaden C, Mulder CL, den Hollander W, Castelein S, Delespaul P, Keet R, van Weeghel J, Kroon H. Effectiveness of Resource Groups for Improving Empowerment, Quality of Life, and Functioning of People With Severe Mental Illness: A Randomized Clinical Trial. JAMA Psychiatry 2021; 78:1309-1318. [PMID: 34643679 PMCID: PMC8515257 DOI: 10.1001/jamapsychiatry.2021.2880] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
IMPORTANCE Although the importance of recovery-oriented care for people with severe mental illness (SMI) is widely acknowledged, essential elements such as personalization and involvement of significant others are not adequately implemented in practice. OBJECTIVE To determine whether using resource groups (RGs) within flexible assertive community treatment (FACT) has favorable effects on empowerment and recovery-related outcomes in people with SMI. DESIGN, SETTING, AND PARTICIPANTS This assessor-blind, multisite randomized clinical trial was conducted from September 1, 2017, to September 30, 2020, with follow-up at 9 and 18 months. A total of 158 participants aged 18 to 65 years meeting the criteria for SMI were randomly allocated to FACT plus RG vs FACT as usual (1:1) in 20 FACT teams throughout the Netherlands. Data were analyzed from September 1, 2020, to January 31, 2021. The study was prespecified in the trial protocol and data from the intent-to-treat population were analyzed. INTERVENTIONS In the FACT plus RG condition, patients chose members from their informal and formal networks to form an RG that meets quarterly to discuss self-formulated recovery goals. The RG was integrated into the multidisciplinary support provided by the FACT team. In the FACT as-usual condition, empowerment (defined as overcoming powerlessness and gaining control of one's life) and involvement of significant others was also part of the provided care, but without the structure of the RG. MAIN OUTCOMES AND MEASURES The primary outcome was self-reported empowerment, measured with the Netherlands Empowerment List. RESULTS A total of 158 participants with SMI (median age, 38 [median absolute deviation, 13] years; 93 men [58.9%]) were randomized to FACT plus RG (n = 80) or FACT as usual (n = 78) care. Intention-to-treat analyses showed that randomization to the RG condition was associated with a clinically significant increase in empowerment (Cohen d, 0.54; 95% CI, 0.21-0.86) and improved outcomes with small to medium effect sizes in terms of quality of life (Cohen d, 0.25; 95% CI, -0.07 to 0.56), personal recovery (Cohen d, 0.38; 95% CI, 0.06-0.69), quality of social contact (Cohen d, 0.24; 95% CI, -0.07 to 0.56), disability (Cohen d, 0.29; 95% CI, -0.03 to 0.60), general functioning (Cohen d, 0.30; 95% CI, -0.01 to 0.62), and social functioning (Cohen d, 0.28; 95% CI, -0.04 to 0.59). No differences between conditions were found regarding psychopathological symptoms, attachment, frequency of social contact, and employment. Compared with FACT as usual, participants who stayed with the assigned treatment in the RG condition were more satisfied with treatment at 9 (Cohen d = 0.45; t135 = -2.62; P = .009) and 18 (Cohen d = 0.41; t116 = -2.22; P = .02) months. CONCLUSIONS AND RELEVANCE These findings show that working with RGs improves empowerment and other mental health outcomes in people with SMI who receive community-based mental health services. This method of network-oriented care empowers people with SMI within their own environment. TRIAL REGISTRATION Netherlands Trial Register Identifier: NL6548.
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Affiliation(s)
- Cathelijn Tjaden
- Department of Reintegration and Community Care, Trimbos Institute, Utrecht, the Netherlands,Tranzo Scientific Center for Care and Welfare, Department of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands
| | - Cornelis L. Mulder
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, the Netherlands,Parnassia Psychiatric Institute, Rotterdam, the Netherlands
| | - Wouter den Hollander
- Department of Reintegration and Community Care, Trimbos Institute, Utrecht, the Netherlands
| | - Stynke Castelein
- Lentis Research, Lentis Psychiatric Institute, Groningen, the Netherlands,Faculty of Behavioural and Social Sciences, Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, the Netherlands,Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Philippe Delespaul
- School of Mental Health and NeuroSciences, Maastricht University, Maastricht, the Netherlands,Mondriaan Mental Health Trust, Maastricht/Heerlen, the Netherlands
| | - Rene Keet
- Department of Community Mental Health, GGZ Noord-Holland-Noord, Heiloo, the Netherlands
| | - Jaap van Weeghel
- Tranzo Scientific Center for Care and Welfare, Department of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands,Phrenos Centre of Expertise, Utrecht, the Netherlands
| | - Hans Kroon
- Department of Reintegration and Community Care, Trimbos Institute, Utrecht, the Netherlands,Tranzo Scientific Center for Care and Welfare, Department of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands
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van Haaren M, de Jong S, Roeg DPK. The foundations of the working alliance in assertive community treatment teams. BMC Psychiatry 2021; 21:559. [PMID: 34758777 PMCID: PMC8582115 DOI: 10.1186/s12888-021-03563-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 10/18/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In this study, we aimed to identify and define the fundamental components of the working alliance in multidisciplinary (Flexible) Assertive Community Treatment teams with shared caseloads, in order to support their daily practice and further research. METHODS After reviewing the literature, concept mapping with professionals and clients was used to define the working alliance in (F) ACT teams. The resulting concept maps formed the basis for the working alliance assessment instrument, which was pilot tested with professionals and clients through cognitive interviews with a think-aloud procedure. RESULTS The study led to the development of a twenty five-item assessment instrument to evaluate working alliances in multidisciplinary teams (WAM) that was comprised of three subscales: bond, task/goal and team. Two different versions were developed for clients and professionals. CONCLUSIONS The WAM instrument was developed to determine the quality of the working alliance in (F) ACT teams. Future research will focus on testing its psychometric properties and predictive value.
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Affiliation(s)
- M. van Haaren
- grid.491104.9Department of Outpatient Psychiatry/Department of Forensic Psychiatry, GGzE Direct/De Woenselse Poort, GGzE, Eindhoven, the Netherlands
| | - S. de Jong
- grid.468630.f0000 0004 0631 9338Research Department, Lentis Groningen, the Netherlands
| | - D. P. K. Roeg
- grid.12295.3d0000 0001 0943 3265Tilburg University, Tilburg, the Netherlands/Tranzo & Kwintes Supported Housing, PO Box 90153, 5000 LE Tilburg, Zeist, the Netherlands
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Brekke E, Clausen HK, Brodahl M, Lexén A, Keet R, Mulder CL, Landheim AS. Service User Experiences of How Flexible Assertive Community Treatment May Support or Inhibit Citizenship: A Qualitative Study. Front Psychol 2021; 12:727013. [PMID: 34566813 PMCID: PMC8457351 DOI: 10.3389/fpsyg.2021.727013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/13/2021] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to explore and describe service user experiences of how receiving services from a Flexible Assertive Community Treatment (FACT) team may support or inhibit citizenship. Within a participatory design, individual interviews with 32 service users from five Norwegian FACT teams were analyzed using thematic, cross-sectional analysis. The findings showed that FACT may support citizenship by relating to service users as whole people, facilitating empowerment and involvement, and providing practical and accessible help. Experiences of coercion, limited involvement and authoritarian aspects of the system surrounding FACT had inhibited citizenship for participants in this study.
