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Assertive community treatment

Marita Campos-Melady, Jane Ellen Smith, Robert J Meyers, Susan H Godley, Mark D Godley
Central to the debate over the implementation of empirically supported treatments is whether therapist skill has a measurable, positive relationship with client outcome. The fidelity and skill with which therapists deliver treatments have been studied under the constructs of adherence and competence. Evidence for a relationship between adherence and competence and client outcomes has been mixed, possibly due to small sample sizes, potentially inadequate measures for rating therapists' skill, and limited statistical methods...
October 13, 2016: Psychology of Addictive Behaviors: Journal of the Society of Psychologists in Addictive Behaviors
Benjamin Milbourn, Beverley McNamara, Angus Buchanan
BACKGROUND/AIM: People with severe mental illness (SMI) do not receive adequate attention in research or clinical practice. They are considered hard to reach and difficult to engage. Information is needed to help provide support for this vulnerable population. This paper aims to investigate the well-being of adults diagnosed with SMI and receiving Assertive Community Treatment (ACT) by applying the occupational well-being framework to the everyday activities of this vulnerable group of people...
October 13, 2016: Scandinavian Journal of Occupational Therapy
Jennifer A Price, Ana I F Sousa Soares, Augustine D Asante, Joao S Martins, Kate Williams, Virginia L Wiseman
BACKGROUND: Despite public health care being free at the point of delivery in Timor-Leste, wealthier patients access hospital care at nearly twice the rate of poorer patients. This study seeks to understand the barriers driving inequitable utilisation of hospital services in Timor-Leste from the perspective of community members and health care managers. METHODS: This multisite qualitative study in Timor-Leste conducted gender segregated focus groups (n = 8) in eight districts, with 59 adults in urban and rural settings, and in-depth interviews (n = 8) with the Director of community health centres...
September 30, 2016: BMC Health Services Research
Nicole Kozloff, Carol E Adair, Luis I Palma Lazgare, Daniel Poremski, Amy H Cheung, Rebeca Sandu, Vicky Stergiopoulos
BACKGROUND AND OBJECTIVES: "Housing First" has been shown to improve housing stability in homeless individuals with mental illness, but had not been empirically tested in homeless youth. We aimed to evaluate the effect of "Housing First" on housing stability in homeless youth aged 18 to 24 years participating in At Home/Chez Soi, a 24-month randomized trial of "Housing First" in 5 Canadian cities. METHODS: Homeless individuals with mental illness were randomized to receive "Housing First" (combined with assertive community treatment or intensive case management depending on their level of need) or treatment as usual...
September 28, 2016: Pediatrics
Stefanie N Rezansoff, Akm Moniruzzaman, Seena Fazel, Lawrence McCandless, Ric Procyshyn, Julian M Somers
Adherence to antipsychotic medication is a significant challenge among homeless patients. No experimental trials have investigated the impact of Housing First on adherence among patients with schizophrenia. We investigated whether Housing First in congregate and scattered-site configurations resulted in superior adherence compared to usual care. Adult participants (n = 165) met criteria for homelessness, schizophrenia, and initiation of antipsychotic pharmacotherapy prior to recruitment to an unblinded, 3-arm randomized controlled trial in Vancouver, Canada...
September 24, 2016: Schizophrenia Bulletin
Remco Boerman, Dan Cohen, Peter F J Schulte, Annet Nugter
OBJECTIVE: Several studies show an association between schizophrenia and low levels of vitamin D. To date, there are only few studies about the prevalence of vitamin D deficiency in patients with bipolar disorder. We hypothesized that vitamin D deficiency is less common among patients with bipolar disorder than among patients with schizophrenia or schizoaffective disorder. A second hypothesis is that vitamin D deficiency is more prevalent among patients with schizophrenia, schizoaffective disorder, or bipolar disorders than among the general Dutch population...
September 21, 2016: Journal of Clinical Psychopharmacology
Maria W Mauritz, Betsie G I Van Gaal, Ruud A Jongedijk, Lisette Schoonhoven, Maria W G Nijhuis-van der Sanden, Peter J J Goossens
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...
