Top

Published in:

Open Access 01-08-2010 | Original Paper

Treatment Outcome in Patients Receiving Assertive Community Treatment

Authors: H. E. Kortrijk, C. L. Mulder, B. J. Roosenschoon, D. Wiersma

Published in: Community Mental Health Journal | Issue 4/2010

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.

Batel, P. (2000). Addiction and schizophrenia. European Journal of Psychiatry, 15(2), 115–122.CrossRef

Bhugra, D., Leff, J., Mallett, R., Der, G., Corridan, B., & Rudge, S. (1997). Incidence and outcome of schizophrenia in Whites, African-Caribbeans and Asians in London. Psychological Medicine, 27, 791–798.CrossRefPubMed

Bien, T. H., Miller, W. R., & Tonigan, J. S. (1993). Brief interventions for alcohol problems: A review. Addiction, 88, 315–335.CrossRefPubMed

Bond, G. R., Drake, R. E., Mueser, K. T., & Latimer, E. (2001). Assertive community treatment for people with severe mental illness. Critical ingredients and impact on patients. Disease Management & Health Care, 9(3), 141–159.CrossRef

Bond, G. R., Evans, L., Salyers, M. P., & Kim, H. H. (2000). Measurement of fidelity in psychiatric rehabilitation. Mental Health Services Research, 2(2), 75–87.CrossRefPubMed

Bond, G. R., & Salyers, M. P. (2004). Prediction of outcome from the Dartmouth assertive community treatment fidelity scale. CNS Spectrum, 9(12), 937–942.

Brown, K. L., & Miller, W. R. (1993). Impact of motivational interviewing on participation and outcome in residential alcoholism treatment. Psychology of Addictive Behaviours, 7, 238–245.CrossRef

Burns, B. J., & Santos, A. B. (1995). Assertive community treatment: An update of randomized trials. Psychiatric Services, 46(7), 669–675.PubMed

Comaty, J. E., Stasio, M., & Advokat, C. (2001). Analysis of outcome variables of a token economy in a state psychiatric hospital: A program evaluation. Research in Developmental Disabilities, 22(3), 233–253.CrossRefPubMed

Dickerson, F. B., Tenhula, W. N., & Green-Paden, L. D. (2005). The token economy for schizophrenia: Review of the literature and recommendations for future research. Schizophrenia Research, 75(2), 405–416.CrossRefPubMed

Dixon, L. (1999). Dual diagnosis of substance abuse in schizophrenia: Prevalence and impact on outcomes. Schizophrenia Research, 1(35 Suppl), S93–S100.CrossRef

Drake, R., Bartels, S., Teague, G., Noordsy, D., & Clarke, R. (1993). Treatment of substance abuse in severely mentally ill patients. The Journal of Nervous and Mental Disease, 181(10), 606–611.CrossRefPubMed

Drake, R. E., Essock, S. M., Shaner, A., Carey, K. B., Minkoff, K., Kola, L., et al. (2001). Implementing dual diagnosis services for clients with severe mental illness. Psychiatric Services, 52(4), 469–476.CrossRefPubMed

Fitzmaurice, G. M., Laird, N. M., & Ware, J. H. (2004). Applied longitudinal analysis. Hoboken, NJ: Wiley.

Gerlach, J. (2002). Improving outcome in schizophrenia: The potential importance of EPS and neuroleptic dysphoria. Annals of Clinical Psychiatry, 4(1), 47–57.

Greenfield, S. F., Brooks, A. J., Gordon, S. M., Green, C. A., Kropp, F., McHugh, R. K., et al. (2006). Substance abuse treatment entry, retention, and outcome in women: A review of the literature. Drug and Alcohol Dependence, 86(1), 1–21.CrossRefPubMed

Grossman, L. S., Harrow, M., Rosen, C., & Faull, R. (2006). Sex differences in outcome and recovery for schizophrenia and other psychotic and nonpsychotic disorders. Psychiatric Services, 57(6), 844–850.

