Individuals with mild intellectual disabilities (MID) or borderline intellectual functioning (BIF) and mental health problems or challenging behavior are difficult to reach by mainstream healthcare facilities and support organizations and frequently avoid the care they need. To improve the care for this client group in the Netherlands, the (Flexible) Assertive Community Treatment (ACT) model—originally developed for people with severe mental illness—was adapted and implemented by five organizations specialized in the care for people with MID/BIF and mental health problems or challenging behavior. After an introduction of the original ACT model and a description of the international state of the art of ACT for people with (M)ID/BIF, this paper describes the (Flexible) ACT‐MID/BIF model as developed and implemented in the Netherlands. Professionals' and clients' experiences with this new type of care are reported as well. Implications for clinical practice, policy and research are discussed.
BackgroundAssertive community treatment (ACT) and Flexible assertive community treatment (FACT) are organisation models for intensive assertive outreach that were originally developed for individuals with severe mental illness. The models are increasingly applied to people with mild intellectual disability (MID) or borderline intellectual functioning (BIF) and challenging behaviour or mental illness. Research on these types of care for this population is limited. To gain experience in FACT MID/BIF in the Netherlands and to obtain insight in its outcomes, four organisations specialised in the treatment of individuals with MID/BIF and challenging behaviour participated in a 6‐year implementation and research project.MethodsA longitudinal study was set up to investigate outcomes over time. Outcome measures concerned admissions to (mental) health care, social and psychological functioning, (risk of) challenging and criminal behaviour, social participation and client satisfaction. Data were analysed using descriptive statistics and linear mixed models.ResultsOver time, clients showed improvement in their social and psychiatric functioning and living circumstances. The number of admissions to (mental) health care diminished as well as the number of contacts with police and justice, the level of social disturbance and the risk factors for challenging and criminal behaviour. Problems related to finances, work and substance abuse remained unchanged.ConclusionsThe results are encouraging and give rise to continued development of and broader research on FACT MID/BIF.
Background
In the Netherlands, Flexible Assertive Community Treatment (FACT) teams have been established for people with mild intellectual disability (MID) or borderline intellectual functioning (BIF) and mental health problems or challenging behaviour. Little is known yet about service users’ experiences with FACT.
Method
An inductive grounded theory approach was used to explore how service users valued the treatment and their own functioning, and which factors were perceived as supportive. Semi‐structured interviews were held with 15 service users.
Results
Most service users highly appreciated the contact with the staff and the practical and emotional support. Persistent involvement, availability and humanity, and respect for autonomy were distinguished as core values in the relationship with the staff. Most service users experienced improvement in time and attributed this to intrapersonal changes and/or less stress in life.
Conclusions
From the perspective of service users with MID/BIF, FACT appears to have an added value.
Purpose
Recent research on flexible assertive community treatment (FACT) for individuals with mild intellectual disabilities (MID) or borderline intellectual functioning (BIF) has shown positive results. This paper aims to identify which client variables are associated with treatment outcome of FACT.
Design/methodology/approach
Analyses were performed on assessments made during a six-year longitudinal study in The Netherlands. Data comprised assessments of 281 clients with at least 2 measurements. Treatment outcome was measured by the learning disability version of the Health of the Nation Outcomes Scales. Demographic variables and dynamic risk variables of the short version of the Dynamic Risk Outcome Scales were selected as potential predictor variables of outcome. Data were analysed using linear mixed models.
Findings
Limited awareness of the need for treatment, limited treatment motivation and cooperation, limited social skills, impulsivity and substance abuse were significantly associated with worse treatment outcome. None of the demographic variables influenced treatment outcome significantly, and neither did intelligence quotient or having a judicial or civil measure.
Research limitations/implications
Because of the observational design, no causal inferences can be drawn.
Practical implications
This study produces guidelines regarding nature and scope of the treatment supply and the competences of professionals working in FACT MID/BIF teams.
Originality/value
This paper encourages other countries to make assertive outreach available for people with MID/BIF on a larger scale, taking into account the acquired insights.
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