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Affiliation(s)
- Eva Brekke
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Inland Hospital Trust, Brumunddal, Norway
| | - Hanne K. Clausen
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Inland Hospital Trust, Brumunddal, Norway
- Department of Research and Development, Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | - Morten Brodahl
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Inland Hospital Trust, Brumunddal, Norway
| | - Annika Lexén
- Department of Health Sciences, Medical Faculty, Lund University, Lund, Sweden
| | - Rene Keet
- Flexible, Innovative Top-ambulatory Academy of Community Mental Health Service, Geestelijke Gezondheidszorg Noord-Holland-Noord, Heerhugowaard, Netherlands
| | - Cornelis L. Mulder
- Department of Psychiatry, Erasmus Medical Center (MC), University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Anne S. Landheim
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Inland Hospital Trust, Brumunddal, Norway
- Department of Health and Nursing Sciences, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
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Hogewind JWF, Nugter MA, Engelsbel F. Pilot Study of the Cost-Effectiveness of Youth F-ACT in the Netherlands. Community Ment Health J 2021; 57:701-710. [PMID: 33630227 DOI: 10.1007/s10597-021-00791-z] [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: 01/12/2020] [Accepted: 01/31/2021] [Indexed: 10/22/2022]
Abstract
Mental healthcare costs are rising. Community-based interventions often are being implemented without sufficient evidence for the effectiveness in terms of care and cost. In this pilot study, we evaluated the cost-effectiveness of youth Flexible Assertive Community Treatment (F-ACT) compared to treatment as usual (TAU). In total 28 adolescents (12-18 years) participated in F-ACT (N = 13) and TAU (N = 15). The outcome measures were the percentage of adolescents with a significant improvement in quality of life and Quality Adjusted Life Years (QALYs). Costs were measured using a retrospective cost-questionnaire. Outcomes were assessed at the start and after three months of care. Compared to TAU, F-ACT resulted in a significantly higher quality of life as reported by adolescents. There was no significant difference in quality of life reported by the parents. The incremental cost-effectiveness ratio (ICER) demonstrated that youth F-ACT is more effective but with higher costs. This study may help to make evidence-based decisions in terms of who benefits the most from youth F-ACT interventions.
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Affiliation(s)
- Johannes W F Hogewind
- Department of Child and Youth Psychiatry, Mental Health Service Organization GGZ Noord-Holland-Noord, PO Box 18, 1850 BA, Heiloo, The Netherlands. .,Department of Research and Monitoring, Mental Health Service Organization GGZ Noord-Holland-Noord, PO Box 18, 1850 BA, Heiloo, The Netherlands.
| | - M Annet Nugter
- Department of Research and Monitoring, Mental Health Service Organization GGZ Noord-Holland-Noord, PO Box 18, 1850 BA, Heiloo, The Netherlands
| | - Fabiana Engelsbel
- Department of Research and Monitoring, Mental Health Service Organization GGZ Noord-Holland-Noord, PO Box 18, 1850 BA, Heiloo, The Netherlands
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The effect of flexible assertive community treatment in Denmark: a quasi-experimental controlled study. Lancet Psychiatry 2021; 8:27-35. [PMID: 33091344 DOI: 10.1016/s2215-0366(20)30424-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/12/2020] [Accepted: 08/21/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Flexible assertive community treatment (FACT) is a community-based treatment model for patients with severe mental illness that has been widely implemented despite little evidence for its effectiveness. We aimed to evaluate the effect of FACT on mental health care outcomes compared with treatment from standard community mental health teams (CMHTs) or assertive community treatment (ACT) teams in Denmark. METHODS We did a quasi-experimental, propensity-score matched, controlled study in five FACT teams, four ACT teams, and five CMHTs in the Capital Region of Denmark. The FACT teams were established on May 1, 2016 (the index date). Patients were identified through the Danish Psychiatric Register and the study population consisted of all patients receiving care from any of these teams on the index date. Assignment to treatment was based on administrative considerations and was not done by the researchers. Patient data were collected from Danish registers. The primary outcome was analysed in the intention-to-treat population and compared mental health care outcomes (psychiatric admissions and bed days, outpatient contacts, self-harm, coercion, and death by any cause) for patients under the care of CMHTs or ACT teams that were reconfigured to FACT teams (CMHT-FACT or ACT-FACT) with patients who remained under the care of CMHTs and ACT teams. Patients who received FACT were matched using propensity scores with control patients from CMHTs and ACT teams to balance differences in baseline characteristics. FINDINGS On May 1, 2016, 2034 individuals (887 in the CMHT-FACT group, 887 in the matched CMHT group, 130 in the ACT-FACT group, 130 in the matched ACT group) were enrolled and were followed up from Nov 1, 2016, to Nov 1, 2018. The number of outpatient contacts was higher for patients receiving FACT than for those in the control groups (CMHT-FACT vs CMHT: incidence rate ratio 1·15; 95 % CI 1·10-1·20; ACT-FACT vs ACT: 1·15; 1·03-1·29). Patients receiving FACT had fewer admissions than those in the control groups (CMHT-FACT vs CMHT: 0·84; 0·76-0·92; ACT-FACT vs ACT: 0·71; 0·59-0·85). However, there were no significant differences in total inpatient days, use of coercion, episodes of self-harm, or deaths. INTERPRETATION To our knowledge, this is the first study to investigate the effect of FACT compared with treatment from a CMHT or ACT team. Our results suggest that FACT can provide a more intensive approach in terms of increased outpatient contacts than CMHT care or ACT. FACT requires further evaluation through randomised controlled trials that include a cost-effectiveness component before wider implementation. FUNDING Mental Health Services in the Capital Region of Denmark.
