Skip to main content
Erschienen in: Community Mental Health Journal 5/2012

01.10.2012 | Original Paper

Implementation of Assertive Community Treatment in Australia: Model Fidelity, Patient Characteristics and Staff Experiences

verfasst von: Carol Harvey, Helen Killaspy, Salvatore Martino, Sonia Johnson

Erschienen in: Community Mental Health Journal | Ausgabe 5/2012

Einloggen, um Zugang zu erhalten

Abstract

The impact of variable implementation of the Assertive Community Treatment (ACT) model on patient outcomes is increasingly recognised. We conducted the first study of four established Australian ACT teams, examining team composition, processes and model fidelity, using previously validated questionnaires. Demographic and clinical details of patients and their own experiences of ACT were gathered from staff. Associations between burnout and work experiences were examined. All teams were ACT-like (mean DACTS score = 3.7, SD = 0.3) with few significant patient differences between teams, except diagnosis (schizophrenia 61–93%, co-morbid substance abuse 16–33%) and proportion living alone (23–72%). Clinicians were fairly satisfied, but inter-team differences in staffing profile and experience emerged and one team scored highly on emotional exhaustion. Increased burnout was associated with greater stress due to taking a team approach. Inter-team differences suggested that attention to effective team working and leadership, as well as model fidelity, may be warranted.
Literatur
Zurück zum Zitat Ash, D., Brown, P., Burvill, P., Davies, J., Hughson, B., Meadows, G., et al. (2007). Mental health services in the Australian states and territories. In G. Meadows, B. Singh, & M. Grigg (Eds.), Mental health in Australia: Collaborative community practice (2nd ed., pp. 99–131). South Melbourne: Oxford University Press. Ash, D., Brown, P., Burvill, P., Davies, J., Hughson, B., Meadows, G., et al. (2007). Mental health services in the Australian states and territories. In G. Meadows, B. Singh, & M. Grigg (Eds.), Mental health in Australia: Collaborative community practice (2nd ed., pp. 99–131). South Melbourne: Oxford University Press.
Zurück zum Zitat Australian Bureau of Statistics. (2003b). 2001 census: Socio-economic indices for areas. Canberra: Australian Bureau of Statistics. Australian Bureau of Statistics. (2003b). 2001 census: Socio-economic indices for areas. Canberra: Australian Bureau of Statistics.
Zurück zum Zitat Billings, J., Johnson, S., Bebbington, P., Greaves, A., Priebe, S., Muijen, M., et al. (2003). Assertive outreach teams in London: Staff experiences and perceptions. Pan-London Assertive Outreach Study, part 2. British Journal of Psychiatry, 183, 139–147.PubMedCrossRef Billings, J., Johnson, S., Bebbington, P., Greaves, A., Priebe, S., Muijen, M., et al. (2003). Assertive outreach teams in London: Staff experiences and perceptions. Pan-London Assertive Outreach Study, part 2. British Journal of Psychiatry, 183, 139–147.PubMedCrossRef
Zurück zum Zitat Bond, G. R. (1990). Intensive case management. Hospital & Community Psychiatry, 41(8), 927–928. Bond, G. R. (1990). Intensive case management. Hospital & Community Psychiatry, 41(8), 927–928.
Zurück zum Zitat Bond, G., Drake, R. E., Mueser, K. T., & Becker, D. R. (1997). An update on supported employment for people with severe mental illness. Psychiatric Services, 48(3), 335–346.PubMed Bond, G., Drake, R. E., Mueser, K. T., & Becker, D. R. (1997). An update on supported employment for people with severe mental illness. Psychiatric Services, 48(3), 335–346.PubMed
Zurück zum Zitat Burns, T., Catty, J., Dash, M., Roberts, C., Lockwood, A., & Marshall, M. (2007). Use of intensive case management to reduce time in hospital in people with severe mental illness: Systematic review and meta-regression. British Medical Journal, 335(7615), 336–342.PubMedCrossRef Burns, T., Catty, J., Dash, M., Roberts, C., Lockwood, A., & Marshall, M. (2007). Use of intensive case management to reduce time in hospital in people with severe mental illness: Systematic review and meta-regression. British Medical Journal, 335(7615), 336–342.PubMedCrossRef
