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BMC Psychiatry

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Open Access 01-12-2017 | Research article

The effect of youth assertive community treatment: a systematic PRISMA review

Authors: Richard Vijverberg, Robert Ferdinand, Aartjan Beekman, Berno van Meijel

Published in: BMC Psychiatry | Issue 1/2017

Abstract

Background

During the past decades deinstitutionalisation policies have led to a transition from inpatient towards community mental health care. Many European countries implement Assertive Community Treatment (ACT) as an alternative for inpatient care for “difficult to reach” children and adolescents with severe mental illness. ACT is a well-organized low-threshold treatment modality; patients are actively approached in their own environment, and efforts are undertaken to strengthen the patient’s motivation for treatment. The assumption is that ACT may help to avoid psychiatric hospital admissions, enhance cost-effectiveness, stimulate social participation and support, and reduce stigma.

ACT has been extensively investigated in adults with severe mental illness and various reviews support its effectiveness in this patient group. However, to date there is no review available regarding the effectiveness of youth-ACT. It is unknown whether youth-ACT is as effective as it is in adults. This review aims to assess the effects of youth-ACT on severity of psychiatric symptoms, general functioning, and psychiatric hospital admissions.

Method

A systematic literature search was conducted in PubMed, Cochrane Library, PsychINFO and CINAHL published up to March 2017. To assess methodological quality of the included studies, the Oxford Centre of Evidence-Based Medicine grading system was used.

Results

Thirteen studies were included in this review. There are indications that youth-ACT is effective in reducing severity of psychiatric symptoms, improving general functioning, and reducing duration and frequency of psychiatric hospital admissions.

Conclusions

The current literature on youth-ACT is limited but promising. There are indications that youth-ACT is effective in reducing severity of psychiatric symptoms, improving general functioning, and reducing duration and frequency of psychiatric hospital admissions. The effect of youth-ACT may be comparable with the effect of ACT in adults. Similar as in adult ACT, the studies on youth-ACT found effects that vary from small to large. Randomized experimental research designs are needed to further corroborate effectiveness.

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Becker K, Kilian R. Psychiatric services for people with severe mental illness across western Europe. What can be generalized from current knowledge about differences in provision, cost and outcomes of mental health care? Acta Psychiat Scand. 2006;113:9–16. doi:10.1111/j.1600-0447.2005.00711.x.CrossRef

Lamb H, Bachrach L. Some perspectives on deinstitutionalization. Psychiatr Serv. 2001;52:1039–45. http://dx.doi.org/10.1176/appi.ps.52.8.1039 CrossRefPubMed

WONCA Health Organization of Family Doctors. Integrated mental health into primary care: a global perspective; 2008.

Stein L, Test M. Alternative to mental hospital tratment: conceptual model, treatment program, and clinical evaluation. Arch Gen Psychiatry. 1980;37:392–7.CrossRefPubMed

van Vugt M. Assertive community treatment in the Netherlands. Rotterdam: Erasmus University Rotterdam; 2015.

Baier V, Favrod J, Ferrari P, Koch N, Holzer L. Early tailored assertive community case management for hard-to-engage adolescents suffering from psychiatric disorders: an exploratory pilot study. Early Interv Psychiatry. 2013;7:94–9. doi:10.1111/j.1751-7893.2012.00380.x.CrossRefPubMed

Teague G, Bond G, Drake R. Program fidelity in assertive community treatment: development and use of a measure. Am J Orthop. 1998;68:216–31. doi:org/10.1037/h0080331

Urben S, Baier V, Mantzouranis G, Pigois E, Graap C, Dutoit F, et al. Predictors and moderators of clinical outcomes in adolescents with severe mental disorders after an assertive community treatment. Child Psychiatry Hum Dev. 2015;46:997–1005. doi:10.1007/s10578-015-0537-z.CrossRefPubMed

Dieterich M, Irving D, Park C, Marshall M. Intensive case management for severe mental illness. Cochrane Db Syst Rev. 2010;10:CD007906. doi:10.1002/14651858.CD007906.pub2.

10.

World Health Organization. WHO, Europe: Policies and practices for mental health in Europe. Meet the challenges, 2008. http://www.euro.who.int/__data/assets/pdf_file/0006/96450/E91732.pdf. Accessed 14 Oct 2016.

11.

Braddick F, Carral V, Jenkins R, Jané-LIopis E. Child and adolescent mental health in Europe: infrastructures, policy and programs. Luxembourg: European Communities; 2009.

12.

