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Integrated primary and mental health care services: An evolving partnership model.
The authors describe how two organizations have partnered together to provide integrated primary and mental health services through two Integrated Health Care (IHC) clinics. This project brings IHC into community settings by using nurse practitioner house calls, group primary care visits and tele-monitoring. Tele-monitoring enhances both the efficiency and effectiveness of physical health care specifically targeted at improving adherence to medication regimes and lifestyle changes and monitoring clinical parameters of physically unstable members with diabetes, obesity, and/or hypertension. These services target high-risk Thresholds clients who are not regularly accessing primary care. This report concludes that primary care outreach has not only helped to connect with hard to reach clients, but it has also further improved the integration of mental health and primary care.
Davis, K., Brigell, E., Christiansen, K., Snyder, M., McDevitt, J., Forman, J., Lloyd Storfjell, J., & Wilkniss, S. (2011). Integrated primary and mental health care services: An evolving partnership model. Psychiatric Rehabilitation Journal, 34(4), 317-320.
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Transforming assertive community treatment into an integrated care system: The role of nursing and primary care partnerships
This article argues that ACT is an ideal platform to provide both primary and behavioural health care to those with complex service needs. This article considers the transformation of the ACT mental health care model into an integrated health care delivery system by expanding and explicitly redefining the role of the ACT nurse to include establishing partnerships with primary care providers.
Weinstein, L., Henwood, B., Cody, J., Jordan, M. & Lelar, R. (2011). Transforming assertive community treatment into an integrated care system: The role of nursing and primary care partnerships. Journal of the American Psychiatric Nurses Association, 17, 64-71.
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Nurses and assertive community treatment teams: A critical combination.
This commentary discusses the critical role that nurses play on ACT teams and ACT as a platform to integrate physical and mental health. It also reviews issues that may affect nursing shortages on ACT teams.
Cuddeback, G., & Shatell, M. (2010). Nurses and assertive community treatment teams: A critical combination. Issues in Mental Health Nursing, 31, 751-752. doi: 10.3109/01612840.2010.518338
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Active medical conditions among patients on an assertive community treatment team.
The authors review the psychiatric hospitalization admission and discharge summaries of 70 ACT clients to determine the number and type of active medical conditions they had. The results show that ACT clients/patients had a median of three active medical conditions. Osteoarthritis, hypertension, viral Hepatitis C infection, gastroesophageal reflux disease (GERD), and reactive airway disease were the most common active medical illnesses. The majority of patients were cigarette smokers and were diagnosed with alcohol or illicit substance use disorders, which were associated with viral hepatitis C infection and reactive airway disease in this patient population.
Ceilley, J.W., Cruz, M., & Denko, T. (2006). Active medical conditions among patients on an assertive community treatment team. Community Mental Health Journal, 42 (2), 205-211. doi: 10.1007/s10597-005-9019-2
Providing nursing leadership in a community residential mental health setting.
This article outlines the leadership role that nurses can and should play within community residential mental health services. It argues that people who use mental health services are at a greater risk for physical illness and are among the most vulnerable and marginalized individuals within our society. As the largest professional workforce, nurses have a leadership responsibility to fight stigma and discrimination while providing a high level of care to these individuals. Although there are several barriers to this leadership development (i.e. lack recognition, stigma from other nurses), providing clear definitions and expectations of mental health nurses is important to develop services. For nurse led services to grow there must be a shared understanding of their principles and purpose. Also, a strong focus on recovery, formal training and the recognition of leadership are essential components for these services to progress.
Hughes, F., & Bamford, A. (2011). Providing nursing leadership in a community residential mental health setting. Journal of Psychological Nursing, 49(7), 35-42.
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NPACT: Enhancing programs of assertive community treatment for the seriously ill.
This two-group community comparison design study examines the impact on psychiatric and physical outcomes through enhancing a standard Program of Assertive Treatment (PACT) with Advanced Practice Psychiatric Mental Health Nurses (APNs) and stabilized consumer peer providers (NPACT). Evaluations were conducted at baseline and at 6 months to assess six outcome variables: psychiatric symptoms, community adjustment, disability, physical symptoms, health promotion orientation, and consumer satisfaction. Significant improvements over time were demonstrated for both groups on all variables. However, treatment effects for NPACT over PACT were demonstrated for psychiatric symptoms, community functioning, and consumer satisfaction. NPACT subjects endorsed more medical problems at baseline than did PACT subjects. This may be due to subjects being more likely to disclose physical health symptoms to nurses. In conclusion, enhancements for PACT using advanced practice nurses and consumer peer providers have the potential to address both health and mental health problems of the seriously mentally ill.
Kane, C.F., & Blank, M.B. (2004). NPACT: Enhancing programs of assertive community treatment for the seriously ill. Community Mental Health Journal, 40 (6), 549-559.
Assertive community treatment and the physical health needs of persons with severe mental illness: issues around integration of mental health and physical health.
This article involves a qualitative study that included five ACT teams and the level that they integrate mental health and physical health. The results of this qualitative study show three main themes (1) all ACT teams recognized serious and chronic physical health problems among consumers they served, (2) ACT teams took a variety of roles to address the physical health problems of their consumers, and (3) there were a number of challenges to integrating primary and mental health care within an ACT setting. The main conclusion is that ACT is well positioned to integrate physical health and mental health care and ACT staff expressed the need, desire, and willingness to integrate physical health care with mental health care.
Shattell, M., Donnelly, N., Scheyett, A., & Cuddeback, G. (2011). Assertive community treatment and the physical health needs of persons with severe mental illness: Issues around integration of mental health and physical health. Journal of the American Psychiatric Nurses Association, 17 (1), 57-63. doi: 10.1177/1078390310393737
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The inextricable nature of mental and physical health: Implications for integrative care.
This article provides evidence that physical health problems are caused and exasperated by psychological factors and psychological distress leads to physical disease. It argues that new approaches are needed to assure adequate professional knowledge of behavioral health at basic licensure, to increase the use of advanced practice psychiatric–mental health nurses in primary care set¬tings, to identify and teach behavioral competencies for primary care providers, and to fund the design and evaluation of integrative models of care.
Weiss, S., Haber, J., Horowitz, J., Stuart, G., & Wolfe, B. (2009). The inextricable nature of mental and physical health: Implications for integrative care. Journal of the American Psychiatric Nurses Association, 15(6), 371–382. doi: 10.1177/1078390309352513
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Assertive community treatment: Evidence based hope for the seriously mentally ill.
This editorial summarizes the overall evidence of ACT, including a paragraph about primary care (i.e., access to primary care and early evidence-based studies that describe the scope of the problem) . The overall conclusion of the editorial is that there is hope for those suffering from serious mental illness with ACT.
Rice, M.J. (2011). Assertive community treatment: Evidence based hope for the seriously mentally ill. Journal of the American Psychiatric Nurses Association, 17(1), 13-15. doi: 10.1177/1078390310396708
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