Zurück zum Zitat Burns, T., Creed, F., Fahy, T., Thompson, S., Tryrer, P., & White, I. (1999). Intensive versus standard case management for severe psychotic illness: A randomised trial. Lancet, 353(9171), 2185–2189.PubMedCrossRef Burns, T., Creed, F., Fahy, T., Thompson, S., Tryrer, P., & White, I. (1999). Intensive versus standard case management for severe psychotic illness: A randomised trial. Lancet, 353(9171), 2185–2189.PubMedCrossRef
Zurück zum Zitat Catty, J., Burns, T., Knapp, M., Watt, H., Wright, C., Henderson, J., et al. (2002). Home treatment for mental health problems: A systematic review. Psychological Medicine, 32, 383–401.PubMedCrossRef Catty, J., Burns, T., Knapp, M., Watt, H., Wright, C., Henderson, J., et al. (2002). Home treatment for mental health problems: A systematic review. Psychological Medicine, 32, 383–401.PubMedCrossRef
Zurück zum Zitat Corrigan, P. W., Steiner, L., McCracken, S. G., Blaser, B., & Barr, M. (2001). Strategies for disseminating evidence-based practices to staff who treat people with serious mental illness. Psychiatric Services, 52(12), 1598–1606.PubMedCrossRef Corrigan, P. W., Steiner, L., McCracken, S. G., Blaser, B., & Barr, M. (2001). Strategies for disseminating evidence-based practices to staff who treat people with serious mental illness. Psychiatric Services, 52(12), 1598–1606.PubMedCrossRef
Zurück zum Zitat Drake, R., Mueser, K., & McHugo, G. (1986). Clinician ratings scales: Alcohol Use Scale (AUS), Drug Use Scale (DUS) and Substance Abuse Treatment Scale (SATS). In L. Sederer & B. Dickey (Eds.), Outcomes assessment in clinical practice. Baltimore: Williams and Wilkins. Drake, R., Mueser, K., & McHugo, G. (1986). Clinician ratings scales: Alcohol Use Scale (AUS), Drug Use Scale (DUS) and Substance Abuse Treatment Scale (SATS). In L. Sederer & B. Dickey (Eds.), Outcomes assessment in clinical practice. Baltimore: Williams and Wilkins.
Zurück zum Zitat Fiander, M., Burns, T., McHugo, G. J., & Drake, R. E. (2003). Assertive community treatment across the Atlantic: Comparison of model fidelity in the UK and USA. British Journal of Psychiatry, 182, 248–254.PubMedCrossRef Fiander, M., Burns, T., McHugo, G. J., & Drake, R. E. (2003). Assertive community treatment across the Atlantic: Comparison of model fidelity in the UK and USA. British Journal of Psychiatry, 182, 248–254.PubMedCrossRef
Zurück zum Zitat Hambridge, J. A., & Rosen, A. (1994). Assertive community treatment for the seriously mentally ill in suburban Sydney: A programme description and evaluation. Australian and New Zealand Journal of Psychiatry, 28, 438–445.PubMedCrossRef Hambridge, J. A., & Rosen, A. (1994). Assertive community treatment for the seriously mentally ill in suburban Sydney: A programme description and evaluation. Australian and New Zealand Journal of Psychiatry, 28, 438–445.PubMedCrossRef
Zurück zum Zitat Harvey, C., Killaspy, H., Martino, S., White, S., Priebe, S., Wright, C., et al. (2011). A comparison of the implementation of Assertive Community Treatment in Melbourne, Australia and London, England. Epidemiologia Psichiatria Sociale, 20(2), 151–161.CrossRef Harvey, C., Killaspy, H., Martino, S., White, S., Priebe, S., Wright, C., et al. (2011). A comparison of the implementation of Assertive Community Treatment in Melbourne, Australia and London, England. Epidemiologia Psichiatria Sociale, 20(2), 151–161.CrossRef
Zurück zum Zitat Health and Community Services. (1994). Victoria’s Mental Health Service. The framework for service delivery. Melbourne: Psychiatric Services division, Victoria. Health and Community Services. (1994). Victoria’s Mental Health Service. The framework for service delivery. Melbourne: Psychiatric Services division, Victoria.
