A Randomized Trial of Assertive Community Treatment for Homeless Persons with Severe Mental Illness

Center for Mental Health Services Research, University of Maryland, Baltimore, USA.
Archives of General Psychiatry (Impact Factor: 14.48). 12/1997; 54(11):1038-43.
Source: PubMed


This experiment evaluated the effectiveness of an innovative program of assertive community treatment (ACT) for homeless persons with severe and persistent mental illnesses.
One hundred fifty-two homeless persons with severe and persistent mental illness were randomized to either the experimental ACT program or to usual community services. Baseline assessments included the Structured Clinical Interview for DSM-III-R, Quality-of-Life Interview, Colorado Symptom Index, and the Medical Outcomes Study 36-Item Short Form Health Survey. All assessments (except the Structured Clinical Interview) were repeated at the 2-, 6-, and 12-month follow-up evaluations.
Subjects in the ACT program used significantly fewer psychiatric inpatient days, fewer emergency department visits, and more psychiatric outpatient visits than the comparison subjects. The ACT subjects also spent significantly more days in stable community housing, and they experienced significantly greater improvements in symptoms, life satisfaction, and perceived health status.
Relative to usual community care, the ACT program for homeless persons with severe and persistent mental illness shifts the locus of care from crisis-oriented services to ongoing outpatient care and produces better housing, clinical, and life satisfaction outcomes.

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    • "). Despite research efforts, it remains unclear which specific approach to outreach care for the homeless results in improved health care utilisation and outcomes; while some outreach programmes have yielded positive results, others have proven less successful (Commander, Sashidharan, Rana & Ratnayake, 2005; Lam & Rosenheck, 1999; Lehman et al., 1997). "
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    ABSTRACT: Elissen AMJ, Van Raak AJA, Derckx EWCC, Vrijhoef HJM. Improving homeless persons' utilisation of primary care: lessons to be learned from an outreach programme in The Netherlands Faced with rising homelessness, countries around the world are in need of innovative approaches to caring for those without shelter, who, more often than not, suffer from severe health problems. We conducted a case study of an innovative Dutch Primary Care for the Homeless (PCH) programme to gain insight into clients' demographic characteristics, health problems and service use, and to develop an explanation for its success in increasing the latter. Our analyses are based on a combination of quantitative and qualitative data. The results of the study suggest that the success of the PCH programme can be explained by the providers' pragmatism and will to adapt their mode of care provision to the behavioural patterns and needs of their homeless clients.
    International Journal of Social Welfare 01/2013; 22(1):80-89. DOI:10.1111/j.1468-2397.2011.00840.x · 0.54 Impact Factor
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    • "Se han desarrollado normas claras y específicas sobre qué es el PACT e incluso se ha creado un comité internacional de expertos de cara a definir y validar el modelo (McGrew, Bond, Dietzn, & Salyers, 1994). Se han realizado modificaciones para adaptar el programa a otros contextos como grandes áreas urbanas, en el caso del programa Bridge, del centro de rehabilitación de Thresholds, en Chicago que utiliza el PACT por primera vez en una gran ciudad (Borland et al., 1990; Witheridge & Dincin, 1985) o el proyecto PRiSM Psychosis Study, que desarrolla y estudia el PACT por un equipo vinculado al Maudsley en dos áreas socioeconómicamente deprimidas del sur de Londres, donde además se compara la eficacia con un modelo estándar de case management (Thornicroft, Wykes et al., 1998) o a zonas rurales (McDonel et al., 1997) o para determinados grupos de riesgo: " homeless " enfermos mentales (Dixon, Krauss, Kernan, Lehman, & DeForge, 1995; Lehman, Dixon, Kernan, & DeForge, 1997; Morse et al., 1997; Susser et al., 1997; Wasylenki, Goering, Lemire, Lindsey, & Lancee, 1993), pacientes con abuso de sustancias (Bond, McDonel, Miller, & Pensec, 1991; Detrick & Stiepock, 1992; Drake, Yovetich, Bebout, Harris, & McHugo, 1997; Durrell, Lechtenberg, Corse, & Francis, 1993; Lehman, Herron, Schwartz, & Myers, 1993; Jerrell & Ridgely, 1995), enfermos en prisión (Challis, Darton, Hughes, Huxley, & Stewart, 1998; Solomon & Draine, 1995), niños, pacientes con trastornos de la personalidad. "
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    ABSTRACT: The case management programs arise in the late 70's in the U.S., in response to problems identified during the process of deinstitutionalization of psychiatric hospitals. Since then, the case management and the assertive community treatment programs have spread throughout the world, with variations and particularities in different regions, becoming the cornerstone of the community care for people with severe and persistent mental illness. This article reviews the origins of these programs in U.S., their development for over thirty years around the world, the philosophy and objectives that have guided its evolution, as well as successes and failures in their development.
    Estudos de Psicologia (Natal) 12/2011; 16(3):305-312.
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    • "A meta-analysis (Coldwell & Bender, 2007) and critical reviews of ACT (Burns & Santos, 1995; Dixon et al., 2010; Lehman, 1999; O'campo et al., 2009; Vanderplasschen et al., 2007) were also read to identify pertinent articles. Eight studies were initially identified; four were excluded as they did not measure substance use (Jerrell, 1999; Lehman et al., 1997) or adequately report substance use outcomes (e.g., relied solely on self-reported measures; Bond & McDonel, 1991; Clarke et al., 2000). We selected four randomized trials that measured substance abuse adequately, in that self-report of substance use was validated with toxicology tests among dually diagnosed patients. "
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    ABSTRACT: Assertive Community Treatment (ACT) has been studied extensively in people with severe mental illness, but there have only been a few clinical trials in which substance use was one of the measured outcomes. The goal of this article was to describe the efficacy of ACT in treating co-occurring substance use disorders and suggest approaches to make it more efficacious. A literature review was conducted and randomized clinical trials describing ACT's impact on substance use were reviewed. Four randomized clinical trials of ACT that measured substance abuse adequately were identified, all of which showed small to no effect on substance abuse compared with control conditions. Methodological issues might account for the small effects. ACT might further reduce substance use by being paired with evidenced-based substance abuse treatment, helping clients become housed or helping them manage their money better. Integrated ACT, in which the ACT team provides substance abuse counseling, has the potential to reduce substance use by several mechanisms, but this has been difficult to demonstrate in clinical trials when participants in control groups receive similar interventions.
    Journal of the American Psychiatric Nurses Association 03/2011; 17(1):45-50. DOI:10.1177/1078390310393509 · 0.98 Impact Factor
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