2016: European Journal of Psychotraumatology
E Sakellaridou, C Chrysanthou, A Nienaber
We examined the effectiveness of a new homebased integrated care intervention model for patients with multiple-episode psychosis in a rural area in Germany, which combines elements of 2 other well-defined interventions: Assertive Community Treatment and Home Treatment. The pilot evaluation was conducted in 2 steps, using a quantitative and a qualitative design. In a 24-month follow-up period, patients showed significant improvement in symptoms, illness severity, global functioning and quality of life, as well as larger reduction in the number of days of inpatient treatment needed...
September 16, 2016: Das Gesundheitswesen
Patricia O'Campo, Vicky Stergiopoulos, Pam Nir, Matthew Levy, Vachan Misir, Antony Chum, Bouchra Arbach, Rosane Nisenbaum, Matthew J To, Stephen W Hwang
OBJECTIVES: We studied the impact of a Housing First (HF) intervention on housing, contact with the justice system, healthcare usage and health outcomes among At Home/Chez Soi randomised trial participants in Toronto, a city with an extensive service network for social and health services for individuals who are experiencing homelessness and mental illness. METHODS: Participants identified as high needs were randomised to receive either the intervention which provided them with housing and supports by an assertive community treatment team (HF+ACT) or treatment as usual (TAU)...
September 12, 2016: BMJ Open
Martin Lambert, Daniel Schöttle, Mary Sengutta, Friederike Ruppelt, Anja Rohenkohl, Daniel Luedecke, Luise Antonia Nawara, Britta Galling, Anne-Lena Falk, Linus Wittmann, Vivien Niehaus, Gizem Sarikaya, Ute Handwerk, Wiebke Rothländer, Liz Rietschel, Charlotte Gagern, Benjamin Lange, Christina Meigel-Schleiff, Dieter Naber, Michael Schulte-Markwort, Helmut Krüger, Hans-Peter Unger, Sven Sippel, Sabine Ott, Georg Romer, Anne Daubmann, Karl Wegscheider, Christoph U Correll, Benno G Schimmelmann, Thomas Bock, Jürgen Gallinat, Anne Karow
AIM: The Integrated Care in Early Psychosis (ACCESS III) Study examined the efficacy and cost-effectiveness of a combined intervention consisting of strategies to improve early detection and quality of care (integrated care including therapeutic assertive community treatment) in adolescents and young adults in the early phase of a severe psychotic disorder from 2011 to 2014. METHODS: This is a prospective, single-centre, 1-year cohort study comparing an intervention condition (early detection plus integrated care, n = 120) to the historical control condition (standard care, SC, n = 105) for adolescents and young adults aged 12-29 years suffering from a severe, early-phase psychotic disorder (i...
September 12, 2016: Early Intervention in Psychiatry
M-J Fleury, Akram Djouini, Christophe Huỳnh, Joël Tremblay, Francine Ferland, J-M Ménard, Geneviève Belleville
OBJECTIVE: This paper presents a systematic review and meta-analysis of available evidence on remission rates for substance use disorders (SUDs), providing weighted mean estimates of SUD remission rates. The review also explores study-level characteristics that may explain variations in remission rates across studies. METHODS: A comprehensive search strategy identified studies published between 2000 and 2015 with follow-up periods of at least three years or reported lifetime remission outcomes for potential inclusion in the review...
August 29, 2016: Drug and Alcohol Dependence
Maaike D van Vugt, Hans Kroon, Philippe A E G Delespaul, Cornelis L Mulder
This article draws on a prospective longitudinal study in which Assertive Community Treatment (ACT) model fidelity and patient outcomes were assessed in twenty outpatient treatment teams. 530 severely mentally ill patients participated in the study. Delinquency outcomes were assessed three times during a two-year follow-up period. At baseline, 49% of the patients had a recent criminal history, meaning that they had at least one reported contact with the police and/or the justice system in the past year. Patients with a recent criminal history had more serious psychosocial problems at baseline compared to those without a recent criminal history...