Zurück zum Zitat Hoult, J. (1986). Community care of the acutely mentally ill. British Journal of Psychiatry, 149, 137–144.PubMedCrossRef Hoult, J. (1986). Community care of the acutely mentally ill. British Journal of Psychiatry, 149, 137–144.PubMedCrossRef
Zurück zum Zitat Human Services Victoria. (1995). Mobile support and treatment services. Guidelines for service provision. Melbourne: Psychiatric Services Branch. Human Services Victoria. (1995). Mobile support and treatment services. Guidelines for service provision. Melbourne: Psychiatric Services Branch.
Zurück zum Zitat Issakidis, C., Sanderson, K., Teeson, M., Johnson, S., & Buhrich, N. (1999). Intensive case management in Australia: A randomized controlled trial. Acta Psychiatrica Scandinavica, 99, 360–367.PubMedCrossRef Issakidis, C., Sanderson, K., Teeson, M., Johnson, S., & Buhrich, N. (1999). Intensive case management in Australia: A randomized controlled trial. Acta Psychiatrica Scandinavica, 99, 360–367.PubMedCrossRef
Zurück zum Zitat Joy, C. B., Adams, C. E., & Rice, K. (2002). Crisis intervention for people with severe mental illness (Cochrane review). In The Cochrane Library (Issue 3). Oxford, Update Software. Joy, C. B., Adams, C. E., & Rice, K. (2002). Crisis intervention for people with severe mental illness (Cochrane review). In The Cochrane Library (Issue 3). Oxford, Update Software.
Zurück zum Zitat Killaspy, H., Bebbington, P., Blizard, R., Johnson, S., Nolan, F., Pilling, S., et al. (2006). The REACT study: Randomised evaluation of assertive community treatment in north London. British Medical Journal, 332(7545), 815–820.PubMedCrossRef Killaspy, H., Bebbington, P., Blizard, R., Johnson, S., Nolan, F., Pilling, S., et al. (2006). The REACT study: Randomised evaluation of assertive community treatment in north London. British Medical Journal, 332(7545), 815–820.PubMedCrossRef
Zurück zum Zitat Killaspy, H., Johnson, S., Pierce, B., Bebbington, P., Pilling, S., Nolan, F., et al. (2009). Successful engagement: a mixed methods study of the approaches of assertive community treatment and community mental health teams in the REACT trial. Social Psychiatry and Psychiatric Epidemiology, 44(7), 532–540.PubMedCrossRef Killaspy, H., Johnson, S., Pierce, B., Bebbington, P., Pilling, S., Nolan, F., et al. (2009). Successful engagement: a mixed methods study of the approaches of assertive community treatment and community mental health teams in the REACT trial. Social Psychiatry and Psychiatric Epidemiology, 44(7), 532–540.PubMedCrossRef
Zurück zum Zitat King, R. (2006). Intensive case management: a critical re-appraisal of the scientific evidence for effectiveness. Administration Policy Mental Health and Mental Heath Services Research, 33(5), 529–535.CrossRef King, R. (2006). Intensive case management: a critical re-appraisal of the scientific evidence for effectiveness. Administration Policy Mental Health and Mental Heath Services Research, 33(5), 529–535.CrossRef
Zurück zum Zitat Kirsh, B., Cockburn, L., & Gewurtz, R. (2005). Best practice in occupational therapy: Program characteristics that influence vocational outcomes for people with serious mental illnesses. Canadian Journal of Occupational Therapy, 72(5), 265–279. Kirsh, B., Cockburn, L., & Gewurtz, R. (2005). Best practice in occupational therapy: Program characteristics that influence vocational outcomes for people with serious mental illnesses. Canadian Journal of Occupational Therapy, 72(5), 265–279.
Zurück zum Zitat Marshall, M., Bond, G., Stein, L. I., Shepherd, G., McGrew, J., Hoult, J., et al. (1999). PRiSM psychosis study. Design limitations, questionable conclusions. British Journal of Psychiatry, 175, 501–503.PubMedCrossRef Marshall, M., Bond, G., Stein, L. I., Shepherd, G., McGrew, J., Hoult, J., et al. (1999). PRiSM psychosis study. Design limitations, questionable conclusions. British Journal of Psychiatry, 175, 501–503.PubMedCrossRef