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Mauritz MW, van Gaal BGI, Goossens PJJ, Jongedijk RA, Vermeulen H. Treating patients with severe mental illness with narrative exposure therapy for comorbid post-traumatic stress disorder. BJPsych Open 2020; 7:e12. [PMID: 33295271 PMCID: PMC7791562 DOI: 10.1192/bjo.2020.124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Interpersonal trauma and post-traumatic stress disorder (PTSD) in patients with severe mental illness (SMI) negatively affect illness course. Narrative exposure therapy (NET) is effective in vulnerable patient groups, but its efficacy and applicability has not been studied in out-patients with SMI. AIMS We aimed to evaluate the efficacy and applicability of NET in SMI on changes in PTSD, dissociation, SMI symptoms, care needs, quality of life, global functioning and care consumption. METHOD The study had a single-group, pre-test-post-test, repeated-measures design and was registered in The Netherlands National Trial Register (identifier TR571). Primary outcomes were assessed at pre-treatment (T0), 1 month post-treatment (T1) and 7 months' follow-up (T2), with a structured interview for PTSD and dissociation screening. Secondary outcomes followed routinely SMI measurements and medical data. Mixed models were used for data analysis. RESULTS The majority of the 23 participants was female (82%). Mean age was 49.9 years (s.d. 9.8) and mean PTSD duration was 24.1 years (s.d. 14.5). Mean PTSD severity decreased from 37.9 at T0 to 31.9 at T1 (-6.0 difference, 95%CI -10.0 to -2.0), and decreased further to 24.5 at T2 (-13.4 difference, 95%CI -17.4 to -9.4). Dissociation, SMI symptoms, duration of contacts, and medication decreased; global functioning increased; and quality of life and perceived needs did not change. Eleven participants were in remission for PTSD at T2, of which five were also in remission for major depression. CONCLUSIONS NET appeared efficacious and applicable to out-patients with SMI and PTSD, and was well tolerated.
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Affiliation(s)
- Maria W Mauritz
- GGNet Center for Mental Health Care, The Netherlands; Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, The Netherlands
| | - Betsie G I van Gaal
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, The Netherlands; HAN University for Applied Sciences, Nursing Studies, Nijmegen, The Netherlands
| | - Peter J J Goossens
- Dimence Group, Center for Mental Health Care, Specialistisch Centrum Bipolaire Stoornissen, The Netherlands; and University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Belgium
| | - Ruud A Jongedijk
- ARQ Centrum '45; and ARQ National Psychotrauma Center, The Netherlands
| | - Hester Vermeulen
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, The Netherlands; and HAN University for Applied Sciences, Nursing studies, Nijmegen, The Netherlands
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O'Donnell R, Savaglio M, Fast D, Vincent A, Vicary D, Skouteris H. MyCare study: protocol for a controlled trial evaluating the effect of a community-based intervention on psychosocial, clinical outcomes and hospital admission rates for adults with severe mental illness. BMJ Open 2020; 10:e040610. [PMID: 33234646 PMCID: PMC7684817 DOI: 10.1136/bmjopen-2020-040610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION People with serious mental illness (SMI) often fail to receive adequate treatment. To provide a higher level of support, mental health systems have been reformed substantially to integrate mental healthcare into the community. MyCare is one such community-based mental health model of care. This paper describes the study protocol of a controlled trial examining the effect of MyCare on psychosocial and clinical outcomes and hospital admission and duration rates for adults with SMI. METHODS AND ANALYSIS This is a multisite non-randomised controlled trial with a 3, 6 and 12-month follow-up period. The study participants will be adults (18-64 years of age) with SMI recruited from Hobart, Launceston and the North-West of Tasmania. The treatment group will include adults who receive both the MyCare intervention and standard mental health support; the control group will include adults who receive only standard mental health support. The primary outcome includes psychosocial and clinical functioning and the secondary outcome will examine hospital admission rates and duration of stay. Mixed-effects models will be used to examine outcome improvements between intake and follow-up. This trial will generate the evidence needed to evaluate the effect of a community mental health support programme delivered in Tasmania, Australia. If MyCare results in sustained positive outcomes for adults with SMI, it could potentially be scaled up more broadly across Australia, addressing the inequity and lack of comprehensive treatment that many individuals with SMI experience. ETHICS AND DISSEMINATION This study has been approved by the Tasmanian Health and Medical Human Research Ethics Committee. The findings will be disseminated to participants and staff who delivered the intervention, submitted for publication in a peer-reviewed journal and shared at academic conferences. TRIAL REGISTRATION NUMBER ACTRN12620000673943.
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Affiliation(s)
- Renée O'Donnell
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - Melissa Savaglio
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| | | | | | | | - Helen Skouteris
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
- Warwick Business School, University of Warwick, Coventry, West Midlands, UK
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Broersen M, Creemers DHM, Frieswijk N, Vermulst AA, Kroon H. Investigating the critical elements and psychosocial outcomes of Youth Flexible Assertive Community Treatment: a study protocol for an observational prospective cohort study. BMJ Open 2020; 10:e035146. [PMID: 32265243 PMCID: PMC7245379 DOI: 10.1136/bmjopen-2019-035146] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION When adolescents experience complex psychiatric and social problems, numerous healthcare services usually become involved. In these cases, fragmentation of care services is a risk that often results in both ineffective care and in patients disengaging from care services. To address these issues, Youth Flexible Assertive Community Treatment (Youth Flexible ACT) was developed in the Netherlands. This client-centred service delivery model aims to tackle the fragmented care system by providing psychiatric treatment and support in a flexible and integrated manner. While Youth Flexible ACT is gaining in popularity, the effectiveness of the care model remains largely unexamined. METHODS AND ANALYSIS Here, we present an observational prospective cohort (2017-2021) in which a broad range of treatment outcomes will be monitored. The primary aim of the study is to examine change in treatment outcomes over the course of the Flexible ACT care. The secondary aim is to examine the association between (elements of) Youth Flexible ACT model fidelity and treatment outcomes. An estimated total number of 200 adolescents who receive care from one of the 16 participating Youth Flexible ACT teams will be included in the study. Participants will be asked to complete assessments at four time points in 6-month intervals, resulting in a study duration of 18 months. Latent growth curve analysis will be conducted to examine change in psychosocial functioning over time and its relation to model fidelity. ETHICS AND DISSEMINATION This study received ethical approval from Trimbos Ethics Committee (201607_75-FACT2). This approval applies for all participating institutions. The results of the study will be reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology statement. Results will be disseminated via peer-reviewed academic journals and presentations at conferences. In addition, results will be made available for participating sites, funders and researchers.
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Affiliation(s)
- Marieke Broersen
- GGZ Oost Brabant, Oss, The Netherlands
- Tranzo - Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | | | | | | | - Hans Kroon
- Tranzo - Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Trimbos Institute, Utrecht, The Netherlands
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Drake RE, Wallach MA. Assessing the Optimal Number of Psychiatric Beds for a Region. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 46:696-700. [PMID: 31292772 DOI: 10.1007/s10488-019-00954-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Robert E Drake
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA. .,IPS Employment Center, Rivermill Commercial Center, Westat, Suite C3-1, Mailbox 4A, Lebanon, NH, 03766, USA.
| | - Michael A Wallach
- Professor Emeritus of Psychological and Brain Sciences, Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
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Roe D, Mazor Y, Gelkopf M. Patient-reported outcome measurements (PROMs) and provider assessment in mental health: a systematic review of the context of implementation. Int J Qual Health Care 2019; 34:ii28–ii39. [DOI: 10.1093/intqhc/mzz084] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 07/25/2019] [Accepted: 08/02/2019] [Indexed: 02/06/2023] Open
Abstract
Abstract
Purpose
To review and integrate the vast amount of literature yielded by recent growing interest in patient-reported outcome measurement and routine outcome measures (PROMs/ROMs), in order to suggest options and improvements for implementation. PROMs are the systematic assessment of service users’ health using standardized self-report measures. Specifically, for ROMs, it includes routine provider or caretaker assessment measures. Both are administered to ascertain routinely, the impact of treatment in mental health settings and to improve care. A review is needed because of the large differences in setting, conceptualization, practice and implementation. Here, we examine the different major projects worldwide.
