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01-12-2008 | Original Paper

Techniques Used by Assertive Community Treatment (ACT) Teams to Encourage Adherence: Patient and Staff Perceptions

Authors: Paul S. Appelbaum, Stephanie Le Melle

Published in: Community Mental Health Journal | Issue 6/2008

Abstract

Assertive community treatment (ACT) has become a cornerstone of care for people with serious mental illnesses. But it has also been suggested that ACT is an inherently coercive approach, with a variety of techniques, including leverage, frequently employed to encourage treatment adherence. Staff and patients of 4 ACT teams participated in focus groups exploring their experiences with and opinions about the use of these techniques in ACT. Little evidence was found of significant use of leverage or perceptions of coercion. Instead both groups reported that supporting patients and building relationships were the preferred mechanisms for promoting treatment goals. This study suggests that ACT need not appear to either staff or patients as an intrinsically coercive model for the delivery of mental health services.

Angell, B., Mahoney, C. A., & Martinez, N. I. (2006). Promoting treatment adherence in assertive community treatment. Social Service Review, 80, 485–526. doi:10.1086/505287.CrossRef

Chinman, A., Allende, M., Bailey, P., Maust, J., & Davidson, L. (1999). Therapeutic agents of assertive community treatment. Psychiatric Quarterly, 70, 137–162. doi:10.1023/A:1022101419854.PubMedCrossRef

Davis, S. (2002). Autonomy versus coercion: Reconciling competing perspectives in community mental health. Community Mental Health Journal, 38, 239–250. doi:10.1023/A:1015267707856.PubMedCrossRef

Dennis, D. L., & Monahan, J. (Eds.). (1996). Coercion and aggressive community treatment: A new frontier in mental health law. New York: Plenum Press.

Diamond, R. J. (1996). Coercion and tenacious treatment in the community: Applications to the real world. In D. L. Dennis & J. Monahan (Eds.), Coercion and aggressive community treatment: A new frontier in mental health law. New York: Plenum Press.

Estroff, S. E. (1981). Making it crazy: An ethnography of psychiatric clients in an American community. Berkeley: University of California Press.

Gerber, G. J., & Prince, P. N. (1999). Measuring client satisfaction with assertive community treatment. Psychiatric Services, 50, 546–550.PubMed

Gomory, T. (2002). The origins of coercion in assertive community treatment: A review of early publications from the Special Treatment Unit of Mendota State Hospital. Ethical Human Sciences and Services, 4, 3–16.PubMed

Krupa, T., Eastabrook, S., Hern, L., Lee, D., North, R., Percy, K., et al. (2005). How do people who receive Assertive Community Treatment experience this service? Psychiatric Rehabilitation Journal, 29, 18–24. doi:10.2975/29.2005.18.24.PubMedCrossRef

Lehman, A. F., Steinwachs, D. M., & The CoInvestigators of the PORT project. (1998). Translating research into practice: The Schizophrenia Patient Outcomes Research Team (PORT) treatment recommendations. Schizophrenia Bulletin, 24, 1–10.PubMed

McGrew, J. H., Wilson, R. G., & Bond, G. R. (2002). An exploratory study of what clients like least about assertive community treatment. Psychiatric Services, 53, 761–763. doi:10.1176/appi.ps.53.6.761.PubMedCrossRef

Monahan, J., Redlich, A., Swanson, J., Robbins, P., Appelbaum, P. S., Petrila, J., et al. (2005). Use of leverage to improve adherence to psychiatric treatment in the community. Psychiatric Services, 56, 37–44. doi:10.1176/appi.ps.56.1.37.PubMedCrossRef

Neale, M. S., & Rosenheck, R. A. (2000). Therapeutic limit setting in an assertive community treatment program. Psychiatric Services, 51, 499–505. doi:10.1176/appi.ps.51.4.499.PubMedCrossRef

Priebe, S., Watts, J., Chase, M., & Matanov, A. (2005). Processes of disengagement and engagement in assertive outreach patients: Qualitative study. British Journal of Psychiatry, 187, 438–443. doi:10.1192/bjp. 187.5.438.PubMedCrossRef

Rosenheck, R. A., & Neale, M. S. (2004). Therapeutic limit setting and six-month outcomes in a Veterans Affairs assertive community treatment program. Psychiatric Services, 55, 139–144. doi:10.1176/appi.ps.55.2.139.PubMedCrossRef

Stein, L. I., & Test, M. A. (1980). An alternative to mental health treatment, I. Conceptual model, treatment program, and clinical evaluation. Archives of General Psychiatry, 37, 392–397.PubMed

Stovall, J. (2001). Is assertive community treatment ethical care? Harvard Review of Psychiatry, 9, 139–143.PubMed

Szmukler, G. (1999). Ethics in community psychiatry? Australian and New Zealand Journal of Psychiatry, 33, 328–338. doi:10.1046/j.1440-1614.1999.00597.x.PubMedCrossRef

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, 216–232. doi:10.1037/h0080331.PubMedCrossRef

Watts, J., & Priebe, S. (2002). A phenomenological account of users’ experiences of assertive community treatment. Bioethics, 16, 439–454. doi:10.1111/1467-8519.00301.PubMedCrossRef

Williamson, T. (2002). Ethics of assertive outreach (assertive community treatment teams). Current Opinion in Psychiatry, 15, 543–547. doi:10.1097/00001504-200209000-00013.PubMedCrossRef

Title: Techniques Used by Assertive Community Treatment (ACT) Teams to Encourage Adherence: Patient and Staff Perceptions
Authors: Paul S. Appelbaum
Stephanie Le Melle
Publication date: 01-12-2008
Publisher: Springer US
Published in: Community Mental Health Journal / Issue 6/2008
Print ISSN: 0010-3853
Electronic ISSN: 1573-2789
DOI: https://doi.org/10.1007/s10597-008-9149-4

At a glance: The STEP trials

Springer Medicine

Techniques Used by Assertive Community Treatment (ACT) Teams to Encourage Adherence: Patient and Staff Perceptions

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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