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1.
Assertive community treatment (ACT) is a widely-used intervention for the most severely impaired persons with mental illness. Because it differs from traditional treatment approaches in its philosophy, its organization, and in the clients it serves, financing strategies that are appropriate for standard services may not be optimal for ACT. In developing new payment systems, policymakers must choose between targeted strategies that attempt to influence the treatment process directly and those that establish broad goals for effectiveness, access, and efficiency while allowing providers more latitude in the treatment process. These choices profoundly influence how and to whom ACT is available.  相似文献   

2.
Assertive Community Treatment (ACT) is a community-based treatment approach intended to help in the recovery and rehabilitation of clients with severe and persistent mental illnesses. A clinical pharmacist is not routinely a member of an ACT team. The purpose of this study is to demonstrate the role of a pharmacist by reviewing recommendations and interventions made by a clinical pharmacist on an ACT team. Information was gathered through a chart review of clients at Community Alternatives in St. Louis, Missouri. All recommendations and interventions performed by the clinical pharmacist between February 1, 2008 and July 31, 2008 were recorded. A total of 341 interventions and recommendations for 29 clients were completed by the pharmacist. Medication management, medication adjustment recommendations, and mental health assessments were the most frequent interventions. This study suggests a clinical pharmacist can be beneficial to an ACT team and provide diverse services to both clients and other team members.  相似文献   

3.
The goal of this study was to learn how assertive community treatment (ACT) contributes to the improvement of those with serious mental illness in order to contribute to the growing clinical literature regarding the therapeutic agents of ACT teams. Methods included reviewing the case records of three ACT clients who have improved significantly, as well as interviewing the clients themselves and their clinicians. The results indicated that there was significant agreement among the case records, the clients, and their clinicians in identifying the most useful aspects of assertive community treatment. Primary among these factors were the persistence demonstrated by ACT clinicians in engaging their clients, the trust that clients developed in their clinicians, and as a result, the process by which their clinicians became guides to the world of psychiatric and social services that further facilitated their clients' community adjustment. In closing, we consider implications from these findings both for staff development for ACT team members, and for suggestions toward the development of a model of recovery from serious mental illness.  相似文献   

4.
This study examined the associations between substance abuse problems in severely mentally ill patients, outcome and Assertive Community Treatment (ACT) model fidelity. In a prospective longitudinal study, ACT model fidelity and patient outcomes were assessed in 20 outpatient treatment teams using the Health of the Nation Outcome Scales, Camberwell Assessment of Needs short appraisal schedule and measures of service use. Five hundred and thirty severely mentally ill patients participated in the study. Substance abuse problems were assessed three times during a 2-year follow-up period. This study found that among patients with severe mental illness, patients with an addiction problem had more serious psychosocial problems at baseline. Substance abuse problems showed improvement over time, but this was not associated with ACT model fidelity. The study indicates that investment by teams to improve a patient’s psychosocial situation can lead to improvements on substance problems.  相似文献   

5.
In an observational study of severely mentally ill patients treated in assertive community treatment (ACT) teams, we investigated how treatment outcome was associated with demographic factors, clinical factors, and motivation for treatment. To determine psychosocial outcome, patients were routinely assessed using the Health of the Nation Outcome Scales (HoNOS). Trends over time were analyzed using a mixed model with repeated measures. The HoNOS total score was modeled as a function of treatment duration and patient-dependent covariates. Data comprised 637 assessments of 139 patients; mean duration of follow-up was 27.4 months (SD = 5.4). Substance abuse, higher age, problems with motivation, and lower educational level were associated with higher HoNOS total scores (i.e., worse outcome). To improve treatment outcome, we recommend better implementation of ACT, and also the implementation of additional programs targeting subgroups which seem to benefit less from ACT.  相似文献   

6.
The Assertive Community Treatment (ACT) model for people with severe mental illness has typically been viewed as a time-unlimited intervention. Without a proscribed service duration, discharge from ACT largely depends on individual clients’ situations and practitioners’ discretion. We conducted semi-structured focus groups and interviews with practitioners to explore their discharge practices and considerations. Results highlight the heterogeneity of the clientele served in ACT, and therefore the importance of individualized treatment and discharge planning, guidance on assessing the timing of discharge for individual cases, practice strategies that balance independence and social connectedness to promote recovery, and the need for substantial system reform to facilitate transition after discharge.  相似文献   