Data sources
Psych INFO and PubMed including Medline, Biomed Central, EMBASE Psychiatry and Elsevier Science’s Direct.
Study selection
We conducted a systematized review of the literature published from 2000 to 2018 on the implementation and sustainability of PROMs and ROMs in mental health services for adults.
Data extraction, synthesis and Results
We described and characterized the programs in different countries worldwide. We identified 103 articles that met the inclusion criteria, representing over 80 PROMs/ROMs initiatives in 15 countries. National policy and structure of mental health services were found to be major factors in implementation. We discuss the great variability in PROMs/ROMs models in different countries, making suggestions for their streamlining and improvement.
Conclusion
We extracted valuable information on the different characteristics of the numerous PROMs/ROMs initiatives worldwide. However, in the absence of a strong nationwide policy effort and support, implementation seems scattered and irregular. Thus, development of the implementation of PROMs/ROMs is left to groups of enthusiastic clinicians and researchers, making sustainability problematic.
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Affiliation(s)
- David Roe
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, 199 Aba Khoushy Ave. Mount Carmel, Haifa, 3498838 Israe
- Center for Community Mental Health, Research, Practice and Policy, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel
- Department of Clinical Medicine, Psychiatry, Aalborg University, Denmark
| | - Yael Mazor
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, 199 Aba Khoushy Ave. Mount Carmel, Haifa, 3498838 Israe
- Center for Community Mental Health, Research, Practice and Policy, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel
| | - Marc Gelkopf
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, 199 Aba Khoushy Ave. Mount Carmel, Haifa, 3498838 Israe
- Center for Community Mental Health, Research, Practice and Policy, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel
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Svensson B, Hansson L, Lexén A. Outcomes of clients in need of intensive team care in Flexible Assertive Community Treatment in Sweden. Nord J Psychiatry 2018; 72:226-231. [PMID: 29373933 DOI: 10.1080/08039488.2018.1430168] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Flexible Assertive Community Treatment (Flexible ACT) has been implemented in Sweden during recent years due to increasing interest in integrated services for people with severe mental illness. To date, few studies have been done on Flexible ACT effectiveness. AIMS The overall aim of this study was to explore the extent to which clients assigned to the Flexible ACT board for ACT intensive care were stabilized with improved everyday functioning, social outcomes, and changes in healthcare use. METHODS Ninety-three participants with psychosis, in need of ACT from six newly started Flexible ACT teams, were included. Data were collected using the Social Outcome Index scale (SIX), Practical and Social Functioning Scale, and a healthcare usage questionnaire. RESULTS There was a significant positive change in everyday functioning and in the SIX-item 'friendship' at 18-months follow-up. A positive correlation was also found between everyday functioning and the SIX-item 'friendship' and a negative correlation between duration of ACT and everyday functioning. A significant increase in number of inpatient hospital days and psychiatric outpatient visits also occurred. CONCLUSION Clients with psychosis who need ACT may benefit from Flexible ACT through improved social functioning. Being involved in meaningful activities and supported by others are key aspects of recovering from mental illness and are enhanced by Flexible ACT.
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Affiliation(s)
- Bengt Svensson
- a Department of Health Sciences/Mental Health and Mental Health Services Research , Lund University , Lund , Sweden
| | - Lars Hansson
- a Department of Health Sciences/Mental Health and Mental Health Services Research , Lund University , Lund , Sweden
| | - Annika Lexén
- a Department of Health Sciences/Mental Health and Mental Health Services Research , Lund University , Lund , Sweden
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Stergiopoulos V, Saab D, Francombe Pridham K, Aery A, Nakhost A. Building flexibility and managing complexity in community mental health: lessons learned in a large urban centre. BMC Psychiatry 2018; 18:20. [PMID: 29368586 PMCID: PMC5784615 DOI: 10.1186/s12888-018-1597-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 01/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Across many jurisdictions, adults with complex mental health and social needs face challenges accessing appropriate supports due to system fragmentation and strict eligibility criteria of existing services. To support this underserviced population, Toronto's local health authority launched two novel community mental health models in 2014, inspired by Flexible Assertive Community Team principles. This study explores service user and provider perspectives on the acceptability of these services, and lessons learned during early implementation. METHODS We purposively sampled 49 stakeholders (staff, physicians, service users, health systems stakeholders) and conducted 17 semi-structured qualitative interviews and 5 focus groups between October 23, 2014 and March 2, 2015, exploring stakeholder perspectives on the newly launched team based models, as well as activities and strategies employed to support early implementation. Interviews and focus groups were audio recorded, transcribed verbatim and analyzed using thematic analysis. RESULTS Findings revealed wide-ranging endorsement for the two team-based models' success in engaging the target population of adults with complex service needs. Implementation strengths included the broad recognition of existing service gaps, the use of interdisciplinary teams and experienced service providers, broad partnerships and collaboration among various service sectors, training and team building activities. Emerging challenges included lack of complementary support services such as suitable housing, organizational contexts reluctant to embrace change and risk associated with complexity, as well as limited service provider and organizational capacity to deliver evidence-based interventions. CONCLUSIONS Findings identified implementation drivers at the practitioner, program, and system levels, specific to the implementation of community mental health interventions for adults with complex health and social needs. These can inform future efforts to address the health and support needs of this vulnerable population.
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Affiliation(s)
- Vicky Stergiopoulos
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, Toronto, ON M5B 1W8 Canada
- Centre for Addiction and Mental Health, 100 Stokes Street, Toronto, ON M6J 1H4 Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON M5T 1R8 Canada
| | - Dima Saab
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, Toronto, ON M5B 1W8 Canada
| | - Kate Francombe Pridham
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, Toronto, ON M5B 1W8 Canada
| | - Anjana Aery
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, Toronto, ON M5B 1W8 Canada
| | - Arash Nakhost
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON M5T 1R8 Canada
- Mental Health Services, St. Michael’s Hospital, 30 Bond Street, Toronto, ON M5B 1W8 Canada
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Signorini G, Singh SP, Boricevic-Marsanic V, Dieleman G, Dodig-Ćurković K, Franic T, Gerritsen SE, Griffin J, Maras A, McNicholas F, O'Hara L, Purper-Ouakil D, Paul M, Santosh P, Schulze U, Street C, Tremmery S, Tuomainen H, Verhulst F, Warwick J, de Girolamo G. Architecture and functioning of child and adolescent mental health services: a 28-country survey in Europe. Lancet Psychiatry 2017; 4:715-724. [PMID: 28596067 DOI: 10.1016/s2215-0366(17)30127-x] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 02/06/2017] [Accepted: 02/20/2017] [Indexed: 11/15/2022]
Abstract
The WHO Child and Adolescent Mental Health Atlas, published in 2005, reported that child and adolescent mental health services (CAMHS) in Europe differed substantially in their architecture and functioning. We assessed the characteristics of national CAMHS across the European Union (EU), including legal aspects of adolescent care. Using an online mapping survey aimed at expert(s) in each country, we obtained data for all 28 countries in the EU. The characteristics and activities of CAMHS (ie, availability of services, inpatient beds, and clinicians and organisations, and delivery of specific CAMHS services and treatments) varied considerably between countries, as did funding sources and user access. Neurodevelopmental disorders were the most frequent diagnostic group (up to 81%) for people seen at CAMHS (data available from only 13 [46%] countries). 20 (70%) countries reported having an official national child and adolescent mental health policy, covering young people until their official age of transition to adulthood. The heterogeneity in resource allocation did not seem to match epidemiological burden. Substantial improvements in the planning, monitoring, and delivery of mental health services for children and adolescents are needed.
