How do People Who Receive Assertive Community Treatment Experience this Service?

Occupational Therapy Program, School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada.
Psychiatric Rehabilitation Journal (Impact Factor: 1.16). 02/2005; 29(1):18-24. DOI: 10.2975/29.2005.18.24
Source: PubMed


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.

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    • "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). "
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    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.
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