Outcomes of clients in need of intensive team care in Flexible Assertive Community Treatment in Sweden

Svensson, Bengt; Hansson, Lars; Lexén, Annika

doi:10.1080/08039488.2018.1430168

Cited by 22 publications

(20 citation statements)

References 26 publications

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“…Data from the FACT board showed that the median duration of a FACT board episode was only 12 days, considerably shorter than results of other studies of FACT conducted in the Netherlands and Sweden; Nugter el al. 5 reported a median of 12•6 weeks, and Svensson et al 7 reported a mean of 6 months. A possible explanation could be a larger caseload in the Danish teams compared with that recommended in the Dutch FACT manual.…”

Section: Comparison With Other Fact Studiesmentioning

confidence: 99%

“…Contacts are less frequent than in ACT, with most appointments offered at the team office and within usual office hours. 3 Although the FACT model has been taken up in many countries [5][6][7] , there is a lack of good quality studies investigating its effectiveness. [8][9][10] To date, no studies have compared FACT with ACT or CMHT control groups .…”

Section: Research In Context Panelmentioning

confidence: 99%

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The effect of flexible assertive community treatment in Denmark: a quasi-experimental controlled study

Nielsen

Hjorthøj

Killaspy

et al. 2021

The Lancet Psychiatry

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Background: A community-based treatment model for patients with severe mental illness called Flexible Assertive Community Treatment (FACT) has been widely implemented despite limited 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 conducted a quasi-experimental controlled study from May 2016 to November 2018, comparing outcomes for patients under the care of CMHTs or ACT teams that were reconfigured to FACT teams (CMHT-FACT or ACT-FACT) with patients that remained under the care of CMHTs and ACT teams.A total of 2094 individuals were included and followed up for two years using Danish registries on multiple mental health care outcomes. Patients who received FACT were matched using propensity scores with control patients from CMHTs and ACT teams to balance differences in baseline characteristics.Findings: The number of outpatient contacts was higher for patients receiving FACT than controls (CMHT-

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Section: Comparison With Other Fact Studiesmentioning

confidence: 99%

Section: Research In Context Panelmentioning

confidence: 99%

The effect of flexible assertive community treatment in Denmark: a quasi-experimental controlled study

Nielsen

Hjorthøj

Killaspy

et al. 2021

The Lancet Psychiatry

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“…They largely link services and contribute to a clearer and more integrated system. In addition, a Swedish study assumed that FACT teams appear to bridge gaps between services [6]. FACT teams as a binding collaboration between specialist and primary care appear to be of great importance in their role as a bridge.…”

Section: Fact Teams Contribute To Positive Changes In the Service Systemmentioning

confidence: 99%

“…15 :38 at providing integrated care for people with severe mental illness (SMI) [4]. The model was developed in the Netherlands [5], has spread internationally [6][7][8][9][10][11] and has been implemented in the Netherlands [12,13], Norway, Sweden, England [7] and Denmark [8]. The Norwegian health authorities have funded implementation of FACT teams since 2013, resulting in approximately 70 teams being implemented.…”

mentioning

confidence: 99%

Flexible assertive community treatment teams can change complex and fragmented service systems: experiences of service providers

Trane

Aasbrenn

Rønningen

et al. 2021

Int J Ment Health Syst

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Background Implementing innovative health service models in existing service systems is complicated and context dependent. Flexible assertive community treatment (FACT) is a multidisciplinary service model aimed at providing integrated care for people with severe mental illness. The model was developed in the Netherlands and is now used in several countries, such as Norway. The Norwegian service system is complex and fragmented, with challenges in collaboration. Limited research has been performed on FACT teams and other new integrative health service models as part of such systems. However, such knowledge is important for future adjustments of innovation processes and service systems. Our aim was to explore how FACT teams are integrated into the existing formal public service system, how they function and affect the system, and describe some influencing factors to this. We sought to address how service providers in the existing service system experience the functioning of FACT teams in the system. Methods Five focus group interviews were undertaken 3 years after the FACT teams were implemented. Forty service providers representing different services from both levels of administration (primary and specialist healthcare) from different Norwegian regions participated in this study. Team leaders of the FACT teams also participated. Service providers were recruited through purposeful sampling. Interviews were analysed using thematic text analysis. Results The analysis revealed five main themes regarding FACT teams: (1) They form a bridge between different services; (2) They collaborate with other services; (3) They undertake responsibility and reassure other services; (4) They do not close all gaps in service systems; and (5) They are part of a service system that hampers their functioning. Conclusions The FACT teams in this study contributed to positive changes in the existing service system. They largely contributed to less complex and fragmented systems by forming a bridge and undertaking responsibility in the system and by collaborating with and reassuring other services; this has reduced some gaps in the system. The way FACT teams function and needs of the existing system appear to have contributed positively to these findings. However, complexity and fragmentation of the system partly hamper functioning of the FACT teams.

