Clinicians' and Clients' Perspectives on the Impact of Assertive Community Treatment

Lang, Michelle; Davidson, Larry; Bailey, Peggy; Levine, Michael S.

doi:10.1176/ps.50.10.1331

Cited by 32 publications

(32 citation statements)

References 47 publications

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“…In this study, social support was found to be the only significant factor associated with low hospitalization rate. Social support was found to be significantly associated with low rehospitalisation in an earlier study by Lang et al (1999). Other factors found in this earlier study to be significantly associated with hospitalization rate were factors related to symptoms as well as social, financial and legal factors; low levels of functioning and inadequate social support; dissatisfaction with family relations and socioeconomic status.…”

Section: Discussionsupporting

confidence: 42%

Hospital‐based community psychiatric service for patients with schizophrenia in Kuala Lumpur: A 1‐year follow‐up study of re‐hospitalization

Dahlan

Midin

Sidi

et al. 2013

Asia-Pacific Psychiatry

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Introduction: Hospital-based community psychiatric service (HCPS) is a developing intervention in Malaysia targeted for patients with severe mental illnesses (SMIs). Its effectiveness had not been systematically measured. This study aimed to assess the outcome of HCPS with respect to re-hospitalization and factors associated with low re-hospitalization among patients with schizophrenia in the metropolitan city of Kuala Lumpur. Methods: A naturalistic and retrospective cohort study was conducted using within-subject pre-post design on 155 patients with schizophrenia who received HCPS in Hospital Kuala Lumpur (HKL). The selection was made by simple random sampling. The hospital admission profiles were obtained from clinical records. The socio-demographic and relevant clinical data were also assessed through clinical interviews. Results: One hundred and forty (90%) of 155 respondents had low rate of hospital admission with significant reduction of being hospitalized within 1 year after receiving HCPS (p < 0.001). Having good social support was significantly associated with lower rate of rehospitalization (p = 0.001). Discussion: The study revealed the effectiveness of HCPS in terms of reducing rates of hospital admission among patients with schizophrenia in Malaysia. The finding may be used as an evidence to develop the service further in other hospitals. However, the finding needs to be replicated through studies with better design involving more psychiatric centres.

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Section: Discussionsupporting

confidence: 42%

Hospital‐based community psychiatric service for patients with schizophrenia in Kuala Lumpur: A 1‐year follow‐up study of re‐hospitalization

Dahlan

Midin

Sidi

et al. 2013

Asia-Pacific Psychiatry

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“…Geralmente, são feitas análises e comparações entre as situações pré e pós-implementação dos programas em um mesmo serviço ou entre a situação no momento de entrada no serviço e a evolução depois de um período determinado pelo pesquisador (Borland et al, 1989;Curtis et al, 1996;Dixon et al, 1993a;Dixon et al,1993-b;Joannette et al, 2005;Lang et al, 1999;McGrew et al, 1995;Shaw et al, 1990;Tibbo et al, 1999;Wasylenki et al, 1993). Wasylenki et al (1993) mediram o impacto da participação no case management sobre uma população de desabrigados com doença mental comparando as situações anterior e posterior à entrada no programa.…”

Section: Resultsunclassified

“…Os estudos podem ter como objetivos descrever os programas e suas replicações ou adaptações, delinear o estado da pesquisa sobre o tema, apontar direções para futuras investigações, fazer comparações com outros serviços (Tabela 2) e análises de desfechos ou de eficácia, demonstrar benefícios para as populações-alvo e fazer comparações entre o PACT e o case management (Bandeira et al, 1998;Burns e Santos, 1995;Lang et al, 1999;Olfson, 1990;Phillips et al, 2001;Taube et al, 1990;Ziguras e Stuart, 2000). Taube et al (1990), em revisão bibliográfica sobre PACT, descrevem o programa, o comparam com abordagens tradicionais de cuidado comunitário -em especial programas dos centros comunitários de saúde mental (Tabela 2) -e sistematizam algumas direções para o futuro da pesquisa sobre o tema.…”

