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Administration and Policy in Mental Health and Mental Health Services Research

16-04-2024 | COVID-19 | Original Article

Impact of the Pandemic was Minor Compared to Systemic Decrease in Fidelity of Assertive Community Treatment Services- A Provincial Study in Ontario, Canada

Authors: Samuel Law, Aly Kassam, Michaela Beder, Saadia Sediqzadah, Matthew Levy, John Maher

Published in: Administration and Policy in Mental Health and Mental Health Services Research

Abstract

Assertive Community Treatment (ACT) model is the gold standard in community psychiatry serving people with severe mental illness. With its outreach-based design, the pandemic has profoundly affected the operations and functioning of ACT. The Dartmouth ACT Scale (DACTS) provides a standardized comprehensive and quantitative way to evaluate ACT quality. Results could inform nature of impact and identify areas for improvement. Current online survey used DACTS during the pandemic in April-May 2021. Clinical and administrative leadership of the 80 ACT teams in Ontario, Canada cross-sectionally rated ACT quality one-year pre-Covid (2018–2019) and one-year post the start of Covid (2020–2021). The overall pre-Covid Ontario ACT DACTS fidelity was 3.65. The pandemic led to decreases in all domains of DACTS (Human Resources: −4.92%, p < 0.001, 95% CI [0.08–0.27]; Organizational Boundary: −1.03%, p < 0.013,95%CI [0.01–0.07]; and Nature of Services: −6.18%, p < 0.001, 95%CI [0.16–0.26]). These changes were accounted by expected lower face-to-face encounters, time spent with clients, reduction in psychosocial services, less interactions with hospitals and diminished workforces. The magnitude of change was modest (−3.84%, p < 0.001, 95%CI [0.09–0.19]). However, the Ontario ACT pre-Covid DACTS was substantially lower (−13.5%) when compared to that from a similar survey 15 years ago (4.22), suggestive of insidious systemic level loss of fidelity. Quantitative fidelity evaluation helped to ascertain specific pandemic impact. Changes were significant and specific, but overall relatively modest when compared to the larger system level drop over the last decade. There is both evidence for model adaptability and resilience during Covid disruption, and concerns over larger downward drift in ACT fidelity and quality.

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Title: Impact of the Pandemic was Minor Compared to Systemic Decrease in Fidelity of Assertive Community Treatment Services- A Provincial Study in Ontario, Canada
Authors: Samuel Law
Aly Kassam
Michaela Beder
Saadia Sediqzadah
Matthew Levy
John Maher
Publication date: 16-04-2024
Publisher: Springer US
Keyword: COVID-19
Published in: Administration and Policy in Mental Health and Mental Health Services Research
Print ISSN: 0894-587X
Electronic ISSN: 1573-3289
DOI: https://doi.org/10.1007/s10488-024-01375-1

Keynote webinar | Spotlight on medication adherence

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Impact of the Pandemic was Minor Compared to Systemic Decrease in Fidelity of Assertive Community Treatment Services- A Provincial Study in Ontario, Canada

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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