Timing of Clinical Improvement in Assertive Community Treatment for Adolescents: A Pilot Naturalistic Observational Study

Urben, Sébastien; Mantzouranis, Gregory; Baier, Vanessa; Halfon, Olivier; Villard, Eva; Holzer, Laurent

doi:10.1016/j.apnu.2016.04.015

Cited by 4 publications

(19 citation statements)

References 12 publications

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“…To assess the quality of the 13 studies, study designs are specified in Table 1 . Most studies had a pre-post design and lacked a control group [ 6 , 8 , 41 – 43 , 46 – 48 ]. One study used a quasi-experimental design with a control group, but patients were not randomized [ 40 ].…”

Section: Resultsmentioning

confidence: 99%

“…The included studies examined adolescents up to age 18, with a wide variety of psychiatric problems including substance abuse, psychotic, emotional, and developmental problems. Patients received youth-ACT as the only treatment [ 6 , 8 , 40 , 42 , 43 , 46 – 48 ] or as an aftercare program [ 49 , 50 , 52 ]. The average ages of included patients ranged from 15 to 17 years.…”

Section: Resultsmentioning

confidence: 99%

“…None of the reviewed studies included children below age 11. Studies were conducted in the United States [ 40 , 41 , 47 , 49 – 52 ], Switzerland [ 6 , 8 , 43 ], Australia [ 42 , 48 ], and Great Britain [ 46 ]. Most studies investigated a Caucasian sample.…”

Section: Resultsmentioning

confidence: 99%

“…Although a study can be classified with a high level of evidence, statistically significant effects can still be small, and thereby in many cases of little clinical relevance [ 39 ]. To assess clinical relevance, effect sizes (ES) of significant effects were retrieved from the papers as Cohen’s d. If not reported in a paper, Cohen’s d was calculated by the first author (RV) if data for this calculation were provided in the manuscript [ 40 – 43 ].…”

Section: Methodsmentioning

confidence: 99%

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

et al. 2017

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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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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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

et al. 2017

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“…Despite the proven efficacy of ACT on adult populations in the United States, research in Europe on both adult and adolescent populations has not come to definite conclusions [30]. The few European studies [1,31,32] concluding on a therapeutic efficacy of ACT only reported statistically significant changes. Although statistical significance is a good hint of the efficacy of ACT, it doesn't necessary imply that the treatment results in clinical improvements felt by patients, nor that the considerable financial investment made in ACT leads to tangible results.…”

Section: Discussionmentioning

confidence: 99%

Clinical significance of assertive community treatment among adolescents

Mantzouranis

Baier

Holzer

et al. 2018

Soc Psychiatry Psychiatr Epidemiol

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The comparative analysis of clinical and social characteristics of patients with schizophrenia and organic mental disorders receiving care in partial inpatient units

Kostyuk¹,

Burygina²,

Berezantsev³

et al. 2021

Vestnik Nevrologii, Psihiatrii I Nejrohirurgii (Bulletin of Neurology, Psychiatry and Neurosurgery)

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The article presents the results of a comparative analysis of the clinical and social characteristics of patients with schizophrenic spectrum disorders (SSD) and organic mental disorders (OMD) who received care in day hospitals and intensive psychiatric care units (Moscow). During the study, a random sample of 487 discharge epicrises was studied, of which 392 (80,49%) were patients with SSD and OMD, who were subjected to further analysis. The study revealed gender differences and low rates of labor and family adaptation in both nosological groups of patients. The highest percentage of patients observed on a long-term basis in neuropsychiatric dispensaries and the rate of hospitalization in a round-the-clock inpatient unit were among the patients with diagnoses of schizophrenic spectrum disorders who were treated in intensive psychiatric care units. There were significant differences in the routing of patients depending on the pathology: district psychiatrists more often refer patients with a diagnosis of schizophrenia to the intensive psychiatric care unit in order to prevent hospitalization and patients with organic mental disorders - to day hospitals for therapy selection and medical and social rehabilitation, while doctors of the round-theclock hospital – vice versa (in order to continue treatment or follow up in out-of-hospital conditions). There was also a circulation of patients between the intensive psychiatric care unit and the day hospitals. Isolated episodes of compliance violations were noted. Indicative indicators such as hospitalization in a round-the-clock psychiatric inpatient unit within a year after the discharge from partial inpatient units was low and was usually due to severe continuous forms of the disease and the formation of therapy resistance in patients. Day hospitals and departments (offices) of intensive psychiatric care in general effectively perform the functions of inpatient unit substitution.

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Timing of Clinical Improvement in Assertive Community Treatment for Adolescents: A Pilot Naturalistic Observational Study

Abstract: AcknowledgementWe would like to thanks all health professionals from the ACT teams, and especially Fabienne Dutoit, Aymeric Faucherand, Esperanza Senent, Mélanie Cherix, Coralie Heinz, Caroline Graap.

Cited by 4 publications

References 12 publications

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

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

Clinical significance of assertive community treatment among adolescents

The comparative analysis of clinical and social characteristics of patients with schizophrenia and organic mental disorders receiving care in partial inpatient units

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