Effects of Youth Flexible Assertive Community Treatment: outcomes of an 18-month observational study

Broersen, Marieke; Creemers, Daan H. M.; Frieswijk, Nynke; Vermulst, Ad A.; Kroon, Hans

doi:10.1007/s00127-023-02508-x

Cited by 3 publications

(3 citation statements)

References 42 publications

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“…Their overall ndings were that clients in the ICM groups were most likely to remain with the service, show an improvement in their general functioning, have accommodation, be employed, and tended to spend less time in hospitals. Flexible ACT programs with youth who don't typically engage with regular mental health services have also been shown to improve their mental health symptomology, and social and personal recovery [20].…”

Section: Discussionmentioning

confidence: 99%

Longitudinal record linked analysis of an Assertive Community Treatment programme in a suburban mental health hospital: Emergency department presentations, hospital admissions and bed days.

Stanley,

Velayudhan,

Hellewell

et al. 2024

Preprint

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Purpose This study aimed to objectively assess a long-term Assertive Community Treatment (ACT) programme run by a suburban mental health hospital in Western Australia. The study examined the programme by tracking Emergency Department (ED) presentations, hospital admissions and length of hospital stays (bed days) of people with severe mental illness who entered the programme. Methods Between January 2008 - June 2019, 160 clients who attended the hospital had presentation and admission activities assessed at two time periods 1) PRE - the period from each client’s first engagement with the mental health service up to their entering the service’s ACT programme, and 2) DURING – which is the time that each client spent engaged in that ACT programme. Results No difference was found between ED presentations before the ACT programme as compared to during the ACT programme. Voluntary mental health hospital admissions were significantly lower during the programme than before the programme, but no difference was found for involuntary mental health hospital admissions. Both voluntary and involuntary hospital stays, however, showed a significant reduction in bed days for clients during their time in the ACT programme. Conclusion This data shows mixed support for the continued use of the ACT programme at suburban mental health services. While ED presentations and involuntary admissions remained the same, the reduction in voluntary hospital admissions and hospital bed days suggests that the increased provision of outpatient and home care through ACT is working to support clients in the community keeping them out of more restrictive hospital settings.

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Section: Discussionmentioning

confidence: 99%

Longitudinal record linked analysis of an Assertive Community Treatment programme in a suburban mental health hospital: Emergency department presentations, hospital admissions and bed days.

Stanley,

Velayudhan,

Hellewell

et al. 2024

Preprint

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“…Our observational cohort study revealed an overall enhancement in clients’ attitudes toward education and work. However, this positive shift did not result in more adolescents accessing appropriate education or employment opportunities during the 18 months of Youth Flexible ACT (Broersen et al, 2023 ). A mental healthcare worker with a broad network and specialized training (such as IPS, preferably enhanced with cognitive remediation; Killackey et al, 2019 ; Erickson, 2021; Van Duin et al, 2021 ) may improve outcomes in this domain.…”

Section: Discussionmentioning

confidence: 99%

“…Teams not previously certified were audited as soon as possible, and other teams were audited as close to the certificate's expiration date as possible (certificates are valid for three years). Mental health workers were asked to complete a ‘content of care questionnaire’ 6 months after the baseline measurement of the cohort study (Broersen et al, 2023 ), with two follow-up measurements (12 and 18 months after baseline), to measure the content of treatment interventions provided in teams.…”

Section: Methodsmentioning

confidence: 99%

Examining Youth Flexible ACT Model Implementation in the Netherlands

Broersen,

Frieswijk,

van Vugt

et al. 2024

Community Ment Health J

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Model adherence is a key indicator of mental health care quality. This study investigates the degree of model adherence, as well as content and staging of care, among the first Youth Flexible Assertive Community Treatment (ACT) teams in the Netherlands. Model fidelity was assessed in sixteen teams with the Youth Flexile ACT model fidelity scale (2014 version). Mental health workers completed a ‘content of care questionnaire’ to map the interventions applied in the teams. Model fidelity scores revealed that twelve teams adhered to the Youth Flexible ACT standard with ‘optimal implementation’ (≥ 4.1 on a 5 point scale) and four teams with ‘adequate implementation’. Most disciplines were well integrated within the teams; however, several items regarding the involvement of specific disciplines and the availability of treatment interventions (peer support worker, employment and education specialist and programs, family interventions, integrated dual disorder treatment) scored below the optimum. Frequency of contact during ACT and the use of Routine Outcome Monitoring instruments scored below the optimum as well. The ‘content of care’ data showed that most clients received an individual psychological intervention, and nearly half of the client sample received scaled-up / intensified ACT care. The findings indicate a predominantly successful translation of care from the theoretical Flexible ACT framework into practice, covering both ACT and non-ACT functions. Further room for improvement lies in the incorporation of specialized disciplines in the personal and social recovery domains, including the peer support worker and employment and education specialist, as well as in specific protocolled interventions.

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Alternative approaches to standard inpatient mental health care: development of a typology of service models

Griffiths,

Baldwin,

Vasikaran

et al. 2023

Preprint

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BackgroundInpatient mental health care is a challenging component of the mental health services system, with frequent reports of negative and coercive experiences and doubts about its therapeutic value. As such, alternative approaches for individuals experiencing a mental health crisis are highly desirable. This research aimed to identify models which offer an alternative to standard inpatient mental health care across all age groups, both nationally and internationally, and to develop a typology for these alternative models.MethodsA dual literature search and expert consultation research methodology was adopted to identify relevant models. Three typologies of models were developed according to age group and acuity, including: alternatives to standard acute inpatient services for adults; alternatives to longer-stay inpatient services for adults, including rehabilitation and forensic inpatient services; and alternatives to standard inpatient services for children and young people.ResultsWe identified an array of service models in each typology, some in community settings, some hospital-based and some working across settings. Models varied greatly in characteristics, extent of implementation and supporting evidence.ConclusionsThrough this mapping exercise, we have developed three novel typologies of alternatives to standard inpatient care. A range of community-based, hospital-based and cross-setting approaches were identified. The identification of services providing inpatient care in a substantially different way to the standard suggests that some improvements could be provided within existing structures. Potential inequities in access to alternatives were identified for certain groups, such as people who are compulsorily detained, younger children and young people transitioning between children’s and adult services. These typologies can inform future description, evaluation and comparison of different service models. This research also yields some key considerations for the design, development and implementation of alternative mental health service models and service arrays.

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Effects of Youth Flexible Assertive Community Treatment: outcomes of an 18-month observational study

Cited by 3 publications

References 42 publications

Longitudinal record linked analysis of an Assertive Community Treatment programme in a suburban mental health hospital: Emergency department presentations, hospital admissions and bed days.

Longitudinal record linked analysis of an Assertive Community Treatment programme in a suburban mental health hospital: Emergency department presentations, hospital admissions and bed days.

Examining Youth Flexible ACT Model Implementation in the Netherlands

Alternative approaches to standard inpatient mental health care: development of a typology of service models

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