Assertive community treatment for patients with co-occurring severe mental illness and substance use disorder: A clinical trial.

Drake, Robert E.; McHugo, Gregory J.; Clark, Robin E.; Teague, Gregory B.; Xie, Haiyi; Miles, Keith M.; Ackerson, Theimann H.

doi:10.1037/h0080330

Cited by 372 publications

(249 citation statements)

References 68 publications

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“…Similar results were published in the US also although less commented upon (e.g. Drake et al, 1998). The two most influential of these European studies were the PRiSM study at the Maudsley Hospital in London (Thornicroft et al, 1998) and the multi-centre UK700 trial (Burns et al, 1999).…”

Section: The Fading Of Act Superioritysupporting

confidence: 71%

Case management and assertive community treatment. What is the difference?

Burns¹

2008

Epidemiol Psichiatr Soc

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Abstract. There has been a long-running controversy about the relative benefits of Assertive Community Treatment (ACT) compared to Case Management (CM). Several health care systems have initiated major service overhauls on the basis of published evidence. Yet this evidence has been ambiguous and supports differing interpretations. Research is examined which explores the differences in outcomes reported. It uses a range of approaches, most prominently meta-regression, to test a small range of hypotheses to explain the heterogeneity in outcomes. The main determinant of differences between ACT and CM studies is the local bed management procedures and occupancy practice. Those organizational aspects of ACT which are generally shared by CM teams are associated with reduced hospital care but the stringent staffing proposed for ACT does not affect it. ACT is a specialized form of CM, not a categorically different approach. The benefits of introducing it will depend on the nature of current local practice. Important lessons about the need to focus on treatments rather than structures seem not to have been learnt. Psychiatry's recent excessive focus on service structures may have had unintended consequences for our professional identity.

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Section: The Fading Of Act Superioritysupporting

confidence: 71%

Case management and assertive community treatment. What is the difference?

Burns¹

2008

Epidemiol Psichiatr Soc

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“…This finding is consistent with the work of Drake et al 22 , and others using long-term models, but is in stark contrast to the findings of Havassy, et al 23 who observed that intensive and expanded brokerage case management were largely ineffective for decreasing hospitalizations among dually diagnosed subjects. It is possible that TLC was successful in reducing re-hospitalization because the program's staff directly addressed the challenges associated with co-morbid disorders through DRT in addition to offering case management services.…”

Section: A Brief Community Linkage Intervention 149contrasting

confidence: 57%

A brief community linkage intervention for veterans with a persistent mental illness and a co-occurring substance abuse disorder

et al. 2007

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-Objective: Individuals with co-occurring psychiatric and substance abuse problems often exhibit poor outpatient treatment engagement and re-hospitalization following discharge from acute psychiatric services. Although case management can improve treatment engagement and reduce attrition, these services are often delivered indefinitely, limiting the availability of treatment slots. In an effort to reduce re-hospitalization rates and improve outcomes during the transition from inpatient to outpatient treatment, we developed and evaluated Time-Limited Case Management (TLC), an eight-week integrated mental health and substance abuse augmentation intervention.Method: Sixty-five dually diagnosed veterans admitted to inpatient psychiatric treatment were included in the program evaluation, 32 who received the TLC service in addition to Treatment as Usual (TAU) that began during inpatient treatment and continued after the transition to outpatient services, and a comparison group of 33 who received only TAU without transitional support provided through the TLC augmentation service.Results: The TLC group had fewer days and episodes of hospitalization at two and six month post-study entry. Furthermore, the TLC group exhibited greater improvements on the Global Assessment of Functioning from baseline to the six-month follow-up.Conclusion: TLC appears to be an effective transitional augmentation service with benefits that persist beyond the eight weeks of the program. Future research should Background and Objectives

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“…Important adaptations exist for using ACT with special problem populations such as people with severe mental illness who are also dually diagnosed with substance abuse [37] and/or early psychosis [38], are homeless [39][40], or have brain or sensory impairment, e.g., deafness. However, insufficient research supports their effectiveness as yet [18].…”

Section: Special Populations and Needsmentioning

confidence: 99%

Assertive community treatmentIssues from scientific and clinical literature with implications for practice

Rosen

Mueser²,

Teesson³

2007

JRRD

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Abstract-This review describes Assertive community treatment (ACT), an integral component of the care of persons with severe mental illness. Drawing on research from North America, Australasia, and Britain, we summarize the current evidence base for ACT and examine the trends and issues that may affect practice. Strong evidence supports the fidelity standardization, efficacy, effectiveness, and cost-effectiveness of ACT models in psychiatry. Yet, significant methodological problems and issues affect implementation. The evidence indicates that the ACT model is one of the most effective systematic models for organizing clinical and functional interventions in psychiatry. Effective systems based on the ACT model meet more ACT fidelity criteria; are often noncoercive; do not rely on compulsory orders; may rely on a wider range of interventions than just medication adherence, including vocational and substance abuse rehabilitation; contain other evidence-based interventions and more mobile in vivo interventions; involve individual and team case management; may involve consumers as direct service providers; and have an interdisciplinary workforce and support structure within the team, providing some protection from work-related stress or burnout.

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Assertive community treatment for patients with co-occurring severe mental illness and substance use disorder: A clinical trial.

Cited by 372 publications

References 68 publications

Case management and assertive community treatment. What is the difference?

Case management and assertive community treatment. What is the difference?

A brief community linkage intervention for veterans with a persistent mental illness and a co-occurring substance abuse disorder

Assertive community treatmentIssues from scientific and clinical literature with implications for practice

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