Using a participatory research approach this study examined Assertive Community Treatment as experienced by service recipients. Overall participants were positive about their involvement with ACT and their experiences reflected critical ingredients of the model. The analysis revealed seven ways the ACT promoted community adjustment. Unhelpful aspects of the experience included staff requiring more training in particular service areas, conflicts over money and medications, stigmatizing aspects of the service, and authoritative practices of individual staff. Services promoting community participation were less well-developed than clinical approaches. Tensions inherent in receiving ACT services were related to the participants' negotiation of personal and social consequences of mental illness while striving for autonomy, community participation and inclusion.
"The working relationship that we identified highlights a " humanistic " feature in which workers conveyed unconditional positive regard and maintained flexibility in the format of contact and service activities. This concurs with mental health consumers' viewpoints on a helpful working relationship (Brun & Rapp, 2001; Green et al., 2008; Kirsh & Tate, 2006; Krupa et al., 2005; Leiphart & Barnes, 2005; Padgett, Henwood, Abrams, & Davis, 2008; Ribner & Knei-Paz, 2002). From client perspectives in case management programs, the informal, friendship-like aspects of the working relationship appear to be of primary value (Angell & Mahoney, 2007; Buck & Alexander, 2006; Estroff, 1981; Kirsh & Tate; Ware, Tugenberg, & Dickey, 2004). "
[Show abstract][Hide abstract] ABSTRACT: We applied grounded theory methodology to generate a working relationship model that influences motivation for stable housing among homeless people with serious mental illness, to understand the role of a working relationship in critical service transitions. We focused on practitioners' perspectives and practices in Critical Time Intervention (CTI), a community intervention aimed to reduce homelessness through providing support during the transition from institutional to community living. We found a working relationship that highlighted "nonauthoritative" and "humanistic" features. Workers respected client autonomy and maintained flexibility in the format of client contact and service activities. They used practice strategies including following client leads and informal relating approaches to facilitate the development of client trust. The trusting relationship enhanced client interest in obtaining housing and the commitment to the transformation crucial for retaining housing. We discuss the significance of the relationship and ethical considerations of relationship-building activities in community mental health practices.
Qualitative Health Research 09/2011; 22(3):373-83. DOI:10.1177/1049732311421180 · 2.19 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This review describes Assertive community treatment (ACT), an integral component of the care of persons with severe mental illness. Drawing on research from North America, Australasia, and Britain, we summarize the current evidence base for ACT and examine the trends and issues that may affect practice. Strong evidence supports the fidelity standardization, efficacy, effectiveness, and cost-effectiveness of ACT models in psychiatry. Yet, significant methodological problems and issues affect implementation. The evidence indicates that the ACT model is one of the most effective systematic models for organizing clinical and functional interventions in psychiatry. Effective systems based on the ACT model meet more ACT fidelity criteria; are often noncoercive; do not rely on compulsory orders; may rely on a wider range of interventions than just medication adherence, including vocational and substance abuse rehabilitation; contain other evidence-based interventions and more mobile in vivo interventions; involve individual and team case management; may involve consumers as direct service providers; and have an interdisciplinary workforce and support structure within the team, providing some protection from work-related stress or burnout.
The Journal of Rehabilitation Research and Development 01/2007; 44(6). DOI:10.1682/JRRD.2006.09.0110 · 1.43 Impact Factor
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.