7.
There has been increasing commentary about the degree to which Assertive Community Treatment (ACT) teams provide recovery-oriented services, often centered around the question of the use of coercion. The present study was designed to contribute to this discussion through an examination of recovery-oriented service provision and ACT fidelity among 67 teams in the province of Ontario, Canada. The findings indicated a moderate to high degree of recovery orientation in service provision, with no significant relationship between ACT fidelity and consumer and family/key support ratings of recovery orientation. A significant relationship was found, however, between the ‘nature of services’ domain of the Dartmouth Assertive Community Treatment Scale (DACTS) and ratings of recovery orientation provided by staff and ACT coordinators. These findings extend the existing dialogue regarding the evaluation of ACT intervention process factors and indicate that current measures of fidelity may not be adequately addressing dimensions of recovery-oriented service provision.  相似文献   

8.
The issue of coercion in community-based mental health programs is frequently linked to the development of the Assertive Community Treatment (ACT) model. Sixty-five adults diagnosed with severe and persistent mental illness, participating in an ACT model program, completed measures that assessed elements of coercion and the perceived frequency of use of ACT staff therapeutic limit setting activities, as well as the relationships between coercion, empowerment, quality of life, and the working alliance. On average, participants did not perceive high degrees of coercion or negative pressures and did not feel excluded from the process of making decisions. On the continuum of restrictiveness of therapeutic limit setting activities, participants perceived staff to be using less restrictive therapeutic limit setting activities more frequently. Elements of perceived coercion and specific activities were negatively related to quality of life, sense of empowerment, and the working alliance.  相似文献   

9.
The original assertive community treatment (ACT) model included time-unlimited treatment. However, resource restrictions and subsequent research call into question the feasibility and necessity of time-unlimited services. This study compares the outcomes of 48 individuals who successfully transitioned from ACT to less intensive Community Mental Health Center (CMHC) services to 19 persons who required return to ACT or did not remain in CMHC treatment. There were no statistically significant differences in demographics, diagnoses, and other treatment factors between the two groups.  相似文献   

10.
We examined racial differences in burnout among case managers working with people with severe mental illness, using the Maslach Burnout Inventory. Compared to Caucasians, African Americans reported significantly less Emotional Exhaustion and Depersonalization, but did not differ on levels of Personal Accomplishment. These differences could not be explained by geographic location or perceptions of the work environment; however, age accounted for group differences in Depersonalization. Racial incongruence with caseload appeared to be one factor in burnout, particularly for Emotional Exhaustion. Race of both staff and clients may be important to consider in understanding staff burnout.  相似文献   

11.
The last decade has witnessed the increasing importance of consumers as providers of mental health services. Assertive Community Treatment (ACT) teams and ACT variants, with their emphasis on rehabilitation and support in the client's natural environment, have hosted consumer-professional collaborations. The authors discuss one such program in which an ACT program for homeless mentally ill adults employed consumer advocates (CAs). Consumer advocates were found to have a service profile similar to other staff. Further, there is suggestive evidence that the employment of CAs created a more positive attitude toward persons with mental illness. Issues of role definition, boundaries, support with supervision and the importance of CAs' experiences with mental illness are discussed.  相似文献   

12.
13.
Ito J, Oshima I, Nishio M, Sono T, Suzuki Y, Horiuchi K, Niekawa N, Ogawa M, Setoya Y, Hisanaga F, Kouda M, Tsukada K. The effect of Assertive Community Treatment in Japan. Objective: The aim of this study was to evaluate the effects of the Assertive Community Treatment (ACT) program in a Japanese mental health service setting. Method: This study was a randomized controlled trial. ACT was the intervention condition (n = 59), and the usual hospital‐based rehabilitation program was the control condition (n = 59). Outcome indicators include in‐patient days, psychiatric symptoms, social functioning, quality of life, and client satisfaction. The follow‐up period was 12 months after the intervention. Results: We found a significant reduction of in‐patient days for the ACT group demonstrated by t‐test (t = 2.33, P = 0.02). However, the results of ancova did not show significant differences for in‐patient days between the two groups (F = 1.85, P = 0.18). The depression score for Brief Psychiatric Rating Scale for the ACT group was significantly lower than the control group at the 12‐month follow‐up assessment (F = 5.57, P = 0.03). According to the t‐test, the ACT group had a higher client satisfaction than the control group (t = 2.08, P = 0.05). Conclusion: We concluded that ACT had a positive influence, as evidenced by a reduction of in‐patient days, lower depressive symptoms, and higher client satisfaction.  相似文献   