Gur, R. E., Petty, R. G., Turetsky, B. I., & Gur, R. C. (1996). Schizophrenia throughout life: Sex differences in severity and profile of symptoms. Schizophrenia Research, 21, 1–12.CrossRef

Jenner, J. A. (2003). Directieve interventies in de acute en sociale psychiatri (4th ed.). Assen, Pa: van Gorcum b.v.

Kent, A., & Burns, T. (2005). Assertive community treatment in UK practice. Advances in Psychiatric Treatment, 11, 388–397.CrossRef

Killaspy, H., Bebbington, P., Blizard, R., Johnson, S., Nolan, F., Pilling, S., et al. (2006). The REACT study: Randomised evaluation of assertive community treatment in north London. British Medical Journal, 332(7545), 815–820.CrossRefPubMed

Latimer, E. (1999). Economic impacts of assertive community treatment: A review of the literature. Canadian Journal of Psychiatry, 44, 443–454.

Lauronen, E., Miettunen, J., Veijola, J., Karhu, M., Jones, P. B., & Isohanni, M. (2007). Outcome and its predictors in schizophrenia within the Northern Finland 1966 Birth Cohort. European Journal of Psychiatry, 22(2), 129–136.CrossRef

Lyons, J. S. (1998). The severity and acuity of psychiatric illness scales. An outcomes management and decision support system. Adult version. Manual. San Antonio: The Psychological Corporation, Harcourt Brace & Company.

Mangrum, L. F., Spence, R. T., & Steinley-Bumgarner, M. D. (2006). Gender differences in substance-abuse treatment clients with co-occurring psychiatric and substance-use disorders. Brief Treatment and Crisis Intervention, 6(3), 255–267.CrossRef

Marshall, M., & Lockwood, A. (1998). Assertive community treatment for people with severe mental disorders. Oxford: The Cochrane Library.

Martino, S., Carroll, K. M., O’Malley, S. S., & Rounsaville, B. J. (2000). Motivational interviewing with psychiatrically ill substance abusing patients. American Journal on Addiction, 9, 88–91.CrossRef

McGrew, J. H., Bond, G. R., Dietzen, L., & Salyers, M. (1994). Measuring the fidelity of implementation of a mental health program model. Journal of Consulting and Clinical Psychology, 62, 670–678.CrossRefPubMed

McHugo, G. J., Drake, R. E., Teague, G. B., & Xie, H. (1999). Fidelity to assertive community treatment and client outcomes in the New Hampshire dual disorders study. Psychiatric Services, 50, 818–824.PubMed

Mulder, C. L., Koopmans, G. T., & Hengeveld, M. W. (2005). Lack of motivation for treatment in emergency psychiatric patients. Social Psychiatry Psychiatric Epidemiology, 40, 484–488.CrossRef

Mulder, C. L., Staring, A. B. P., Loos, J., Buwalda, V. J. A., Kuijpers, D., Sytema, S., et al. (2004). De Health of the nations outcome scales in nederlandse vertaling. Psychometrische kenmerken (The HoNOS in Dutch translation; Psychometrics). Dutch Journal of Psychiatry, 46, 273–285.

Neisser, U., Boodoo, G., Bouchard, T. J., Boykin, A. W., Brody, N., Ceci, S. J., et al. (1996). Intelligence: Knowns and unknowns. American Psychologist, 51, 77–101.CrossRef

RachBeisel, J., Scott, J., & Dixon, L. (1999). Co-occurring severe mental illness and substance use disorders: A review of recent research. Psychiatric Services, 50, 1427–1434.PubMed

Remschmidt, H., Schulz, E., Martin, M., Fleischhaker, C., & Trott, G. E. (1994). Early manifestations of schizophrenic psychoses. Zeitschrift für Kinder- und Jugendpsychiatrie, 22(4), 239–252.PubMed

Roberts, J. S., Blow, F. C., Copeland, L. A., Barry, K. L., & Van Stone, W. (2000). Age-group differences in treatment outcomes for male veterans with severe schizophrenia: A three-year longitudinal study. Journal of Geriatric Psychiatry and Neurology, 13(2), 78–86.CrossRefPubMed

