A Review of Consumer-Provided Services on Assertive Community Treatment and Intensive Case Management Teams: Implications for Future Research and Practice

Abstract

Background Assertive community treatment (ACT) is an evidence-based practice that provides intensive, in vivo services for adults with severe mental illness. Some ACT and intensive case management teams have integrated consumers as team members with varying results. Methods We reviewed the literature examining the outcomes of having consumer providers on case management teams, with attention devoted to randomized controlled trials (RCTs). Results We identified 16 published studies, including 8 RCTs. Findings were mixed, with evidence supporting consumer-provided services for improving engagement, and limited support for reduced hospitalizations. However, evidence was lacking for other outcomes areas such as symptom reduction or improved quality of life. Conclusion Including a consumer provider on an ACT team could enhance the outreach mechanisms of ACT, using a more recovery-focused approach to bring consumers into services and help engage them over time. More rigorous research is needed to further evaluate integrating consumer providers on teams.

The “Critical” Elements of Illness Management and Recovery: Comparing Methodological Approaches

“…For instance, the element may accord with important values or support other elements which do impact outcomes. Regarding the former, the inclusion of peer specialists on assertive community treatment teams is considered critical because peer inclusion is consistent with recovery oriented services; however, there is inconsistent evidence as to the impact of peer inclusion on outcomes (McGrew et al, 1994; Wright-Berryman, McGuire, & Salyers, 2011). As an example of a critical element with indirect impact, the inclusion of a credentialed employment specialist or registered nurse (versus a licensed practicing nurse) may not be directly linked with consumer outcomes in assertive community treatment (McGrew et al, 1994), but these elements are still considered critical to the model, in part because they help guarantee quality staff who can address consumer needs.…”

Implementation of Consumer Providers into Mental Health Intensive Case Management Teams

“…There is growing evidence for the effectiveness of CPs in national and international mental health settings. 1–5 However, those who have conducted studies of CPs have consistently noted challenges related to implementation of this role, including boundary issues, potential breaches in confidentiality, disclosure of disability status, discrimination, and poorly defined job structure. 6–8 Furthermore, the nature of CP qualifications for employment (i.e., the requirement for personal experience with the clinical condition) necessitates delineation of professional behaviors in ways that might not be explicit for other workplace roles.…”

Participation and social participation: are they distinct concepts?

“…Although the World Health Organization did not mention social participation in the ICF manual, 24 the website of the World Health Organization 38 describes social participation from a similar angle: '… a way to contribute to a broader society by working with, consulting and empowering communities.' This kind of social participation, also referred to as consumer participation or community engagement, [39][40][41] , can take place at a micro-level (e.g. partner in the delivery of care), meso-level (e.g.…”