Zurück zum Zitat Marshall, M., & Lockwood, A. (1998). Assertive community treatment for people with severe mental disorders (Review) (Publication no. CD001089. doi:10.1002/14651858). Retrieved November 4, 2005, from John Wiley & Sons Ltd. Marshall, M., & Lockwood, A. (1998). Assertive community treatment for people with severe mental disorders (Review) (Publication no. CD001089. doi:10.​1002/​14651858). Retrieved November 4, 2005, from John Wiley & Sons Ltd.
Zurück zum Zitat Maslach, C., Jackson, S. E., & Leiter, M. P. (1996). The Maslach Burnout Inventory (3rd ed.). Palo Alto, CA: Consulting Psychologists Press. Maslach, C., Jackson, S. E., & Leiter, M. P. (1996). The Maslach Burnout Inventory (3rd ed.). Palo Alto, CA: Consulting Psychologists Press.
Zurück zum Zitat McGrew, J. H., Bond, G. R., Dietzen, L., & Salyers, M. (1994). Measuring the fidelity of implementation of a mental health program model. Journal of Consulting and Clinical Psychology, 62(4), 670–678.PubMedCrossRef McGrew, J. H., Bond, G. R., Dietzen, L., & Salyers, M. (1994). Measuring the fidelity of implementation of a mental health program model. Journal of Consulting and Clinical Psychology, 62(4), 670–678.PubMedCrossRef
Zurück zum Zitat McHugo, G. J., Drake, R. E., Whitley, R., Bond, G. R., Campbell, K., Rapp, C. A., et al. (2007). Fidelity outcomes in the national implementing evidence-based practices project. Psychiatric Services, 58(10), 1279–1284.PubMedCrossRef McHugo, G. J., Drake, R. E., Whitley, R., Bond, G. R., Campbell, K., Rapp, C. A., et al. (2007). Fidelity outcomes in the national implementing evidence-based practices project. Psychiatric Services, 58(10), 1279–1284.PubMedCrossRef
Zurück zum Zitat Priebe, S., Fakhoury, W., Watts, J., Bebbington, P., Burns, T., Johnson, S., et al. (2003). Assertive outreach teams in London: Patient characteristics and outcomes. Pan-London Assertive Outreach Study, part 3. British Journal of Psychiatry, 183, 148–154.PubMedCrossRef Priebe, S., Fakhoury, W., Watts, J., Bebbington, P., Burns, T., Johnson, S., et al. (2003). Assertive outreach teams in London: Patient characteristics and outcomes. Pan-London Assertive Outreach Study, part 3. British Journal of Psychiatry, 183, 148–154.PubMedCrossRef
Zurück zum Zitat Prosser, D., Johnson, S., Kuipers, E., Szmukler, G., Bebbington, P., & Thornicroft, G. (1997). Perceived sources of work stress and satisfaction among hospital and community mental health staff, and their relation to mental health, burnout and job satisfaction. Journal of Psychosom Research, 43(1), 51–59.CrossRef Prosser, D., Johnson, S., Kuipers, E., Szmukler, G., Bebbington, P., & Thornicroft, G. (1997). Perceived sources of work stress and satisfaction among hospital and community mental health staff, and their relation to mental health, burnout and job satisfaction. Journal of Psychosom Research, 43(1), 51–59.CrossRef
Zurück zum Zitat Rosen, A., Mueser, K., & Teesson, M. (2007). Assertive community treatment-issues from scientific and clinical literature with implications for practice. Journal of Rehabilitation Research and Development, 44(6), 813–825.PubMedCrossRef Rosen, A., Mueser, K., & Teesson, M. (2007). Assertive community treatment-issues from scientific and clinical literature with implications for practice. Journal of Rehabilitation Research and Development, 44(6), 813–825.PubMedCrossRef
Zurück zum Zitat Salyers, M. P., Bond, G. R., Teague, G. B., Cox, J. F., Smith, M. E., Hicks, M. L., et al. (2003). Is it ACT yet? Real-world examples of evaluating the degree of implementation for assertive community treatment. Journal of Behavioral Health Services and Research, 30(3), 304–320.PubMedCrossRef Salyers, M. P., Bond, G. R., Teague, G. B., Cox, J. F., Smith, M. E., Hicks, M. L., et al. (2003). Is it ACT yet? Real-world examples of evaluating the degree of implementation for assertive community treatment. Journal of Behavioral Health Services and Research, 30(3), 304–320.PubMedCrossRef