14.
Past research has found that a positive working alliance between clients and their case managers is modestly correlated with client outcomes. The current study tried to identify the predictors of the working alliance in a sample of 115 clients who were receiving services from Assertive Community Treatment (ACT) teams. All of the clients suffered from severe mental illness, had a substance use disorder and were homeless at baseline. Both the client’s rating and the case manager’s rating of the working alliance were assessed at 3 months and 15 months post baseline. Client characteristics, particularly motivation to change, explained more of the variance of the client’s rating of the alliance than treatment variables or client change on the outcome variables. On the other hand, treatment variables (e.g., the amount of transportation services provided) and client change on the outcome variables explained more of the variance of the case manager’s rating of the alliance.Dr. Robert J. Calsyn and Mr. Lemming are affiliated with the University of Missouri-St. Louis. Dr. Gary A. Morse is affiliated with the Community Alternatives. Dr. W.D. Klinkenberg is affiliated with the Missouri Institute of Mental health.  相似文献   

15.
Family Psychoeducation and Assertive Community Treatment are both state-of-the-art service systems with rich empirical foundations, demonstrating unusual effectiveness in randomized clinical trials. Recent research suggests a possible additive effect on selected outcomes when the two approaches are integrated. This paper reviews the role of family support and intervention in the care of persons with serious mental illnesses, presents the research literature on psychoeducation, and highlights benefits of merging the multiple-family version of this approach into the work of assertive community treatment programs.  相似文献   

16.
17.
The compatibility of recovery work with the Assertive Community Treatment (ACT) model has been debated; and little is known about how to best measure the work of recovery. Two ACT teams with high and low recovery orientation were identified by expert consensus and compared on a number of dimensions. Using an interpretive, qualitative approach to analyze interview and observation data, teams differed in the extent to which the environment, team structure, staff attitudes, and processes of working with consumers supported principles of recovery orientation. We present a model of recovery work and discuss implications for research and practice.  相似文献   

18.
This exploratory qualitative study examined contexts and processes of social relationship development as experienced by adults with schizophrenia participating in assertive community treatment (ACT) programs. Semistructured interviews with 20 ACT clients diagnosed with schizophrenia-spectrum disorders and 2 ACT staff members were analyzed using grounded theory analysis methods. Results showed that aside from contacts with family members and providers, participants' interactions with fellow mental health clients tended to dominate social interactions, and that this pattern appeared to be influenced by both the concentration of social opportunities in daily activities of service utilization and the ACT program emphasis upon facilitating relationships between clients. Participants described their relationships with other mental health clients in primarily positive terms, yet several participants expressed dissatisfaction and desired greater integration into mainstream social networks. Implications for mental health service delivery are discussed.  相似文献   

19.
An extensive body of literature provides evidence supporting the effectiveness of assertive community treatment (ACT) with regard to non-forensic outcome measures, such as number of hospital admissions and length of stay. However, research findings on the effectiveness of ACT for forensic outcome measures, such as rearrests or detentions, is much less clear. The present review, therefore, focuses on the application of ACT in forensic populations, combining key elements of ACT with elements of forensic rehabilitation models. Specifically, a review of the literature was conducted using a systematic methodology in an attempt to combine evidence-based elements of 40 years of research on regular ACT with elements of forensic rehabilitation models. Results reveal limited yet promising evidence in support of the effectiveness of forensic ACT for forensic outcome measures. Implications for future research and clinical practice are discussed.  相似文献   

20.
We examined burnout and job satisfaction among 216 case managers serving clients with severe mental illness, comparing assertive community treatment (ACT) workers with traditional case managers (TCMs) in two Midwestern states. Compared to TCM, ACT workers reported significantly lower levels of burnout, higher levels of job satisfaction, and more favorable perceptions of their work environment. In the TCM sample, length of time in current job was associated with greater burnout, and severity of client problems was associated with greater burnout and job dissatisfaction. Neither of these sets of factors predicted burnout in the ACT sample, however. Instead, no case manager characteristics, caseload characteristics, or service delivery variables, except for age, predicted burnout in the ACT sample. The findings suggest that the ACT model may be especially suited to protect against burnout in case managers serving clients with the most severe disabilities and who are most prone to psychiatric readmissions. However, the small effect sizes and the lack of a prospective, experimental design suggest that further research is needed before drawing firm conclusions.  相似文献   

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