Sillivan G, Layte R, Burfeind C, McDaid D, Salize H, Daumerie N, et al. Promoting social inclusion and combating stigma for better health and well-being backround document to the European Commission Thematic Conference 2010. European Commission, 2010. http://ec.europa.eu/health/mental_health/policy/index_en.htm. Accessed 14 Nov 2016.

13.

World Health Organization. Child and adolescent mental health policies and plans, 2005.

14.

National Institute for Health and Care Excellence. Psychosis and schizophrenia in children and young people: Recognition and management, 2013. http://www.nice.org.uk/guidance. Accessed 16 Sept 2016.

15.

National Centre for Health Outcomes Development. Outcome indicators for severe mental illness. 2000. http://nchod.uhce.ox.ac.uk/mentalillness.pdf. Accessed 1 May 2017.

16.

National Institute for Health and Care Excellence. Bipolair disorder: the assessment and management of bipolar disorders in adults, children and young people in primary and secondary care, 2013. http//https://www.nice.org.uk/guidance. Accessed 15 Sept 2016.

17.

Horatio European Psychiatric Nurses. Horatio Position Paper, 2010. http://ec.europa.eu/health/mental_health/docs/horatio_paper_youth_en.pdf. Accessed 11 Oct 2016.

18.

Executive Agency for Health and Consumers; DG SANCO. Child and adolescent mental health in enlarged European Union. European Union, 2011. http://www.ec.europa.eu/health. Accessed 20 Sept 2016.

19.

McCrone P, Killaspy H, Bebbington P, Johnson S, Nolan F, Pilling S, et al. The REACT study: cost-effectiveness analysis of assertive community treatment in North London. Psychiatr Serv. 2009;60(7):908–13. doi:10.1176/appi.ps.60.7.908.CrossRefPubMed

20.

Jerrell JM, Ridgely MS. Evaluating changes in symptoms and functioning of dually diagnosed clients in specialized treatment. Psychiatr Serv. 1995;46(3):233–8. doi:10.1176/ps.46.3.233.CrossRefPubMed

21.

Lafave HG, de Souza HR, Gerber GJ. Assertive community treatment of severe mental illness: a Canadian experience. Psychiatr Serv. 1996;47(7):757–9. doi:10.1176/ps.47.7.757.CrossRefPubMed

22.

Tempier R, Balbuena L, Garety P, Craig TJ. Does assertive community outreach improve social support? Results from the Lambeth study of early-episode psychosis. Psychiatr Serv. 2012;63(3):216–22. doi:10.1176/appi.ps.20110013.CrossRefPubMed

23.

Ziguras SJ, Stuart GW. A meta-analysis of the effectiveness of mental health case-management over 20 years. Psychiatr Serv. 2000;51(11):1410–2. doi:10.1176/appi.ps.51.11.1410.CrossRefPubMed

24.

Essock SM, Mueser KT, Drake RE, Covell NH, McHugo GJ, Frisman LK, et al. Comparison of ACT and standard casemanagement for delivering integrated treatment for co-occuring disorders. Psychiatr Serv. 2006;57(2):185–96. doi:10.1176/appi.ps.57.185.CrossRefPubMed

25.

McHugo GJ, Drake RE, Teague GB, Xie H. Fidelity to assertive community treatment and client outcomes in the New Hampshire dual disorders study. Psychiatr Serv. 1999;50(6):818–24. doi:10.11176/ps.50.6.818.CrossRefPubMed

26.

Marks IM, Connolly J, Muijen M, Audini B, McNamee G, Lawrence RE. Home-based versus hospital-based care for people with serious mental illness. Brit J Psychiatry. 1994;165(2):179–94. doi:10.1192/bjp.165.2.179.CrossRef

27.

Bond GR, Miller LD, Krumwied RD, Ward RS. Assertive case Management in Three CMHCs: a controlled study. Psychiatr Serv. 1988;39(4):411–8. doi:10.1176/ps.39.4.411.CrossRef

28.

Morse GA, Calsyn RJ, Klinkenberg WD, Trusty ML, Gerber F, Smith R, et al. An experimental comparison of three types of case management for homeless mentally ill persons. Psychiatr Serv. 1997;48(4):497–503. doi:10.1176/ps.48.4.497.CrossRefPubMed

29.

Nelson G, Laurier W, Aubry T, Lafrance A. Review of the literature on the effectiveness of housing and support, assertive community treatment, and intensive case management interventions for persons with mental illness who have been homeless. Am J Psychiatry. 2007;77(3):350–61. doi:10.1037/0002-9432.77.3.350.

30.

Burns T, Catty J, Dash M, Robberts C, Lockwood A, Marshall M. Use of intensive case management to reduce time in hospital in people with severe mental illness: systematic review and meta-regression. BMJ. 2007;335(7615):336–40. doi:10.1136/bmj.39251.599259.55.CrossRefPubMedPubMedCentral

31.