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“…En oppsummering av fem studier viste at en ikke finner signifikant bedring hos pasienter i FACT når det gjelder symptomreduksjon eller funksjonsnivå, men studiene hadde flere metodiske svakheter som liten styrke i utvalgene, uklare kriterier for mål på symptomer, ulikheter i utvalg som sammenliknes, samt uklarheter rundt hva som er faktiske resultater og hva som er antakelser (Nordén & Norlander, 2014). Nyere forskning som har undersøkt effekten av FACT i Nederland, Sverige og Danmark har vist bedring i psykososial fungering, livskvalitet og etterlevelse av behandling, samt nedgang i udekkede behov, antall innleggelser og lengde på innleggelsene (Nugter et al, 2016;Kortrijk et al, 2019;Svensson, Hansson & Lexen, 2018;Lexen & Svensson, 2016;Nielsen, Hjorthøj, Killaspy & Nordenhoft, 2021). Den norske evalueringsstudien av FACT viste at pasienter som var fulgt opp i to år hadde oppnådd bedre bosituasjon, økt deltakelse i meningsfull aktivitet, bedre praktisk og sosial fungering, mindre symptombelastning og økt livskvalitet (Landheim & Odden, 2020).…”

Section: Bakgrunnunclassified

Hvilken fagkompetanse kan ergoterapeuter tilføre FACT-team i oppfølgingen av personer med alvorlig psykisk lidelse?

Neverdal

Pinxsterhuis

2021

NorTidHelse

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«Flexible Assertive Community Treatment» (FACT) ble utviklet for oppfølging av personer med alvorlig psykisk lidelse. Ergoterapeuter blir ikke nevnt som yrkesgruppe i FACT-håndboken, men noen team har likevel ansatt ergoterapeut. Hensikten med denne studien var å belyse hvordan ergoterapeuter beskriver at de bruker sin fagkompetanse i et FACT-team. Individuelle intervjuer ble gjennomført med seks ergoterapeuter. Tematisk analyse ble anvendt. Resultatene viser at informantene bruker sin fagkompetanse gjennom fremming av meningsfulle aktiviteter, kartlegging av aktivitetsutførelse og fokus på omgivelsenes betydning for aktivitetsutførelse og deltakelse. Ergoterapeutenes tilnærmingsmåter er i tråd med målene og prinsippene i FACT-modellen. Studien tyder på at ergoterapeuters fagkompetanse kan bidra til å styrke FACT-teamene. What competence can occupational therapists add to FACT-teams in treatment of persons with severe mental illness? - a qualitative study Abstract «Flexible Assertive Community Treatment» (FACT) has been developed to provide treatment services for persons with severe mental illness. Occupational therapists (OTs) are not mentioned in the FACT-handbook as part of the FACT-team, but some teams have included OTs. The aim of the study was to explore how OTs describe the usage of their professional expertise in FACT-teams. Individual interviews were conducted with six OTs and analysed using thematic analysis. The OTs appeared to utilise their expertise through enabling meaningful activities, assessment of activity performance, and by emphasizing the influence of environments on occupational performance and participation. Their approaches correspond with the goals and principles of FACT. This study indicates that OTs may strengthen FACT-teams.

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Outcomes of clients in need of intensive team care in Flexible Assertive Community Treatment in Sweden

Abstract: 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.

Cited by 22 publications

References 26 publications

The effect of flexible assertive community treatment in Denmark: a quasi-experimental controlled study

The effect of flexible assertive community treatment in Denmark: a quasi-experimental controlled study

Flexible assertive community treatment teams can change complex and fragmented service systems: experiences of service providers

Hvilken fagkompetanse kan ergoterapeuter tilføre FACT-team i oppfølgingen av personer med alvorlig psykisk lidelse?

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