Rossi, A., Arduini, L., Prosperini, P., Kalyvoka, A., Stratta, P., & Daneluzzo, E. (2000). Awareness of illness and outcome in schizophrenia. European Archives of Psychiatry and Clinical Neuroscience, 250(2), 73–75.CrossRefPubMed

Salyers, M. P., Bond, G. R., Teague, G. B., Cox, J. F., Smith, M. E., Hicks, M. L., et al. (2003). Is it ACT yet? Real-world examples of evaluating the degree of implementation for assertive community treatmentc. The Journal of Behavioral Health Services & Research, 30(3), 304–320.CrossRef

Shrier, I., Boivin, J.-F., Steele, R. J., Platt, R. W., Furlan, A., Kakuma, R., et al. (2007). Should meta-analyses of interventions include observational studies in addition to randomized controlled trials? A critical examination of underlying principles. American Journal of Epidemiology, 166(10), 1203–1209.CrossRefPubMed

Singh, S. P. (2007). Outcome measures in early psychosis. Relevance of duration of untreated psychosis. The British Journal of Psychiatry, 191, 58–63.CrossRef

Sytema, S., Wunderink, L., Bloemers, W., Roorda, L., & Wiersma, D. (2007). Assertive community treatment in the Netherlands: A randomized controlled trial. Acta Psychiatrica Scandinavica, 116(2), 105–112.CrossRefPubMed

Teague, G. B., Bond, G. R., & Drake, R. E. (1998). Program fidelity in assertive community treatment. Development and use of a measure. American Journal of Orthopsychiatry, 68(2), 216–231.CrossRefPubMed

Wennström, E. (2008). The Camberwell assessment of need as an outcome measure in community mental health care. Uppsala: Acta Universitatis Upsaliensis.

Wieselgren, I. M., Lindström, E., & Lindström, L. H. (1996). Symptoms at index admission as predictor for 1–5 year outcome in schizophrenia. Acta Psychiatrica Scandinavica, 94(5), 311–319.CrossRefPubMed

Wing, J. K., Beevor, A. S., & Curtis, R. H. (1998). Health of the Nation Outcome Scales (HoNOS); research and development. British Journal of Psychiatry, 172, 11–18.CrossRefPubMed

Winter, J. P., & Calsyn, R. J. (2000). The Dartmouth Assertive Community Treatment scale (DACTS). A generalizability study. Evaluation Review, 24(3), 319–338.CrossRefPubMed

Wolbers, M. H. J. (2000). The effects of level of education on mobility between Employment and unemployment in the Netherlands. European Sociological Review, 16, 185–200.CrossRef

Title: Treatment Outcome in Patients Receiving Assertive Community Treatment
Authors: H. E. Kortrijk
C. L. Mulder
B. J. Roosenschoon
D. Wiersma
Publication date: 01-08-2010
Publisher: Springer US
Published in: Community Mental Health Journal / Issue 4/2010
Print ISSN: 0010-3853
Electronic ISSN: 1573-2789
DOI: https://doi.org/10.1007/s10597-009-9257-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Treatment Outcome in Patients Receiving Assertive Community Treatment

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 4/2010

Multi-Family Psycho-Education Group for Assertive Community Treatment Clients and Families of Culturally Diverse Background: A Pilot Study

Feasibility and Usefulness of Training Assertive Community Treatment Team in Cognitive Behavioral Therapy

Housing Preferences and Choices Among Adults with Mental Illness and Substance Use Disorders: A Qualitative Study

Criminal Justice Involvement, Behavioral Health Service Use, and Costs of Forensic Assertive Community Treatment: A Randomized Trial

Understanding the Role of Individual Consumer–Provider Relationships Within Assertive Community Treatment

Mediated Learning Experience Intervention Increases Hope of Family Members Coping with a Relative with Severe Mental Illness