Rosen A, Mueser KT, Teesson M. Assertive community treatment-issues from scientific and clinical literature with implications for practice. Rehabil Res Dev. 2007;44:813–26.CrossRef

32.

Moher D, Liberati A, Tetzlaff J, Altman DG. The PRISMA group. Preferred Reporting Items for Systematic reviews and Meta-Analyses: The PRISMA Statement. PLoS Med. 2009;6:e1000097. doi:10.1371/journal.pmed.1000097.CrossRefPubMedPubMedCentral

33.

Steijn D, Philips A, Folford K, Sadler J, Kendler S. What is a mental/psychiatric disorder? From DSM-IV to DSM-V. J Psychol Med Ment Pathol. 2010;11(40):759–65. doi:10.1017/S0033291709992261.

34.

Yager J, Ehmann T. Untangling social functioning and social cognition: a review of concepts and measurement. Psychiatry. 2006;69:47–68. doi:10.1521/psyc.2006.69.1.47.CrossRefPubMed

35.

Verhulst FC. Ontwikkeling van het kind (development of a child). Assen: Koninklijke van Gorcum; 2005.

36.

Hoza B, Mrug S, Gerdes A, Hinshaw S, Bukowski B, Gold J, et al. What aspect of peer relationships are impaired in children with attention-deficit/hyperactivity disorder? J Consult Clin Psychol. 2005;73(3):411–23. doi:10.1037/0022-006X.73.3.411.CrossRefPubMed

37.

Czuchry M, Dansereau DF, Sia TL, Simpson DD. Using peer, self, and counselor ratings to evaluate treatment progress. J Psychoactive Drugs. 1998;30(1):81–7. doi:10.1080/02791072.1998.10399673.CrossRefPubMed

38.

Oxford Centre for Evidence-based Medicine. Oxford Centre for Evidence-based Medicine-Levels of Evidence. 2009. http://www.cebm.net/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/. Accessed 14 Oct 2016.

39.

Polit D, Beck C, Loiselle C, Profetto-McGrath J. Canadian essentials. Philadelphia: Lippincott Williams & Wilkins; 2007.

40.

McFarlane W, Levin B, Travis L, Lucas F, Lynch S, Verdi M, et al. Clinical and functional outcomes after 2 years in the early detection and intervention for the prevention of psychosis multisite effectiveness trial. Schizophr Bull. 2015;41(1):30–41. doi:10.1093/schbul/sbu108.CrossRefPubMed

41.

McGarvey E, Leon-Verdin M, Bloomfield K, Wood S, Winters E, Smith J. Effectiveness of A-CRA/ACC in treatment adolescents with cannabis-use disorders. Community Ment Health J. 2014;50(2):150–7. doi:10.1007/s10597-012-9566-2.CrossRefPubMed

42.

Schley C, Ryall V, Crothers L, Radovini S, Fletcher K, Marriage K, et al. Early intervention with difficult to engage, “high-risk” youth: evaluating an intensive outreach approach in youth mental health. Early Interv Psychiatry. 2008;2(3):195–200. doi:10.1111/j.1751-7893.2008.00079.x.CrossRefPubMed

43.

Urben S, Mantzouranis G, Baier V, Halfon O, Vallard E, Holzer L. Timing of clinical improvement in assertive community treatment for adolescents: a pilot naturalistic observational study. Arch Psychiatr Nurs. 2016;30(5):645–6. doi:10.1016/j.apnu.2016.04.015.CrossRefPubMed

44.

Trusty J, Thompson B, Pretocelli J. Practical guide for reporting effect size in quantitative research in the journal of counseling & development. J Couns Dev. 2004;82:107–10.CrossRef

45.

GRADE Working Group. Grading. Quality of evidence and strength of recommendations. Brit Med J. 2004;328:1490–4.CrossRefPubMedCentral

46.

Adrian N, Smith J. Occupied bed days a redundent currency? An evaluation of the first 10 years of an integrated model of care for mentally ill adolescents. Clin Child Psychol Psychiatry. 2015;20(3):458–71. doi:10.1177/1359104514527298.CrossRefPubMed

47.

Ahrens C, Frey J, Knoedler W, Senn-Burke S. Effect of PACT on inpatient psychiatric treatment for adolescents with severe mental illness: a preliminary analysis. Psychiatr Serv. 2007;58:1486–8.CrossRefPubMed

48.

Chai A, Assan B, Finch E, Stargatt R, Burchell P, Jones H, et al. Innovations in practice: effectiveness of specialist adolescent outreach service for at-risk adolescents. J Child Adolesc Ment Health. 2013;18(2):116–9. doi:10.1111/j.1475-3588.2012.00654.x.CrossRef

49.

