Assertive Community Treatment in the Netherlands: Outcome and Model Fidelity

Vugt, Maaike D. van; Kroon, Hans; Delespaul, Philippe; Dreef, Fred G; Nugter, Annet; Roosenschoon, Bert-Jan; Weeghel, Jaap van; Zoeteman, Jeroen; Mulder, Cornelis L.

doi:10.1177/070674371105600305

Cited by 44 publications

(46 citation statements)

References 35 publications

(31 reference statements)

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“…In fact, the level of illness severity observed in our study is even more pronounced than that found with similar instruments in national [18] and international [19] samples of patients with psychoses. In the study of Parabiaghi et al [18], carried out in 2003 in nine communities mental health services in Italy, a large cohort of 2059 patients was monitored over a one-year period.…”

Section: Discussioncontrasting

confidence: 53%

A follow-up on patients with severe mental disorders in Sardinia after two changes in regional policies: poor resources still correlate with poor outcomes

et al. 2013

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BackgroundThis survey followed a cohort of patients with chronic psychosis recruited from five catchment areas (DSMs) of the Sardinian community mental health services. The objective was to examine whether the amount of resources in the different sites may be a determinant of the outcomes.MethodsNaturalistic follow-up study on 309 consecutive users with diagnosis of schizophrenic disorder, schizoaffective disorder, bipolar affective disorder with psychotic symptoms (DSM-IV TR) of five Sardinian community mental health services. Mental state and clinical symptoms along with functioning were assessed using semi-structured clinical interviews (ANTAS), Clinical Global Impression Severity Scale (CGI-S), Global Assessment of Functioning Scale (GAF) and Health of the Nation Outcome Scales (HONOS). Assessments were conducted at the beginning of the study and after one year.ResultsThe proportion of professionals working in all DSMs participating in the study was found lower than the national Italian standard (0.7 vs 1.0 per 1,500 inhabitants). Follow-up revealed significant differences between DSMs in the improvement of the Honos scores (F = 5.932, p = 0.000). These differences correlate with the improvement of resources in terms of number of professionals during, and one year prior, to the trial.ConclusionsThe study shows that mental health services provided in the public sector in Sardinia are still very resource-poor, at least in terms of human resources. Our findings suggest that mental health service resources influence outcomes as regards the social functioning of users. We urge policy makers to take these observations into account when planning future services.

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Section: Discussioncontrasting

confidence: 53%

A follow-up on patients with severe mental disorders in Sardinia after two changes in regional policies: poor resources still correlate with poor outcomes

et al. 2013

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“…Explanations for the lack of results were sought in lack of experience of the teams (Killaspy et al 2006) and the fact that standard care incorporated many elements that are characteristic of ACT (Killaspy et al 2006; Sytema et al 2007). Another Dutch study found a (negative) relationship between level of ACT model fidelity, especially team structure, and some items of the HoNOS and the number of homeless days (Van Vugt et al 2011). Implementation of fully fledged ACT is especially difficult in rural areas because of the low population density, the lack of adequate services for patients and the lack of personnel (Meyer and Morrissey 2007).…”

Section: Introduction: Act and Flexible Actmentioning

confidence: 99%

Outcomes of FLEXIBLE Assertive Community Treatment (FACT) Implementation: A Prospective Real Life Study

Nugter

Engelsbel

Bähler

et al. 2015

Community Ment Health J

103

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This study aimed to investigate social and clinical outcomes and use of care during and after implementation of FLEXIBLE Assertive Community Treatment (ACT). Three teams and 372 patients were involved. Model fidelity, clinical and social assessments were performed at baseline and after 1 and 2 years. Use of care was registered continuously. Model fidelity was good at the end of the study. Data showed much variation between patients in number and duration of ACT periods. Statistically significant improvements were found in compliance, unmet needs and quality of life. Improvement of quality of life and functioning was related to duration of ACT. The percentage of remissions increased with 9 %. The number of admissions, admission days and face to face contacts differed between ACT and non-ACT patients, but generally decreased. Findings suggest that implementation of FACT results in a more flexible adaptation of care to the needs of the patients.

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“…H. McGrew, Bond, Dietzen, & Salyers, 1994;McGuire et al, in press; McHugo, Drake, Teague, & Xie, 1999;van Vugt et al, 2011). Fidelity monitoring is a critical tool for providing developmental feedback, either in program start-up for learning program principles and practices or as an important component in supporting the long-term sustainability of such practices (Bond et al, 2014).…”

mentioning

confidence: 99%

Comparing the Costs and Acceptability of Three Fidelity Assessment Methods for Assertive Community Treatment

Rollins

Kukla

Salyers

et al. 2017

Adm Policy Ment Health

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Assertive Community Treatment in the Netherlands: Outcome and Model Fidelity

Abstract: Our evidence supports the importance of model fidelity for improving patient outcomes.

Cited by 44 publications

References 35 publications

A follow-up on patients with severe mental disorders in Sardinia after two changes in regional policies: poor resources still correlate with poor outcomes

A follow-up on patients with severe mental disorders in Sardinia after two changes in regional policies: poor resources still correlate with poor outcomes

Outcomes of FLEXIBLE Assertive Community Treatment (FACT) Implementation: A Prospective Real Life Study

Comparing the Costs and Acceptability of Three Fidelity Assessment Methods for Assertive Community Treatment

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