Service User Experiences of How Flexible Assertive Community Treatment May Support or Inhibit Citizenship: A Qualitative Study

Brekke, Eva; Clausen, Hanne Kristin; Brodahl, Morten; Lexén, Annika; Keet, R.; Mulder, Cornelis L.; Landheim, Anne

doi:10.3389/fpsyg.2021.727013

Cited by 12 publications

(13 citation statements)

References 62 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This emphasizes the importance of collaboration in both urban and rural FACT teams, implying the need to increase the focus on service system collaboration in the FACT model. However, a study of patients of urban and rural FACT teams reported that the patients experienced FACT to be better than their earlier treatment because the FACT teams to a large extent provided the services they needed ( 73 ). Nevertheless, one challenge that remains is the remoteness in relation to crisis management.…”

Section: Discussionmentioning

confidence: 99%

Flexible Assertive Community Treatment in Rural and Remote Areas: A Qualitative Study of the Challenges and Adaptations of the Model

Trane

Aasbrenn

Rønningen

et al. 2022

Front. Public Health

Self Cite

View full text Add to dashboard Cite

BackgroundFlexible assertive community treatment (FACT) is an innovative model for providing long-term treatment to people with severe mental illness. The model was developed in the Netherlands but is now used in other countries, including Norway, which has a geography different from the Netherlands, with many rural and remote areas. Implementation of innovations is context dependent. The FACT model's potential in rural and remote areas has not been studied. Therefore, we aimed to gain knowledge regarding the challenges and modifications of the model in rural and remote contexts and discuss how they can affect the model's potential in such areas. This knowledge can improve the understanding of how FACT or similar services can be adapted to function most optimally in such conditions. We sought to address the following questions: Which elements of the FACT model do team leaders of the rural FACT teams find particularly challenging due to the context, and what modifications have the teams made to the model?MethodsDigital interviews were conducted with five team leaders from five rural FACT teams in different parts of Norway. They were selected using purposive sampling to include team leaders from some of the most rural teams in Norway. The interviews were analyzed using thematic text analysis.ResultsThe following three themes described elements of the FACT model that were experienced particularly challenging in the rural and remote context: multidisciplinary shared caseload approach, intensive outreach and crisis management. The following eight themes described the modifications that the teams had made to the model: intermunicipal collaboration, context-adaptive planning, delegation of tasks to municipal services, part-time employment, different geographical locations of staff, use of digital tools, fewer FACT board meetings, and reduced caseload.ConclusionsRural and remote contexts challenge the FACT model's potential. However, modifications can be made, some of which can be considered innovative modifications that can increase the model's potential in such areas, while others might move the teams further away from the model.

show abstract

Section: Discussionmentioning

confidence: 99%

Flexible Assertive Community Treatment in Rural and Remote Areas: A Qualitative Study of the Challenges and Adaptations of the Model

Trane

Aasbrenn

Rønningen

et al. 2022

Front. Public Health

Self Cite

View full text Add to dashboard Cite

show abstract

“…Norwegian FACT teams have been described by other service providers as working to promote collaboration and improving collaboration in the service system [ 61 ]. However, a study that interviewed patients from the same study as ours noted the potential for improvement in their collaboration with other services [ 77 ]. Our findings indicate that collaboration is essential for FACT teams in complex and fragmented systems.…”

Section: Discussionmentioning

confidence: 99%

“…This way of working may promote the opportunities for integration. The previously mentioned study that interviewed patients from the same FACT teams as our described that being treated as a whole person and finding help with all their challenges from the same team made them feel safer, improved their daily life situation and made it easier to relate to the service system [ 77 ]. This indicates that FACT teams can contribute to better integrated care even in complex and fragmented service systems.…”

Section: Discussionmentioning

confidence: 99%

Integration of Care in Complex and Fragmented Service Systems: Experiences of Staff in Flexible Assertive Community Treatment Teams

