Investigating the critical elements and psychosocial outcomes of Youth Flexible Assertive Community Treatment: a study protocol for an observational prospective cohort study

Abstract

IntroductionWhen 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 analysisHere, 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 disseminationThis 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.

Effects of Youth Flexible Assertive Community Treatment: outcomes of an 18-month observational study

“…Adolescents and their mental health workers were asked to complete a baseline and 3 follow-up measurements every 6 months, totaling four measurements ( T 0, T 1, T 2, T 3; data collection period October 2016–January 2020). See our Study Protocol for an extensive description of the research setting, data collection, and procedure [ 21 ].…”

“…Table 2 presents an overview of outcomes and respective measures. Additional information about the questionnaires is described in our study protocol [ 21 ].…”

Case Study in Youth Flexible Assertive Community Treatment: An Illustration of the Need for Integrated Care

“…Although the popularity of Youth Flexible ACT is increasing, evidence supporting the effectiveness of this particular model remains scarce. Therefore, our ongoing Multicenter Youth Flexible ACT Study examines the effect of Youth Flexible ACT on a group of 199 adolescents ( 24 ). Yet, a clear description of the model with its core principles has not been described before in the international literature.…”

Young Patients With Persistent and Complex Care Needs Require an Integrated Care Approach: Baseline Findings From the Multicenter Youth Flexible ACT Study

“…Nowadays, ∼60 teams are active or under development in the Netherlands (27). A detailed portrayal of Youth Flexible ACT is outlined in the Youth Flexible ACT model description (7) and our study protocol (28).…”

“…In our ongoing Multicenter Youth Flexible ACT Study (28), we examine the effect of the care model by investigating (1) improvement in treatment outcomes throughout the Flexible ACT care and (2) associations between (elements of) Youth Flexible ACT model fidelity and treatment outcomes. Theoretically, Youth Flexible ACT targets a specific patient group with specific care needs.…”