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Affiliation(s)
- Giulia Signorini
- Psychiatric Epidemiology and Evaluation Unit, Saint John of God Clinical Research Center, Brescia, Italy.
| | - Swaran P Singh
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Gwen Dieleman
- Erasmus University Medical Centre, Rotterdam, Netherlands
| | | | - Tomislav Franic
- Department of Psychiatry, Clinical Hospital Center Split, Split, Croatia
| | | | - James Griffin
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Athanasios Maras
- Erasmus University Medical Centre, Rotterdam, Netherlands; Yulius Academy, Rotterdam, Netherlands
| | - Fiona McNicholas
- Department of Child and Adolescent Psychiatry, School of Medicine and Medical Science, University College Dublin, Dublin; Geary Institute, University College Dublin, Dublin; Department of Child Psychiatry, Our Lady's Hospital for Sick Children, Crumlin, Dublin; Lucena Clinic, Rathgar, Dublin
| | - Lesley O'Hara
- Department of Child and Adolescent Psychiatry, School of Medicine and Medical Science, University College Dublin, Dublin
| | - Diane Purper-Ouakil
- Département de Médecine Psychologique Enfants et Adolescents, CHU Montpellier-St Eloi Hôpital, Montpellier, France
| | - Moli Paul
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Paramala Santosh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, National and Specialist Child and Adolescent Mental Health Services, Maudsley Hospital, London, UK; HealthTracker Ltd, Gillingham, UK
| | - Ulrike Schulze
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - Cathy Street
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sabine Tremmery
- Department of Neurosciences, Child & Adolescent Psychiatry, University of Leuven, Leuven, Belgium
| | - Helena Tuomainen
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Frank Verhulst
- Department of Child and Adolescent Psychiatry and Psychology, Rotterdam, Netherlands
| | - Jane Warwick
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Giovanni de Girolamo
- Psychiatric Epidemiology and Evaluation Unit, Saint John of God Clinical Research Center, Brescia, Italy
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Nugter MA, Engelsbel F, Bähler M, Keet R, van Veldhuizen R. Outcomes of FLEXIBLE Assertive Community Treatment (FACT) Implementation: A Prospective Real Life Study. Community Ment Health J 2016; 52:898-907. [PMID: 25648552 PMCID: PMC5108818 DOI: 10.1007/s10597-015-9831-2] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 01/17/2015] [Indexed: 11/30/2022]
Abstract
This study aimed to investigate social and clinical outcomes and use of care during and after implementation of FLEXIBLE Assertive Community Treatment (ACT). Three teams and 372 patients were involved. Model fidelity, clinical and social assessments were performed at baseline and after 1 and 2 years. Use of care was registered continuously. Model fidelity was good at the end of the study. Data showed much variation between patients in number and duration of ACT periods. Statistically significant improvements were found in compliance, unmet needs and quality of life. Improvement of quality of life and functioning was related to duration of ACT. The percentage of remissions increased with 9 %. The number of admissions, admission days and face to face contacts differed between ACT and non-ACT patients, but generally decreased. Findings suggest that implementation of FACT results in a more flexible adaptation of care to the needs of the patients.
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Affiliation(s)
- M Annet Nugter
- Department of Research and Monitoring, Mental Health Service Organization GGZ Noord-Holland-Noord, PO Box 18, 1850 BA, Heiloo, The Netherlands.
| | - Fabiana Engelsbel
- Department of Research and Monitoring, Mental Health Service Organization GGZ Noord-Holland-Noord, PO Box 18, 1850 BA, Heiloo, The Netherlands
| | - Michiel Bähler
- Department of Community Mental Health, Mental Health Service Organization GGZ Noord-Holland-Noord, PO Box 18, 1850 BA, Heiloo, The Netherlands
| | - René Keet
- Department of Community Mental Health, Mental Health Service Organization GGZ Noord-Holland-Noord, PO Box 18, 1850 BA, Heiloo, The Netherlands
| | - Remmers van Veldhuizen
- Centre for Certification ACT and FACT (CCAF), Praediniussingel 20/9, 9711 AG, Groningen, The Netherlands
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22
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Mauritz MW, Van Gaal BGI, Jongedijk RA, Schoonhoven L, Nijhuis-van der Sanden MWG, Goossens PJJ. Narrative exposure therapy for posttraumatic stress disorder associated with repeated interpersonal trauma in patients with severe mental illness: a mixed methods design. Eur J Psychotraumatol 2016; 7:32473. [PMID: 27658371 PMCID: PMC5034153 DOI: 10.3402/ejpt.v7.32473] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 08/19/2016] [Accepted: 08/23/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In the Netherlands, most patients with severe mental illness (SMI) receive flexible assertive community treatment (FACT) provided by multidisciplinary community mental health teams. SMI patients with comorbid posttraumatic stress disorder (PTSD) are sometimes offered evidence-based trauma-focused treatment like eye movement desensitization reprocessing or prolonged exposure. There is a large amount of evidence for the effectiveness of narrative exposure therapy (NET) within various vulnerable patient groups with repeated interpersonal trauma. Some FACT-teams provide NET for patients with comorbid PTSD, which is promising, but has not been specifically studied in SMI patients. OBJECTIVES The primary aim is to evaluate NET in SMI patients with comorbid PTSD associated with repeated interpersonal trauma to get insight into whether (1) PTSD and dissociative symptoms changes and (2) changes occur in the present SMI symptoms, care needs, quality of life, global functioning, and care consumption. The second aim is to gain insight into patients' experiences with NET and to identify influencing factors on treatment results. METHODS This study will have a mixed methods convergent design consisting of quantitative repeated measures and qualitative semi-structured in-depth interviews based on Grounded Theory. The study population will include adult SMI outpatients (n=25) with comorbid PTSD and receiving NET. The quantitative study parameters will be existence and severity of PTSD, dissociative, and SMI symptoms; care needs; quality of life; global functioning; and care consumption. In a longitudinal analysis, outcomes will be analyzed using mixed models to estimate the difference in means between baseline and repeated measurements. The qualitative study parameters will be experiences with NET and perceived factors for success or failure. Integration of quantitative and qualitative results will be focused on interpreting how qualitative results enhance the understanding of quantitative outcomes. DISCUSSION The results of this study will provide more insight into influencing factors for clinical changes in this population.
