Outcomes of Assertive Community Treatment for Adolescents with Complex Mental Health Problems Who are Difficult to Engage

The Impact of Community Mental Health Programs for Australian Youth: A Systematic Review

“…A summary of each study's design, participant characteristics, and intervention content is presented in Supplementary Table 2. All studies were conducted across various states and territories in Australia, with the majority from Victoria (n = 19), followed by New South Wales (n = 6, Conrad et al, 2017;Curtis et al, 2016;Howe et al, 2017;Hudson et al, 2015;Nasstasia et al, 2017Nasstasia et al, , 2019, Queensland (n = 5, Daubney et al, 2021;Edwards et al, 2018;Farrell et al, 2012;Klag et al, 2016;Tan & Martin, 2015), Western Australia (n = 3, Goel et al, 2021;Porter & Nuntavisit, 2016;Sabbioni et al, 2018), andTasmania (n = 1, Westwater et al, 2020). Two studies were conducted nationally (Bassilios et al, 2017;Rickwood et al, 2015), and the final study collected data from three states (VIC, NSW, and QLD, Hall et al, 2021).…”

“…Only eight studies described the cultural and linguistic diversity of the sample, defined as being born in non-English speaking countries (n = 7, Hall et al, 2021;Hayes et al, 2011;Killackey et al, 2017McGuire et al, 2021;Pearce et al, 2020;Sabbioni et al, 2018) or do not speak English at home (n = 1, Kehoe et al, 2014), yet the specific countries were often not specified. There was also a lack of inclusion and reporting on the sexual and gender diversity of young people in the reviewed studies (n = 4): two studies each included two young people who identified as non-binary or gender queer (i.e., do not identify as male or female, Hall et al, 2021;Hickey et al, 2020); one study reported that 3% of the sample identified as transgender or gender diverse (Goel et al, 2021); and 15% of young people identified as same-sex attracted or bisexual in Daubney et al' (2021) study. Only five studies discussed families' socioeconomic status, encompassing parental income, educational attainment or employment, which were considered representative of the general population (Bassilios et al, 2017;Farrell et al, 2012;Havighurst et al, 2015;Hides et al, 2011;Kehoe et al, 2014).…”

“…Four programs were conducted at a University (Farrell et al, 2012;Hudson et al, 2015;Nasstasia et al, 2017Nasstasia et al, , 2019 while three programs were delivered at a local community center (Havighurst et al, 2015;Kehoe et al, 2014;Tan & Martin, 2015). Eight studies were conducted entirely via assertive outreach, predominantly in clients' homes, or other community meeting points, such as parks, cafes, skateparks, or during transportation to various appointments to engage the young people within their naturalistic environment (Brewer et al, 2015;Chia et al, 2013;Daubney et al, 2021;Howe et al, 2017;Killackey et al, 2017;Porter & Nuntavisit, 2016;Sabbioni et al, 2018;Schley et al, 2012). The remaining nine programs were delivered across various types of community settings, including a combination of center-based and outreach locations (e.g., homes, Curtis et al, 2016;Conrad et al, 2017;Goel et al, 2021;Hall et al, 2021;Hides et al, 2011;Pearce et al, 2020;Poole et al, 2018;Wagner et al, 2017).…”

“…Seven of these studies implemented an assertive outreach model of case management support, which involved a multidisciplinary team of clinicians (i.e., psychologists, social workers, clinical nurses, case managers, psychiatrists) who provided tailored wrap-around support to meet each young person's individualized psychosocial needs via flexible service delivery and assertive outreach (i.e., home visits, 'in-transit', intensive or extended contact hours, and practical support, etc.). The specific names of each assertive outreach service and their further details are presented in Supplementary Table 2 (Brewer et al, 2015;Chia et al, 2013;Conrad et al, 2017;Daubney et al, 2021;Howe et al, 2017;Sabbioni et al, 2018;Schley et al, 2012). These programs are distinguished from traditional case management by smaller caseloads (1:5), longer duration (i.e., 10-18 months), higher frequency of client contact, greater care coordination, multidisciplinary support, and an emphasis on outreach, including the provision of in-home support, to engage youth in holistic assessment and treatment.…”

“…Six of the nine case management interventions were evaluated by the extent of pre-post improvements in mental health symptomology, eight studies (n = 7 pre-post, n = 1 controlled) assessed psychosocial functioning, and four of nine studies (all pre-post) measured hospital admissions (Brewer et al, 2015;Chia et al, 2013;Conrad et al, 2017;Daubney et al, 2021). All six studies that assessed young people's mental health symptomology, all via pre-post evaluation, yielded a significant reduction in general symptom severity with consistently large effect sizes (d = 0.80-1.37, Brewer et al, 2015;Conrad et al, 2017;Daubney et al, 2021;Howe et al, 2017;Killackey et al, 2017;Schley et al, 2012). Further, young people reported a medium to large reduction in suicidality (Daubney et al, 2021;Schley et al, 2012), and anxiety and depressive disorders (Conrad et al, 2017) following assertive case management.…”