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Critical ingredients of assertive community treatment: Judgments of the experts
Reports experts’ opinions on the ideal specifications of the ACT model. Describes two subgroups of experts — those who advocated large multidisciplinary teams (100 or more clients) with day and evening shifts and those who advocated smaller, often generalist, teams (approximately 50 clients).
McGrew, J.H. & Bond, G.R. (1995). Critical ingredients of assertive community treatment: Judgments of the experts. The Journal of Mental Health Administration, 22(2), 113-125.
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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Models of community care for severe mental illness: A review of research on case management.
Reviews results of 75 studies of community care for consumers and compares the effectiveness of ACT and intensive case management.
Mueser, K. T., Bond, G. R., & Drake, R. E. (1998). Models of community care for severe mental illness: A review of research on case management. Schizophrenia Bulletin, 24, 37-74.
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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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Program fidelity in Assertive Community Treatment: development and use of a measure.
Describes the development of the Dartmouth Assertive Community Treatment Scale (DACTS) and the results of applying it to 50 diverse programs.
Teague, G. B., Bond, G. R., & Drake, R. E. (1998). Program fidelity in Assertive Community Treatment: development and use of a measure. American Journal of Orthopsychiatry, 68, 216-232.
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Cognitive behavioural therapy for major psychiatric disorder: does it really work? A meta-analytical review of well-controlled trials.
This meta-analytical review of the CBT for major psychiatric disorders states that although cognitive behavioural therapy (CBT) is claimed to be effective in schizophrenia, major depression and bipolar disorder, there have been negative findings in well-conducted studies and meta-analyses have not fully considered the potential influence of blindness or the use of control interventions. In the current meta-analysis it found that CBT is no better than non-specific control interventions in the treatment of schizophrenia and does not reduce relapse rates.
Lynch, D., Laws, K. R., & McKenna, P. J. (2010). Cognitive behavioural therapy for major psychiatric disorder: does it really work? A meta-analytical review of well-controlled trials. Psychological medicine, 40(01), 9-24. doi:10.1017/S003329170900590X
Assertive Community Treatment Literature Review.
Provides a detailed overview of ACT and the outcomes associated with the evidence-based practice. The implementation issues are also discussed in great detail, with particular attention to issues related to staffing, financing, and geographical differences in implementing ACT.
Linkins, K., Tunkelrott, T., Dybdal, K., & Robinson, G. (2000, April 28). Assertive Community Treatment Literature Review. Falls Church, VA: Lewin Group, Inc.
From the hospital to the community: a shift in the primary locus of care.
A community-based mental health team assertively providing a variety of support services to both the patient and the community can effectively treat the patient, substantially reduce use of the hospital, and virtually eliminate the revolving-door syndrome
Stein, Leonard, I., and Test, Mary Ann. (1979) From the hospital to the community: a shift in the primary locus of care. New Directions for Mental Health Services, 1, 15-32.
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Cost-effectiveness of Assertive Community Treatment versus standard case management for persons with co-occurring severe mental illness and substance use disorders.
Examines the cost-effectiveness of ACT in comparison to standard case management.
Clark, R. E., Teague, G. B., Ricketts, S. K., Bush, P. W., Xie, H., McGuire, T. G. et al. (1998). Cost-effectiveness of Assertive Community Treatment versus standard case management for persons with co-occurring severe mental illness and substance use disorders. Health Services Research, 33, 1285-1308.
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Assertive Community Treatment: An update of randomized trials.
Reviews outcomes of randomized controlled trials of ACT including studies of special populations (i.e., homeless, dual diagnoses).
Burns, B. J. & Santos, A. B. (1995). Assertive Community Treatment: An update of randomized trials. Psychiatric Services, 46, 669-675.
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Economic impacts of Assertive Community Treatment: A review of the literature.
Focuses on economic impact of ACT on hospital use, emergency-room use, use of outpatient services, housing costs.
Latimer, E. (1999). Economic impacts of Assertive Community Treatment: A review of the literature. Canadian Journal of Psychiatry, 44, 443-454.
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Moving Assertive Community Treatment into standard practice
Describes ACT, summarizes its effectiveness for different client populations, and discusses cost effectiveness. This article also discusses the critical components of ACT and how it has been adapted locally. Additionally, the authors outline issues that mental health system administrators, ACT staff, and consumers are likely to face when implementing ACT.
Phillips, S., Burns, B., Edgar, E., Mueser, K. T., Linkins, K. W., Rosenheck, R. A. et al. (2001). Moving Assertive Community Treatment into standard practice, Psychiatric Services, 52 (6), 771-779.
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Assertive Community Treatment for people with severe mental illness: Critical ingredients and impact on patients.
Summarizes the results of 25 studies of the effectiveness of ACT. Includes information on cost-effectiveness and fidelity.
Bond, G. R., Drake, R. E., Mueser, K. T., & Latimer, E. (2001). Assertive Community Treatment for people with severe mental illness: Critical ingredients and impact on patients. Disease Management & Health Outcomes, 9, 141-159.
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Assertive community treatment of severe mental illness: a Canadian experience.
The study assessed one-year outcomes for 110 clients with serious mental illness who were randomly assigned to an assertive community rehabilitation program that provides psychiatric rehabilitation services in community settings or to hospital-based rehabilitation programs. Key elements of the community program include a multidisciplinary team on call 24 hours a day, in vivo treatment, and instruction and assistance in basic living skills. Data from client interviews after one year of service were used to assess clients' quality of life, satisfaction with services, and psychopathology. Clients in the assertive community rehabilitation program were more likely to be maintained in community settings and reported better quality of life than clients in the hospital-based programs.
Lafave, H.G., de Souza, H.R, and Gerber, G.J. (1996). Assertive community treatment of severe mental illness: a Canadian experience. Psychiatric Services 47(7), 757-9.
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