Assertive community treatment of severe mental illness: a Canadian experience

doi:10.1176/ps.47.7.757

Cited by 59 publications

(3 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Youth-ACT appears to improve general functioning in adolescents with severe psychiatric symptoms [ 6 , 41 – 43 , 46 , 48 , 52 ]. Effects seem comparable with studies investigating ACT in adults that found small (ES = 0.2 [ 25 ]; ES = 0.3 [ 21 ]), medium (ES = 0.6 [ 22 ]) and large (ES = 1.7 [ 24 ]) effects. Large significant effects on general functioning coincided with large effects on psychotic symptoms and mood disorders.…”

Section: Discussionsupporting

confidence: 82%

The effect of youth assertive community treatment: a systematic PRISMA review

et al. 2017

View full text Add to dashboard Cite

Background: During the past decades deinstitutionalisation policies have led to a transition from inpatient towards community mental health care. Many European countries implement Assertive Community Treatment (ACT) as an alternative for inpatient care for "difficult to reach" children and adolescents with severe mental illness. ACT is a well-organized low-threshold treatment modality; patients are actively approached in their own environment, and efforts are undertaken to strengthen the patient's motivation for treatment. The assumption is that ACT may help to avoid psychiatric hospital admissions, enhance cost-effectiveness, stimulate social participation and support, and reduce stigma. ACT has been extensively investigated in adults with severe mental illness and various reviews support its effectiveness in this patient group. However, to date there is no review available regarding the effectiveness of youth-ACT. It is unknown whether youth-ACT is as effective as it is in adults. This review aims to assess the effects of youth-ACT on severity of psychiatric symptoms, general functioning, and psychiatric hospital admissions. Method: A systematic literature search was conducted in PubMed, Cochrane Library, PsychINFO and CINAHL published up to March 2017. To assess methodological quality of the included studies, the Oxford Centre of Evidence-Based Medicine grading system was used. Results: Thirteen studies were included in this review. There are indications that youth-ACT is effective in reducing severity of psychiatric symptoms, improving general functioning, and reducing duration and frequency of psychiatric hospital admissions. Conclusions: The current literature on youth-ACT is limited but promising. There are indications that youth-ACT is effective in reducing severity of psychiatric symptoms, improving general functioning, and reducing duration and frequency of psychiatric hospital admissions. The effect of youth-ACT may be comparable with the effect of ACT in adults. Similar as in adult ACT, the studies on youth-ACT found effects that vary from small to large. Randomized experimental research designs are needed to further corroborate effectiveness.

show abstract

Section: Discussionsupporting

confidence: 82%

The effect of youth assertive community treatment: a systematic PRISMA review

et al. 2017

View full text Add to dashboard Cite

show abstract

“…For the ACT versus hospital-based rehabilitation comparison, three trials had been eligible for inclusion (De Cangas-Canada, Lafave-Canada, Marx-Wisconsin). All three have been excluded from the current update as they did not met inclusion criteria.…”

Section: Resultsmentioning

confidence: 99%

“…Four trials included in the original reviews have been excluded in this update as they now do not match the new inclusion criteria (De Cangas-Canada, Franklin-Texas, Lafave-Canada, Marx-Wisconsin). Morse-Missouri2 had to be excluded in this update as it did not report the number of people randomised to each treatment group.…”

Section: Resultsmentioning

confidence: 99%

Intensive case management for severe mental illness

Dieterich

Irving

Bergman

et al. 2010

Cochrane Database of Systematic Reviews

272

101

View full text Add to dashboard Cite

Background Intensive Case Management (ICM) is a community based package of care, aiming to provide long term care for severely mentally ill people who do not require immediate admission. ICM evolved from two original community models of care, Assertive Community Treatment (ACT) and Case Management (CM), where ICM emphasises the importance of small caseload (less than 20) and high intensity input. Objectives To assess the effects of Intensive Case Management (caseload <20) in comparison with non-Intensive Case Management (caseload > 20) and with standard community care in people with severe mental illness. To evaluate whether the effect of ICM on hospitalisation depends on its fidelity to the ACT model and on the setting. Search methods For the current update of this review we searched the Cochrane Schizophrenia Group Trials Register (February 2009), which is compiled by systematic searches of major databases, hand searches and conference proceedings. Selection criteria All relevant randomised clinical trials focusing on people with severe mental illness, aged 18 to 65 years and treated in the community-care setting, where Intensive Case Management, non-Intensive Case Management or standard care were compared. Outcomes such as service use, adverse effects, global state, social functioning, mental state, behaviour, quality of life, satisfaction and costs were sought. Data collection and analysis We extracted data independently. For binary outcomes we calculated relative risk (RR) and its 95% confidence interval (CI), on an intention-to-treat basis. For continuous data we estimated mean difference (MD) between groups and its 95% confidence interval (CI). We employed a random-effects model for analyses. We performed a random-effects meta-regression analysis to examine the association of the intervention’s fidelity to the ACT model and the rate of hospital use in the setting where the trial was conducted with the treatment effect. Main results We included 38 trials (7328 participants) in this review. The trials provided data for two comparisons: 1. ICM versus standard care, 2. ICM versus non-ICM. 1. ICM versus standard care Twenty-four trials provided data on length of hospitalisation, and results favoured Intensive Case Management (n=3595, 24 RCTs, MD −0.86 CI −1.37 to −0.34). There was a high level of heterogeneity, but this significance still remained when the outlier studies were excluded from the analysis (n=3143, 20 RCTs, MD −0.62 CI −1.00 to −0.23). Nine studies found participants in the ICM group were less likely to be lost to psychiatric services (n=1633, 9 RCTs, RR 0.43 CI 0.30 to 0.61, I2=49%, p=0.05). One global state scale did show an Improvement in global state for those receiving ICM, the GAF scale (n=818, 5 RCTs, MD 3.41 CI 1.66 to 5.16). Results for mental state as measured through various rating scales, however, were equivocal, with no compelling evidence that ICM was really any better than standard care in improving mental state. No differences in mortality between ICM and standard care ...

show abstract