Section: Equipe Terapêuticaunclassified

Programa de tratamento assertivo na comunidade (PACT) e gerenciamento de casos (case management): revisão de 20 anos da literatura

Machado

Dahl

Carvalho³

et al. 2007

J. bras. psiquiatr.

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Palavras-chaveCase management, desinstitucionalização, serviços comunitários em saúde mental. resumo objetivo: Realizar uma revisão de estudos sobre programa de tratamento assertivo na comunidade (PACT) e case management para verificar se os resultados demonstram desfechos mais favoráveis quando tais modelos são implementados na rede comunitária de assistência para portadores de doença mental grave e persistente. métodos: A coleta de artigos -publicados entre 1985 e 2005 -foi realizada em duas etapas: a primeira, na base de dados PubMed, com expressões-chave mental health, community care, services evaluation e seleção de artigos cuja temática era PACT e case management, e a segunda, no banco de dados da revista Psychiatric Services, com palavras-chave assertive community treatment, PACT e case management. Foram desconsiderados estudos que analisavam serviços exclusivos para crianças, idosos e pacientes com diagnóstico único de abuso de álcool/drogas; abordavam unicamente os custos da intervenção e se referiam exclusivamente a serviços hospitalares. resultados: A partir da leitura dos 73 estudos selecionados, os autores descreveram oito categorias nas quais os artigos foram agrupados, visto que um artigo poderia pertencer a mais de uma categoria. Conclusões: O PACT e o case management são estratégias importantes e reconhecidamente mais eficazes, quando comparados a outros modelos de cuidado, em trazer evoluções favoráveis para indivíduos com doença mental grave e persistente.

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“…Problems with narrative coherence have been observed in other samples with significant psychopathology, such as borderline personality disorder (Adler et al., ), as well as in samples with generally low psychological well‐being (e.g., Baerger & McAdams, ). Psychotherapy has often been construed as a process that is fundamentally concerned with enhancing the client's narrative coherence (e.g., Dimaggio, Salvatore, Azzara, & Catania, ; Neimeyer, Herrero, & Botella, ; Salvatore et al., ; Singer & Rexhaj, ). Cross‐sectional retrospective research has demonstrated that clients in good mental health recount their experiences in psychotherapy with a greater degree of narrative coherence than those who are worse off after treatment (Adler et al., ).…”

Section: Unitymentioning

confidence: 99%

Clients' and Therapists' Stories about Psychotherapy

Adler

2013

Journal of Personality

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This article provides an overview of the emerging field of research on clients' stories about their experiences in psychotherapy. The theory of narrative identity suggests that individuals construct stories about their lives in order to provide the self with a sense of purpose and unity. Psychotherapy stories serve both psychological functions. Focusing on the theme of agency as a vehicle for operationalizing purpose and coherence as a way of operationalizing unity, this article will describe the existing scholarship connecting psychotherapy stories to clients' psychological well-being. Results from cross-sectional qualitative and quantitative studies as well as longitudinal research indicate a connection between the stories clients tell about therapy and their psychological well-being, both over the course of treatment and after it is over. In addition, a preliminary analysis of therapists' stories about their clients' treatment is presented. These analyses reveal that the way therapists recount a particular client's therapy does not impact the relationships between clients' narratives and their improvement.The article concludes with a discussion of how this body of scholarship might be fruitfully applied in the realm of clinical practice.

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Clinicians' and Clients' Perspectives on the Impact of Assertive Community Treatment

Abstract: These findings emphasize the importance of clients' perspectives in treatment planning and suggest that clinicians may overlook the smaller incremental steps toward improvement that are valued by clients.

Cited by 32 publications

References 47 publications

Hospital‐based community psychiatric service for patients with schizophrenia in Kuala Lumpur: A 1‐year follow‐up study of re‐hospitalization

Hospital‐based community psychiatric service for patients with schizophrenia in Kuala Lumpur: A 1‐year follow‐up study of re‐hospitalization

Programa de tratamento assertivo na comunidade (PACT) e gerenciamento de casos (case management): revisão de 20 anos da literatura

Clients' and Therapists' Stories about Psychotherapy

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