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Affiliation(s)
- Maria W Mauritz
- GGNet Mental Health Care Center, Warnsveld, The Netherlands
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands;
| | - Betsie G I Van Gaal
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
| | - Ruud A Jongedijk
- Foundation Centrum '45, Oegstgeest, The Netherlands
- Arq Psychotrauma Expert Group, Diemen, The Netherlands
| | - Lisette Schoonhoven
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
- Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
| | | | - Peter J J Goossens
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
- Dimence Group, Center for Mental Health Care, SCBS Bipolar Disorders, Deventer, The Netherlands
- University Centre for Nursing and Midwifery, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University Ghent, Belgium
- GGZ-VS, Institute for Education of Clinical Nurse Specialist in Mental Health, Utrecht, The Netherlands
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Blankers M, van Emmerik A, Richters B, Dekker J. Blended internet care for patients with severe mental illnesses: An open label prospective controlled cohort pilot study. Internet Interv 2016; 5:51-55. [PMID: 30135807 PMCID: PMC6096193 DOI: 10.1016/j.invent.2016.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 07/26/2016] [Accepted: 07/26/2016] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION This paper reports first experiences while providing blended (combined face-to-face and internet-based) flexible assertive community treatment (FACT) to outpatients with severe mental illnesses (SMI). The aim was to compare treatment satisfaction, clinical outcome and quality of life in the short term (3 months) of patients receiving blended FACT with those receiving conventional FACT. METHOD This pilot study was designed as an open label prospective controlled cohort study. 47 SMI patients were found eligible and non-randomly allocated to Blended FACT (n = 25) or to conventional FACT (n = 22). Data were collected at baseline and at a 3-month follow-up. Measures included were the Dutch Mental Health Care Thermometer, Health of the Nation Outcome Scales (HONOS), Manchester Short Assessment of Quality of Life (MANSA), EuroQoL 5 dimensional (EQ5D) and the Mental Health Confidence Scale (MHCS). RESULTS At a three months follow-up, patients reported slightly improved quality of life (EuroQoL 5 dimensional, Wald χ2(1) = 6.80, p = 0.01; MANSA, Wald χ2(1) = 4.02, p = 0.05) and self-efficacy beliefs regarding their mental health problems (MHCS, Wald χ2(1) = 3.71, p = 0.05). HONOS scores did not change over time, Wald χ2(1) = 2.34, p = 0.13. Satisfaction scores were on average between satisfactory - good (BI: M = 7.50, SD = 1.54; CAU: M = 7.53 SD = 0.96; on a 1-10 scale). These results did not differ between the two study groups. CONCLUSION It appears acceptable to patients to provide blended FACT with SMI, with outcomes comparable to face-to-face FACT. A future high quality trial is warranted to establish (cost-)effectiveness of blended FACT.
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Affiliation(s)
- Matthijs Blankers
- Arkin Mental Health Care, Amsterdam, The Netherlands,Trimbos institute, Utrecht, The Netherlands,Department of Psychiatry, Academic Medical Centre, Amsterdam, The Netherlands,Corresponding author at. Arkin Mental Health Care, Department of Research, PO Box 75848, 1070 AV Amsterdam, The Netherlands.
| | - Arnold van Emmerik
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Jack Dekker
- Arkin Mental Health Care, Amsterdam, The Netherlands,Department of Clinical Psychology, VU University, Amsterdam, The Netherlands
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Lexén A, Svensson B. Mental health professional experiences of the flexible assertive community treatment model: a grounded theory study. J Ment Health 2016; 25:379-384. [DOI: 10.1080/09638237.2016.1207236] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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25
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van der Lee A, de Haan L, Beekman A. Schizophrenia in the Netherlands: Continuity of Care with Better Quality of Care for Less Medical Costs. PLoS One 2016; 11:e0157150. [PMID: 27275609 PMCID: PMC4898758 DOI: 10.1371/journal.pone.0157150] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 05/25/2016] [Indexed: 01/31/2023] Open
Abstract
Background Patients with schizophrenia need continuous elective medical care which includes psychiatric treatment, antipsychotic medication and somatic health care. The objective of this study is to assess whether continuous elective psychiatric is associated with less health care costs due to less inpatient treatment. Methods Data concerning antipsychotic medication and psychiatric and somatic health care of patients with schizophrenia in the claims data of Agis Health Insurance were collected over 2008–2011 in the Netherlands. Included were 7,392 patients under 70 years of age with schizophrenia in 2008, insured during the whole period. We assessed the relationship between continuous elective psychiatric care and the outcome measures: acute treatment events, psychiatric hospitalization, somatic care and health care costs. Results Continuous elective psychiatric care was accessed by 73% of the patients during the entire three year follow-up period. These patients received mostly outpatient care and accessed more somatic care, at a total cost of €36,485 in three years, than those without continuous care. In the groups accessing fewer or no years of elective care 34%-68% had inpatient care and acute treatment events, while accessing less somatic care at average total costs of medical care from €33,284 to €64,509. Conclusions Continuous elective mental and somatic care for 73% of the patients with schizophrenia showed better quality of care at lower costs. Providing continuous elective care to the remaining patients may improve health while reducing acute illness episodes.
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Affiliation(s)
- Arnold van der Lee
- Kenniscentrum, Zilveren Kruis Achmea, Leusden, The Netherlands
- Department of Psychiatry, VUmc University Medical Center and GGZIngeest, Amsterdam, The Netherlands
- * E-mail:
| | - Lieuwe de Haan
- Department of Psychiatry, Academic Medical Centre, UvA, Amsterdam, The Netherlands
| | - Aartjan Beekman
- Department of Psychiatry, VUmc University Medical Center and GGZIngeest, Amsterdam, The Netherlands
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Norlander T, Nordén T. The Hourglass Model: Are There Structural Problems with the Scarcity of Positive Results for Flexible ACT? Clin Pract Epidemiol Ment Health 2015; 11:155-7. [PMID: 26464577 PMCID: PMC4598425 DOI: 10.2174/1745017901511010155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 05/20/2015] [Accepted: 05/20/2015] [Indexed: 11/22/2022]
Abstract
The aim of the present article was to discuss the commentary by van Veldhuizen, Delespaul and Mulder (2015) regarding the review by Nordén and Norlander (2014) based on five empirical articles about Flexible Assertive Community Treatment (FACT). Veldhuizen et al. agree on that there is insufficient evidence for the effectiveness of FACT. However, van Veldhuizen et al. avoid a discussion of the lack of positive results despite extensive research during several years and therefore an analysis of why FACT did not fare better is missing. According to FACT it is an advantage that one single team spans the entire chain of care and rehabilitation, but no evidence is given for such an opinion. Instead there may be difficulties for the staff to shift between psychiatric care and psychiatric rehabilitation and the clients perhaps don’t want to encounter the same professional team during all phases of care and rehabilitation.