Godley M, Godley S, Dennis M, Funk R, Passetti L. Preliminary outcomes from the assertive continuing care experiment for adolescents discharged from residential treatment. J Subst Abus Treat. 2002;23(1):21–32. doi:10.1016/S0740-5472(02)00230-1.CrossRef

50.

Godley M, Godley S, Dennis M, Funk R, Passetti L. The effect of assertive continuing care on continuing care linkage, adherence and abstinence following residential treatment for adolescents with substance use disorders. Addiction. 2006;102(1):81–93. doi:10.1111/j.1360-0443.2006.01648.x.CrossRef

51.

Godley S, Garner B, Passetti L, Funk R, Dennis M, Godley M. Adolescent outpatient treatment and continuing care: main findings form a randomized clinical trial. Drug Alcohol Depend. 2010;110(1–2):44–54. doi:10.1016/j.durgsalcdep.2010.02.003.CrossRefPubMedPubMedCentral

52.

Godley M, Godley S, Dennis M, Funk R, Pasetti L, Petry N. A randomized trial of assertive continuing care and contingency management for adolescents with substance use disorders. J Consult Clin Psychol. 2015;82(1):40–51. doi:10.1007/s10597-015-9984-z.CrossRef

53.

Guy W. The clinical global Impession scale, 1976.

54.

Brann P, Coleman G, Luk E. Routine outcome measurement in a child and adolescent mental health service: an evaluation of HoNOSCA. The health of the nation outcome scales for children and adolescents. Aust N Z J Psychiatry. 2001;35(3):370–6. doi:10.1046/j.1440-1614.2001.00890.x.CrossRefPubMed

55.

Gowers S, Harrington R, Whitton A, Beevor A, Lellitiot P, Wing J. Brief scale for measuring the outcomes of emotional and behavioural disorders in children. Health of the nation outcome scales for children and adolescents (HoNOSCA). Br J Psychiatry. 1999;174(5):413–6. doi:10.1192/bjp.174.5.413.CrossRefPubMed

56.

Dennis M, Titus J, White M, Unsicker J, Hodgkinds D. Global appraisal of individual needs (GAIN): administration guide for the GAIN and related measures. Version 5. Normal: Chestnut Health Systems; 2003. http://www.gaincc.org/psychometrics-publications/gain-publications/. Accessed 14 Dec 2016

57.

McGlashan T, Miller T, Woods S, Rosen J, Hoffman R, Davidson L. Structured interview for prodromal syndromes. Schizophr Bull. 2003;4(29):703–15.

58.

Robinson SM, Sobell MB, Leo GI. Reliability of the timeline followback for cocaine, cannabis, and cigarette use. Psychol Addict Behav. 2014;28(1):154–62. doi:10.1037/a0030992.CrossRefPubMed

59.

Flakierska N, Lindstrøm M, Gillberg C. Schoolrefusal: a 15-20 year follow-up study of 35 Swedish urban children. Br J Psychiatry. 1988;152:834–7. doi:10.1192/bjp.152.6.834.CrossRefPubMed

60.

Jones S, Thornicroft G, Coffey M, Dunn G. A brief mental health outcome scale-reliability and validity of the global assessments of functioning (GAF). Brit J Psychiatry. 1995;166:654–9. doi:10.1192/bjp.166.5.654.CrossRef

61.

Schaffer D, Gloud M, Brasic J, Ambrosini P, Fisher P, Bird H, et al. A Children's global assessment Scall (CGAS). Arch Gen Psychiatry. 1983;40(11):1228–31. doi:10.1001/archpsyc.1983.01790100074010.CrossRef

62.

National Institute for Health and Care Excellence. Depression in children and young people. http://www.nice.org.uk/guidance/qs48. Accessed 29 Nov 2016.

63.

Mendenhall A, Demeter C, Findling R, Frazier T, Fristad M, Youngstrom E, et al. Factors influencing mental health services utilization by children with serious emotional and behavioral disturbance: results from the LAMS study. Psychiatr Serv. 2011;62(6):650–8.CrossRefPubMedPubMedCentral

64.

Yearwood EL. Efforts to meet the health care needs of children and adolescents. J Child Adolesc Psychiatr Nurs. 2012;25(1):51–2. doi:10.1111/j.1744-6171.2011.00314.x.CrossRefPubMed

65.