Trane

Aasbrenn

Rønningen

et al. 2022

International Journal of Integrated Care

Self Cite

View full text Add to dashboard Cite

Introduction: To provide more integrated care, several countries have implemented the Flexible Assertive Community Treatment (FACT) model. However, this model does not guarantee full integration, especially in complex and fragmented service systems like in Norway. Hence, we investigated which barriers that might reduce the potential for integrated care in the Norwegian system, as described by staff in FACT teams, and how they adjust their way of working to increase the opportunities for integration. Methods: Online focus group interviews involving 35 staff members of five Norwegian FACT teams were conducted using a semi-structured interview guide. The material was analysed using thematic text analysis. Results: Six themes described the barriers to integrated care in the service system: fragmentation, different legislation and digital systems, challenges in collaboration, bureaucracy and limited opening hours. Three themes described adjustments in the teams’ way of working to enhance integration: working as the responsible co-ordinator, being a collaborator, and the only entry channel into the service system. Conclusion: The FACT team staff described several barriers to integration within the system. However, they made some adjustments in their way of working that might provide opportunities for integrated care within complex and fragmented service systems.

show abstract

“…Some of these patients may benefit from a more customized, flexible setup with faster turnaround and better availability [ 7 ], such as the Flexible Assertive Community Treatment model (FACT). FACT provides prolonged, extensive, and combined services to persons with severe substance use or mental disorders [ 44 ]. Such a low-threshold service is resource demanding but could prove a cost-effective option from a longer-term socioeconomic perspective, at least for some SUD patients.…”

Section: Discussionmentioning

confidence: 99%

Effects of a brief pre-admission telephone reminder on no-show and dropout rates in substance use disorder treatment: a quasi-experimental study

Gallefoss

Gabrielsen

Haugland

et al. 2022

Subst Abuse Treat Prev Policy

View full text Add to dashboard Cite

Background Appointment no-show and early dropout from treatment represent major challenges in outpatient substance use disorder treatment, adversely affecting clinical outcomes and health care productivity. In this quasi-experimental study, we examined how a brief reminder intervention for new patients before their first appointment affected treatment participation and retention. No-shows (not attending any sessions) and dropouts (discontinuation of initiated treatment because of three consecutively missed appointments) were compared between a period with pre-admission telephone calls (intervention) and a period without such reminders (non-intervention). Methods Participants were all eligible patients (N = 262) admitted to a Norwegian specialist clinic for substance use disorder treatment. We used the Chi-square test for the no-show analysis. Of the eligible patients, 147 were included in a subsequent dropout analysis. We used the number of visits up to 10 appointments as a measure for time to event. Group differences were analyzed using a Kaplan–Meier plot and the log-rank test. To control for relevant sociodemographic variables, as well as substance use and mental distress severity, we used Cox regression. Results No-show rates did not differ between the two periods (12% for non-intervention vs. 14% for intervention; χ2 = 0.20, p = 0.653). Of those consenting to participate in the dropout analysis (n = 147), 28 (19%) discontinued treatment within the time frame of 10 appointments, with no differences between the two periods (log-rank test = 0.328, p = 0.567). Controlling for baseline characteristics did not alter this finding. In fact, of the registered covariates at baseline, only higher education level was associated with attrition, linked to a reduced risk for dropout (hazard ratio = 0.85, 95% CI = 0.74–0.98, p = 0.025). Conclusion These findings do not provide support for the systematic use of a brief pre-admission telephone reminder in the current treatment setting. Trial registration The study was retrospectively registered 13 Jan 2021 at ClinicalTrials.gov, NCT04707599.

show abstract

Service User Experiences of How Flexible Assertive Community Treatment May Support or Inhibit Citizenship: A Qualitative Study

Cited by 12 publications

References 62 publications

Flexible Assertive Community Treatment in Rural and Remote Areas: A Qualitative Study of the Challenges and Adaptations of the Model

Flexible Assertive Community Treatment in Rural and Remote Areas: A Qualitative Study of the Challenges and Adaptations of the Model

Integration of Care in Complex and Fragmented Service Systems: Experiences of Staff in Flexible Assertive Community Treatment Teams

Effects of a brief pre-admission telephone reminder on no-show and dropout rates in substance use disorder treatment: a quasi-experimental study

Contact Info

Product

Resources

About