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Affiliation(s)
- Torsten Norlander
- Center for Research and Development, Evidens University College, Göteborg, Sweden ; Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
| | - Tommy Nordén
- Center for Research and Development, Evidens University College, Göteborg, Sweden
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Meijwaard SC, Kikkert M, de Mooij LD, Lommerse NM, Peen J, Schoevers RA, Van R, de Wildt W, Bockting CLH, Dekker JJM. Risk of Criminal Victimisation in Outpatients with Common Mental Health Disorders. PLoS One 2015; 10:e0128508. [PMID: 26132200 PMCID: PMC4489091 DOI: 10.1371/journal.pone.0128508] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 04/28/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Crime victimisation is a serious problem in psychiatric patients. However, research has focused on patients with severe mental illness and few studies exist that address victimisation in other outpatient groups, such as patients with depression. Due to large differences in methodology of the studies that address crime victimisation, a comparison of prevalence between psychiatric diagnostic groups is hard to make. Objectives of this study were to determine and compare one-year prevalence of violent and non-violent criminal victimisation among outpatients from different diagnostic psychiatric groups and to examine prevalence differences with the general population. METHOD Criminal victimisation prevalence was measured in 300 outpatients living in Amsterdam, The Netherlands. Face-to-face interviews were conducted with outpatients with depressive disorder (n = 102), substance use disorder (SUD, n = 106) and severe mental illness (SMI, n = 92) using a National Crime Victimisation Survey, and compared with a matched general population sample (n = 10865). RESULTS Of all outpatients, 61% reported experiencing some kind of victimisation over the past year; 33% reported violent victimisation (3.5 times more than the general population) and 36% reported property crimes (1.2 times more than the general population). Outpatients with depression (67%) and SUD (76%) were victimised more often than SMI outpatients (39%). Younger age and hostile behaviour were associated with violent victimisation, while being male and living alone were associated with non-violent victimisation. Moreover, SUD was associated with both violent and non-violent victimisation. CONCLUSION Outpatients with depression, SUD, and SMI are at increased risk of victimisation compared to the general population. Furthermore, our results indicate that victimisation of violent and non-violent crimes is more common in outpatients with depression and SUD than in outpatients with SMI living independently in the community.
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Affiliation(s)
- Sabine C. Meijwaard
- Arkin Institute for Mental Health Care, PO Box 75848, 1070 AV, Amsterdam, The Netherlands
| | - Martijn Kikkert
- Arkin Institute for Mental Health Care, PO Box 75848, 1070 AV, Amsterdam, The Netherlands
| | - Liselotte D. de Mooij
- Arkin Institute for Mental Health Care, PO Box 75848, 1070 AV, Amsterdam, The Netherlands
| | - Nick M. Lommerse
- Arkin Institute for Mental Health Care, PO Box 75848, 1070 AV, Amsterdam, The Netherlands
| | - Jaap Peen
- Arkin Institute for Mental Health Care, PO Box 75848, 1070 AV, Amsterdam, The Netherlands
| | - Robert A. Schoevers
- University of Groningen, University Medical Centre Groningen, Department of Psychiatry, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Rien Van
- Arkin Institute for Mental Health Care, PO Box 75848, 1070 AV, Amsterdam, The Netherlands
| | - Wencke de Wildt
- Arkin Institute for Mental Health Care, PO Box 75848, 1070 AV, Amsterdam, The Netherlands
| | - Claudi L. H. Bockting
- University of Groningen, Faculty of Behavioural and Social Sciences, Department of Clinical Psychology, Grote Kruisstraat 2–1, 9721 TS, Groningen, The Netherlands
- University Utrecht, Faculty of Behavioural and Social Sciences, Department of Clinical Psychology, Padualaan 14, 3584 CH, Utrecht, The Netherlands
| | - Jack J. M. Dekker
- Arkin Institute for Mental Health Care, PO Box 75848, 1070 AV, Amsterdam, The Netherlands
- Free University of Amsterdam, Department of Clinical Psychology, Room 2B-73, Van der Boechorststraat 1, 1081 CD, Amsterdam, The Netherlands
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Preventing brain disorders: a framework for action. Soc Psychiatry Psychiatr Epidemiol 2015; 50:833-41. [PMID: 25595136 DOI: 10.1007/s00127-015-1007-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 01/08/2015] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Prevention efforts have greatly reduced the prevalence of many communicable and non-communicable diseases worldwide. In contrast, prevention strategies for mental disorders remain in their infancy. This paper provides a summary of the key issues surrounding mental disorder prevention and proposes a framework for how to catalyze action in the area. MATERIALS AND METHODS Three core assumptions guide this work (1) the onset of mental disorders is often preventable, (2) among those individuals with a mental disorder, the trajectory of health and functioning can be shaped by external resources, and (3) many specific and generic risk and protective factors for mental disorders are associated with specific stages of the life course. CONCLUSION We propose that the adoption of a life course approach to prevention can be clarifying and motivating for both research and practice.
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van Veldhuizen R, Delespaul P, Kroon H, Mulder N. Flexible ACT & Resource-group ACT: Different Working Procedures Which Can Supplement and Strengthen Each Other. A Response. Clin Pract Epidemiol Ment Health 2015; 11:12-5. [PMID: 25767558 PMCID: PMC4353123 DOI: 10.2174/1745017901511010012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 12/22/2014] [Accepted: 12/22/2014] [Indexed: 11/25/2022]
Abstract
This article is a response to Nordén and Norlander’s ‘Absence of Positive Results for Flexible Assertive Community
Treatment. What is the next approach?’[1], in which they assert that ‘at present [there is] no evidence for Flexible
ACT and… that RACT might be able to provide new impulses and new vitality to the treatment mode of ACT’. We question
their analyses and conclusions. We clarify Flexible ACT, referring to the Flexible Assertive Community Treatment
Manual (van Veldhuizen, 2013) [2] to rectify misconceptions. We discuss Nordén and Norlander’s interpretation of research
on Flexible ACT. The fact that too little research has been done and that there are insufficient positive results cannot
serve as a reason to propagate RACT. However, the Resource Group method does provide inspiration for working
with clients to involve their networks more effectively in Flexible ACT.