Henggeler SW, Schaeffer CM. Multisystemic therapy®: clinical overview, outcomes, and implication research. Fam Process. 2016;55(3):514–28. doi:10.1111/famp.12232.CrossRefPubMed

66.

van der Stouwe T, Asscher J, Stams G, Deković M, van der Laan P. The effectiveness of multisystemic therapy (MST): a meta analysis. Clin Psychol Rev. 2014;34(6):468–81. doi:10.1016/j.cpr.2014.06.006.CrossRefPubMed

67.

Wevodau AL. A meta-analytic review of multidimensional family therapy (MDFT) treatment outcomes in 11 randomized controlled trials. Houston: Sam Houston State University; 2012.

68.

National Institue for Health and Care Excellence. Antisocial behaviour and conduct disorders in children and young people: recognition and management. 2013. http://www.nice.org.uk/guidance. Accessed 18 Oct 2016.

69.

Prabhu A, Pandit L, Vardhan G. Pathways to tertiary care adopted by individuals with psychiatric illness. Asian J Psychatr. 2015;16:32–5.CrossRef

70.

Gochman P, Miller R, Rapoport J. Childhood-onset schizophrenia: the challenge of diagnosis. Curr Psychiatry Rep. 2011;13(5):321–2. doi:10.1007/s11920-011-0212-4.CrossRefPubMedPubMedCentral

71.

Sharfstein S, Dickerson F, Oldham J. The textbook of hospital psychiatry. Washington DC: American Psychiatric Publishing; 2009.

72.

Early Psychosis Guidelines Writing Group. Australian clinical guidelines for early psychosis. In: A brief summary for practitioners. Australia. 2nd ed. Melbourne: Orygen Youth; 2007. Health, https://www.ranzcp.org.

73.

National Institute for Health and Care Excellence. Drug misuse in over 16s: psychosocial interventions. 2007. http://www.nta.nhs.uk/uploads/clinical_guidelines_2007.pdf. Accessed 20 Oct 2016.

74.

Tielemans L, Middendorp C, Brook F, de Jong C. Literatuurstudie naar de effectiviteit van casemanagement bij verslaafde patienten. Nijmegen, NISPA/VNN; 2007.

75.

Trimbos Instituut. Multidisciplinaire richtlijn Alcohol. 2008. http://www.ggzrichtlijnen.nl. Accessed 30 Oct 2016.

76.

National Institute of Health and Care Excellence. Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence. 2011. http://www.nice.org.uk/guidance/cg115/chapter/1-recommendations#interventions-for-alcohol-misuse. Accessed 30 Oct 2016.

77.

Farrington D. Later life outcomes of truants in the Cambridge study. In: Berg I, Nursen J, editors. Unwillingly to school. London: Gaskell; 1996. p. 96–116.

78.

Steiner M, Wagner E. Dropoutstrategie. Grundlage zur Prävetion und Reïngetration von Dropouts in Ausbildung und Beschläftigung. Institut für höhere studien: Wien; 2007.

79.

Geller B, Tillman R, Bolhofner K, Zimerman B. Child bipolar I disorder: prospective continuity with adult bipolar I disorder; characteristics of second and third episodes; predictors of 8 year outcome. Arch Gen Psychiatry. 2008;65(10):1125–33. doi:10.1001/archpsyc.65.10.1125.CrossRefPubMedPubMedCentral

80.

Coldwell CM, Bender WS. The effectiveness of assertive community treatment for homeless populations with severe mental illness: a meta-analysis. Am J Psychiatry. 2007;164(3):393–9. doi:10.1176/ajp.2007.164.3.393.CrossRefPubMed

81.

Furr-Holden C, Anthony J. Epidemiological differences in drug dependence. A US-UK cross-national comparison. J Soc Psychiatry Psychiatr Epidemiol. 2003;38:165–72. doi:10.1007/s00127-003-0614-7.CrossRef

82.

Costello EJ, Foley D, Angold A. 10-year research update review: the epidemiology of child and adolescent psychiatric disorders: II. Developmental epidemiology. J Am Acad of Child Adolesc Psychiatry. 2006;44(10):972–86. doi:10.1097/01.chi.0000184929.41423.c0.CrossRef

83.

International Organization for Standardization. Codes for representation names of countries and subdivisions Part 1. http://www.iso.org/home.html. Accessed 18 Nov 2016.

Title: The effect of youth assertive community treatment: a systematic PRISMA review
Authors: Richard Vijverberg
Robert Ferdinand
Aartjan Beekman
Berno van Meijel
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: BMC Psychiatry / Issue 1/2017
Electronic ISSN: 1471-244X
DOI: https://doi.org/10.1186/s12888-017-1446-4

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

The effect of youth assertive community treatment: a systematic PRISMA review

Abstract

Background

Method

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Method

Results

Conclusions

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