Outcomes of FLEXIBLE Assertive Community Treatment (FACT) Implementation: A Prospective Real Life Study

Abstract

This study aimed to investigate social and clinical outcomes and use of care during and after implementation of FLEXIBLE Assertive Community Treatment (ACT). Three teams and 372 patients were involved. Model fidelity, clinical and social assessments were performed at baseline and after 1 and 2 years. Use of care was registered continuously. Model fidelity was good at the end of the study. Data showed much variation between patients in number and duration of ACT periods. Statistically significant improvements were found in compliance, unmet needs and quality of life. Improvement of quality of life and functioning was related to duration of ACT. The percentage of remissions increased with 9 %. The number of admissions, admission days and face to face contacts differed between ACT and non-ACT patients, but generally decreased. Findings suggest that implementation of FACT results in a more flexible adaptation of care to the needs of the patients.

Complex Interventions and Interorganisational Relationships: Examining Core Implementation Components of Assertive Community Treatment

“…The results of different trials have been inconsistent, however, and the generalisability outside the US has been questioned. Several studies have found no evidence for ACT being more effective compared to less intense CM interventions [202122]. With regard to hospital use, Burns et al [23] found that ACT works best in settings where the participants’ initial hospital use is high.…”

“…A study of one of the few Swedish national initiatives to disseminate ACT found a “drift” away from the model’s core elements [1]. Although ACT has been established as an effective treatment model [22] and the model has been given the highest priority in national guidelines of psychosocial interventions for people with severe mental illness [29], it has not gained any stable foothold in the Swedish CMHS system.…”

Family Group Conferencing—Its Added Value in Mental Health Care

“…In the Netherlands, an adaptation on the ACT-model was established 10 years ago which is known under the name Flexible ACT, abbreviated as FACT. This model is characterised by switching flexibly between intensive team coaching and less intensive individual counselling, and a daily adaptation to the specific needs of clients (Nugter, Engelsbel, Bähler, Keet, & Van Veldhuizen, 2015;Van Veldhuizen, 2007). A second relatively new form of ACT is the Resource Group ACT (RACT), which is an approach to enrich FACT.…”

Mental health professional experiences of the flexible assertive community treatment model: a grounded theory study

“…In contrast to ACT teams, Flexible ACT teams deliver services for the entire group of persons with severe mental illness in a region (van Veldhuizen, 2007). In Flexible ACT (Nugter et al, 2015), a multidisciplinary recovery-oriented team provides both "individual care" including case management and home visits for consumers who are mostly stable and "team-care" with a shared case-load for consumer in need for more intensive care. When a consumer is at risk of relapse, or in crisis, he or she is put on a digital Flexible ACT board.…”

“…Little research has been done on the effectiveness of Flexible ACT (Nugter et al, 2015). Preliminary results indicate positive trends in quantitative medical outcomes, such as a higher probability of symptomatic remission for patients with severe mental illness than for controls receiving standard treatment, increased remission of psychotic symptoms (Drukker et al, 2008), higher levels of psychosocial functioning (Drukker et al, 2013), fewer hospital admissions and a 50% reduction of inpatient bed use (Firn et al, 2013), increased compliance with treatment, decrease in unmet needs, and improved quality of life (Nugter et al, 2015).…”