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Affiliation(s)
| | - Philippe Delespaul
- Innovations in Mental Health Care, Maastricht University and Mondriaan (Mental Health Service), The Netherlands
| | - Hans Kroon
- Reintegration and Community Care, Trimbos Institute, Utrecht, The Netherlands
| | - Niels Mulder
- Public Mental Health, Epidemiological and Social Psychiatric Research institute, Erasmus MC; Parnassia Psychiatric Institute, The Netherlands
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Nordén T, Norlander T. Absence of Positive Results for Flexible Assertive Community Treatment. What is the next Approach? Clin Pract Epidemiol Ment Health 2014; 10:87-91. [PMID: 25320634 PMCID: PMC4197527 DOI: 10.2174/1745017901410010087] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Revised: 06/03/2014] [Accepted: 07/13/2014] [Indexed: 11/22/2022]
Abstract
Aims were to review results of the five psychiatric studies on Flexible Assertive Community Treatment (FACT) published during 2007-2013, and to compare FACT with Resource-group Assertive Community Treatment (RACT) which specifically focuses on empowerment and rehabilitation of clients in the stable phase. During 2007 articles appeared in scientific journals arguing in favor of the need for the development of the treatment method Assertive Community Treatment (ACT). A particularly notable article was one that featured a Dutch version of ACT, namely FACT. The initiative received great sympathy given that clinical practice and research showed that both American and British versions of ACT were in need of new impulses to be able to maintain an optimal level of care. Seven years have passed since the Dutch model was international presented and five empirical studies about FACT have been published and therefore a first critical examination of FACT was conducted. The review indicated that the five empirical studies failed to show that FACT involves improvement of the clients in terms of symptoms, functioning, or well-being. The conclusions were that at present there is no evidence for FACT and that RACT with its small, flexible ACT teams, where the client him/herself is included and decides on the treatment goals, might be able to provide new impulses and a new vitality to the treatment mode of an assertive community treatment.
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Affiliation(s)
- Tommy Nordén
- Center for Research and Development, Evidens University College, Göteborg, Sweden
| | - Torsten Norlander
- Center for Research and Development, Evidens University College, Göteborg, Sweden ; Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
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31
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Affiliation(s)
- F Amaddeo
- Department of Public Health and Community Medicine, Section of Psychiatry, Verona, Italy.
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Carta MG, Maggiani F, Pilutzu L, Moro MF, Mura G, Cadoni F, Sancassiani F, Vellante M, Machado S, Preti A. Sailing for rehabilitation of patients with severe mental disorders: results of a cross over randomized controlled trial. Clin Pract Epidemiol Ment Health 2014; 10:73-9. [PMID: 25191520 PMCID: PMC4150377 DOI: 10.2174/1745017901410010073] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 05/12/2014] [Accepted: 05/12/2014] [Indexed: 11/22/2022]
Abstract
This study set out to evaluate the effectiveness of a sailing and learning-to-sail rehabilitation protocol in a sample of patients diagnosed with severe mental disorders. The study was a randomized, crossover, waiting-list controlled trial, following recruitment in the Departments of Mental Health of South Sardinia. Participants were outpatients diagnosed with severe mental disorders, recruited through announcements to the directors of the Departments of Mental Health of South Sardinia. Out of the 40 patients enrolled in the study, those exposed to rehabilitation with sailing during a series of guided and supervised sea expeditions near the beach of Cagliari (Sardinia), where the aim to explore the marine environment while sailing was emphasized, showed a statistically significant improvement of their clinical status (measured by BPRS) and, as well, of their general functioning (measured by HoNOS Scale) against the control group. The improvement was maintained at follow-up for some months only: after 12 months, the patients returned to their baseline values on the measures of psychopathology and showed a worsening trend of their quality of life. Sailing can represent a substitute of important experiences that the patients with severe mental disorders miss because of their illness.
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Affiliation(s)
- Mauro G Carta
- Department of Public Health and Clinical and Molecular Medicine University of Cagliari and Centro di Psichiatria di Consulenza e Psicosomatica AUOC Cagliari, Cagliari, Italy
| | - Federica Maggiani
- Department of Public Health and Clinical and Molecular Medicine University of Cagliari and Centro di Psichiatria di Consulenza e Psicosomatica AUOC Cagliari, Cagliari, Italy
| | - Laura Pilutzu
- Department of Public Health and Clinical and Molecular Medicine University of Cagliari and Centro di Psichiatria di Consulenza e Psicosomatica AUOC Cagliari, Cagliari, Italy
| | - Maria F Moro
- Department of Public Health and Clinical and Molecular Medicine University of Cagliari and Centro di Psichiatria di Consulenza e Psicosomatica AUOC Cagliari, Cagliari, Italy
| | - Gioia Mura
- Department of Public Health and Clinical and Molecular Medicine University of Cagliari and Centro di Psichiatria di Consulenza e Psicosomatica AUOC Cagliari, Cagliari, Italy
| | - Federica Cadoni
- Department of Public Health and Clinical and Molecular Medicine University of Cagliari and Centro di Psichiatria di Consulenza e Psicosomatica AUOC Cagliari, Cagliari, Italy
| | - Federica Sancassiani
- Department of Public Health and Clinical and Molecular Medicine University of Cagliari and Centro di Psichiatria di Consulenza e Psicosomatica AUOC Cagliari, Cagliari, Italy
| | - Marcello Vellante
- Department of Public Health and Clinical and Molecular Medicine University of Cagliari and Centro di Psichiatria di Consulenza e Psicosomatica AUOC Cagliari, Cagliari, Italy
| | - Sergio Machado
- Institute de Psychiatry of Federal University of Rio de Janeiro (IPUB/UFRJ)
| | - Antonio Preti
- Department of Public Health and Clinical and Molecular Medicine University of Cagliari and Centro di Psichiatria di Consulenza e Psicosomatica AUOC Cagliari, Cagliari, Italy
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The use of a Cumulative Needs for Care Monitor for individual treatment v. care as usual for patients diagnosed with severe mental illness, a cost-effectiveness analysis from the health care perspective. Epidemiol Psychiatr Sci 2012; 21:381-92. [PMID: 22793689 PMCID: PMC6998139 DOI: 10.1017/s2045796012000248] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIMS To study the systematic assessment of need for care and clinical parameters for use in treatment plans in patients diagnosed with severe mental illness. METHODS The Cumulative Needs for Care Monitor (CNCM) includes various validated instruments, such as the Camberwell Assessment of Need. A Markov-type cost-effectiveness model (health care perspective, 5-year time horizon) was used to compare CNCM with care as usual (CAU). Two studies were used to determine model parameters: a before–after study (n = 2155) and a matched-control study (n = 937). RESULTS The CNCM may lead to a gain in psychiatric functioning according to the models. CNCM patients remain in (outpatient) care, while CAU patients drop out more frequently. There is only a small difference in inpatient care. As a result, average costs per patient in the CNCM group are between €2809 (before–after model) and €5251 (matched-control model) higher. The iCER was between €45 127 and €57 839 per life year without psychiatric dysfunction gained. CONCLUSIONS CNCM may be only cost-effective when willingness to pay for a life year without psychiatric dysfunction is higher than €45 000. However, this result is highly sensitive to the level of psychiatric dysfunctioning in patients who do not receive care.
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