September 3, 2016: International Journal of Law and Psychiatry
Obiora E Onwuameze, Aghaegbulam Uga, Sergio Paradiso
BACKGROUND: During initial assessment of individuals with schizophrenia and related disorders (schizophrenia spectrum disorders [SSDs]), clinicians tend to pay greater attention to psychotic symptoms than mood symptoms, including depression. Depression is reported to influence the course of SSDs, but not much is known about the risk factors for depression in SSDs. In the present study, we examined clinical predictors of depression in SSDs. METHODS: The sample included 71 patients with SSDs followed in a modified Assertive Community Treatment program, the Community Support Network of Springfield, Illinois...
August 2016: Annals of Clinical Psychiatry: Official Journal of the American Academy of Clinical Psychiatrists
Annika Lexén, Bengt Svensson
BACKGROUND: Despite the lack of evidence for effectiveness of the Flexible Assertive Community Treatment (Flexible ACT), the model is considered feasible and is well received by mental health professionals. No current studies have adequately examined mental health professional experiences of working with Flexible ACT. AIMS: The aim of this study was to explore mental health professional experiences of working with the Flexible ACT model compared with standard care...
July 27, 2016: Journal of Mental Health
Stéphane Morandi, Benedetta Silva, Martine Monnat, Charles Bonsack
Despite the increasing number of specialized addiction services and the constant deployment of health care resources, a coordinated needs-based treatment is not always available for people with severe drugs and/or alcohol problems. Too often the involved health care professionals feel helpless and overwhelmed by the complexity of the situation. In order to promote the treatment engagement of the hard-to-reach substance users, a multidisciplinary mobile team project for addiction (SIMA) was developed in Lausanne, Switzerland, in 20174...
June 8, 2016: Revue Médicale Suisse
Thomas Marquant, Bernard Sabbe, Meike Van Nuffel, Kris Goethals
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...
July 15, 2016: Community Mental Health Journal
Piper S Meyer-Kalos, Michael G Lee, Lynette M Studer, Tanya A Line, Colleen M Fisher
This qualitative study assessed the experiences of assertive community treatment (ACT) team members regarding the integration of physical and mental health self-management for persons with serious mental illness. Three focus groups elicited information from participants concerning barriers, strategies, and recommendations. Findings from inductive analyses revealed six overarching themes: (1) collaboration with primary care, (2) improvements in engagement, (3) team-focused roles, (4) education and training, (5) recommendations for system level barriers, and (6) systems collaboration...
July 11, 2016: Community Mental Health Journal
Sébastien Urben, Gregory Mantzouranis, Vanessa Baier, Olivier Halfon, Eva Villard, Laurent Holzer
Understanding the trajectories of youths within Child and Adolescents Mental Health Service (CAMHS) is of primary importance. Our objective is to assess the usefulness of the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) to predict inpatient (IP) stay for youths followed by assertive community treatment (ACT) teams. 82 youths followed exclusively by ACT and 42 who needed IP were assessed with the HoNOSCA at admission to the program. The HoNOSCA allowed the computing of three scores: a total score, an externalizing symptoms (Ext) score and an emotional problems (Emo) score...
August 30, 2016: Psychiatry Research
Jing Ye, Timothy F Chen, Diane Paul, Rebecca McCahon, Sumitra Shankar, Alan Rosen, Claire L O'Reilly
AIMS: To describe the perceived experiences of stigma and discrimination among people living with severe and persistent mental illness in assertive community treatment (ACT teams) settings in New South Wales (NSW), Australia. METHODS: The Discrimination and Stigma Scale (DISC) was used in this cross-sectional study with people living with severe and persistent mental illness. The DISC is a reliable and valid, quantitative and qualitative instrument used to explore and measure levels of negative, anticipated and positive discrimination...
September 2016: International Journal of Social Psychiatry
Dana-Adriana Botesteanu, Stanley Lipkowitz, Jung-Min Lee, Doron Levy
Women constitute the majority of the aging United States (US) population, and this has substantial implications on cancer population patterns and management practices. Breast cancer is the most common women's malignancy, while ovarian cancer is the most fatal gynecological malignancy in the US. In this review, we focus on these subsets of women's cancers, seen more commonly in postmenopausal and elderly women. In order to systematically investigate the complexity of cancer progression and response to treatment in breast and ovarian malignancies, we assert that integrated mathematical modeling frameworks viewed from a systems biology perspective are needed...
July 2016: Wiley Interdisciplinary Reviews. Systems Biology and Medicine
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