Zurück zum Zitat SPSS. (2009). SPSS for Windows, Version 19. Chicago: SPSS Inc. SPSS. (2009). SPSS for Windows, Version 19. Chicago: SPSS Inc.
Zurück zum Zitat Stein, L. I., & Test, M. A. (1980). Alternatives to mental hospital treatment. Archives of General Psychiatry, 37, 392–397.PubMedCrossRef Stein, L. I., & Test, M. A. (1980). Alternatives to mental hospital treatment. Archives of General Psychiatry, 37, 392–397.PubMedCrossRef
Zurück zum Zitat Sytema, S., Wunderink, L., Bloemers, W., Roorda, L., & Wiersma, D. (2007). Assertive community treatment in the Netherlands: A randomized controlled trial. Acta Psychiatrica Scandinavica, 116(2), 105–112.PubMedCrossRef Sytema, S., Wunderink, L., Bloemers, W., Roorda, L., & Wiersma, D. (2007). Assertive community treatment in the Netherlands: A randomized controlled trial. Acta Psychiatrica Scandinavica, 116(2), 105–112.PubMedCrossRef
Zurück zum Zitat Teague, G., Bond, G., & Drake, R. (1998). Program fidelity in assertive community treatment: Development and use of a measure. American Journal of Orthopsychiatry, 68(2), 216–232.PubMedCrossRef Teague, G., Bond, G., & Drake, R. (1998). Program fidelity in assertive community treatment: Development and use of a measure. American Journal of Orthopsychiatry, 68(2), 216–232.PubMedCrossRef
Zurück zum Zitat Thornicroft, G., Wykes, T., Holloway, F., Johnson, S., & Szmukler, G. (1998). From efficacy to effectiveness in community mental health services. PRiSM Psychosis Study 10. British Journal of Psychiatry, 173, 423–427.PubMedCrossRef Thornicroft, G., Wykes, T., Holloway, F., Johnson, S., & Szmukler, G. (1998). From efficacy to effectiveness in community mental health services. PRiSM Psychosis Study 10. British Journal of Psychiatry, 173, 423–427.PubMedCrossRef
Zurück zum Zitat Victorian Government. (1986). Mental Health Act 1986. Melbourne: Department of Human Services. Victorian Government. (1986). Mental Health Act 1986. Melbourne: Department of Human Services.
Zurück zum Zitat Weiss, D. J., Dawis, R. V., England, G. W., & Lofquist, L. H. (1967). Manual for the Minnesota Satisfaction Questionnaire. Minnesota Studies in Vocational Rehabilitation: XXII. Minneapolis: University of Minnesota, Industrial Relations Center Work Adjustment Project. Weiss, D. J., Dawis, R. V., England, G. W., & Lofquist, L. H. (1967). Manual for the Minnesota Satisfaction Questionnaire. Minnesota Studies in Vocational Rehabilitation: XXII. Minneapolis: University of Minnesota, Industrial Relations Center Work Adjustment Project.
Zurück zum Zitat Winter, J., & Caslyn, R. (2000). The Dartmouth Assertive Community Treatment Scale (DACTS): A generalizability study. Evaluation Review, 24(2), 319–337.PubMedCrossRef Winter, J., & Caslyn, R. (2000). The Dartmouth Assertive Community Treatment Scale (DACTS): A generalizability study. Evaluation Review, 24(2), 319–337.PubMedCrossRef
Zurück zum Zitat Wright, C., Burns, T., James, P., Billings, J., Johnson, S., Muijen, M., et al. (2003). Assertive outreach teams in London: Models of operation. Pan-London Assertive Outreach Study, part 1. British Journal of Psychiatry, 183, 132–138.PubMedCrossRef Wright, C., Burns, T., James, P., Billings, J., Johnson, S., Muijen, M., et al. (2003). Assertive outreach teams in London: Models of operation. Pan-London Assertive Outreach Study, part 1. British Journal of Psychiatry, 183, 132–138.PubMedCrossRef
Metadaten
Titel
Implementation of Assertive Community Treatment in Australia: Model Fidelity, Patient Characteristics and Staff Experiences
verfasst von
Carol Harvey
Helen Killaspy
Salvatore Martino
Sonia Johnson
Publikationsdatum
01.10.2012
Verlag
Springer US
Erschienen in
Community Mental Health Journal / Ausgabe 5/2012
Print ISSN: 0010-3853
Elektronische ISSN: 1573-2789
DOI
https://doi.org/10.1007/s10597-011-9466-x

Weitere Artikel der Ausgabe 5/2012

Community Mental Health Journal 5/2012 Zur Ausgabe

Update Psychiatrie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.