Treatment Outcome in Patients Receiving Assertive Community Treatment

Abstract

In an observational study of severely mentally ill patients treated in assertive community treatment (ACT) teams, we investigated how treatment outcome was associated with demographic factors, clinical factors, and motivation for treatment. To determine psychosocial outcome, patients were routinely assessed using the Health of the Nation Outcome Scales (HoNOS). Trends over time were analyzed using a mixed model with repeated measures. The HoNOS total score was modeled as a function of treatment duration and patient-dependent covariates. Data comprised 637 assessments of 139 patients; mean duration of follow-up was 27.4 months (SD = 5.4). Substance abuse, higher age, problems with motivation, and lower educational level were associated with higher HoNOS total scores (i.e., worse outcome). To improve treatment outcome, we recommend better implementation of ACT, and also the implementation of additional programs targeting subgroups which seem to benefit less from ACT.

Parents served by assertive community treatment: Parenting needs, services, and attitudes.

“…Consequently, ACT research has tended to ignore parental status as an important variable. Though studies have investigated the impact of different variables (e.g., age, substance use) on outcomes, no study has explicitly examined the potential impact of parenting on treatment outcomes with ACT (Nicholson, Hinden, Biebel, Henry, & Katz-Leavy, 2007; Kortrijk, Mulder, Roosenschoon, & Wiersma, 2010). …”

The Characteristics of Consumers Receiving Case Management in the Community: A Review of Literature

“…In an Irish study (Meagher et al, 2009), for example, the consumers who received care from community mental health nurses had an average HoNOS score of 8.2 (SD = 5.9) and 58% were classified as having severe mental illnesses. Furthermore, in a Dutch study (Kortrijk et al, 2010), half (49.0%) of the consumers who were part of a study on assertive community treatment had HoNOS scores that equalled or exceeded 15. An additional 16.6% of consumers had scores ranging from 11 to 15, and 5.1% had scores of 10 or below (22.3% of consumers had missing data).…”

“…To gain an indication of the health and social functioning of community mental health consumers, several researchers have used the Health of the Nation Outcome Scales ( HoNOS; Wing et al, 1998 ) in their studies (e.g., Happell & Koehn, 2010;Kortrijk, Mulder, Roosenschoon, & Wiersma, 2010;Meagher, O'Brien, Pullela, Oshun, & Brosnan, 2009;Monzani, Erlicher, Lora, Lovaglio, & Vittadini, 2008;Prowse & Coombs, 2009;Rees, Richards, & Shapiro, 2004;Segal, Daffern, Thomas, & Ferguson, 2010).…”

“…Expert opinion suggests that a rating of 2 ("mild problem but definitely present") on any of the 12 items is clinically significant and highlights an issue that requires active monitoring or intervention (Burgess, Trauer, Coombs, McKay, & Pirkis, 2009). Because researchers in community mental health have typically reported total HoNOS scores, rather than those for each item (e.g., Kortrijk et al, 2010;Meagher et al, 2009), it is difficult to accurately gauge the severity of the problems that consumers were experiencing.…”

Predictors of Clinical Outcome of Assertive Community Treatment (ACT) in a Rural Area in Denmark: An Observational Study with a Two-Year Follow-Up

“…In the Netherlands, the inpatient capacity is relatively high, but despite that the Dutch modified version of ACT, termed Function Assertive Community Treatment (F-ACT), has only been shown to sustain better contact with patients and to increase the proportion of patients reaching symptomatic remission compared to standard care (Bak et al 2007). Moreover, treatment outcome has also been shown to be associated with ACT-model fidelity and selection criteria including demographic and clinical factors (Kortrijk et al 2010).…”