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

Abstract

Background: The Multicenter Youth Flexible ACT Study is an ongoing observational prospective cohort study that examines the effects of Youth Flexible ACT (Assertive Community Treatment) on young people with complex care needs who are difficult to engage in traditional (office-based) mental health services. However, a clear and detailed description of this patient group is lacking. In the current paper, we present baseline characteristics and psychosocial outcomes of the Youth Flexible ACT target group and explore the existence of underlying specific patient subgroups.Methods: Sixteen Youth Flexible ACT teams from seven mental healthcare institutes in the Netherlands participated in the study. Research participants were monitored for 18 months and administered questionnaires measuring psychiatric- and social functioning every 6 months, yielding four measurements. Baseline data were obtained from 199 adolescents, their mental health workers, and parents/carers. Latent Class Analysis based on HoNOSCA scores (measuring psychosocial and daily functioning) was conducted to identify underlying subgroups.Results: The target group of Youth Flexible ACT mainly consisted of patients older than 15 years of age with a history of (specialized) mental healthcare. They face many complex problems, including trauma; developmental, mood, and anxiety disorders; and problems with school attendance, family life, and peer relationships. Other frequently reported difficulties were substance misuse, the involvement of the legal system or police, problems with intellectual functioning, and personal finance. Patients were classified into four distinct classes: the “internalizing,” “externalizing,” “non-specific,” and the “overly impulsive” subgroup. Each subgroup had its unique pattern of difficulties and focus, respectively, high levels of depression and anxiety, disruptive behavior, unspecific difficulties, and substance misuse.Conclusions: As expected, patients in Youth Flexible ACT experienced many severe problems, rendering them vulnerable to fragmented and, thus, ineffective care. Our findings underscore the need for an integrated care approach with a multidisciplinary team of skilled professionals that can bridge these wide-ranging psychosocial problems, as each class of participants experienced a different set of difficulties. Youth Flexible ACT teams need to adjust their care services accordingly.

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

“…We selected the case of Michelle for description in the present article as it aptly demonstrates the need for integrated care across different domains, which is at the core of Youth Flexible ACT. Her age was above 18, she had problems in multiple life domains and she had a long history in care, all of which are hallmarks of the Youth Flexible ACT population ( 2 ). Yet, it should be noted that this case is not meant to serve as a representative client, because such a client does not exist due to the heterogeneous nature of the care models’ target population.…”

“…Yet, it should be noted that this case is not meant to serve as a representative client, because such a client does not exist due to the heterogeneous nature of the care models’ target population. In fact, we previously showed that this population consists of four subgroups: the “internalizing,” “externalizing,” “non-specific,” and the “overly impulsive” subgroup ( 2 ). Michelle’s case best matches the “externalizing” subgroup, characterized by emotion regulation problems that manifest in disruptive behavior.…”

“…Second, the treatment period provided by Youth Flexible ACT teams is limited because of the age limit. Most adolescents in Youth Flexible ACT are between 15 and 22 years, the “transitional age youth” that is preparing to transition to AMHS ( 2 ). Although Flexible ACT teams provide a “smooth” transfer to new care providers, clients face several obstacles when moving to AMHS.…”

“…In addition, the model is adopted in various other countries ( 19 – 23 ). The Adult Flexible ACT model is adapted to young people (0–24 years of age) who experience interrelated psychiatric- and social problems and do not readily engage with office-based traditional mental health services (intake criteria; Table 1 ) ( 1 , 2 ). Youth Flexible ACT is becoming more widespread in the Netherlands, with ∼60 teams being active or under development ( 18 ).…”

An observational comparison of FACT and ACT in the Netherlands and the US

“…In a similar fragmented mental health context in Norway, FACT-teams have shown to support closing of the gaps between organizations [ 28 ]. Additionally, the Dutch have included clients with a variety of diagnoses [ 29 ] and ages [ 30 ] that indicate a need for intensive treatment and not just adult clients with serious mental disorders.…”