OBJECTIVE: The implementation of assertive community treatment (ACT) varies widely. To date, the association between model fidelity and effect has not been investigated in Europe. We investigated the association between model fidelity and outcome in the Dutch mental health system. METHOD: In a prospective longitudinal study, ACT model fidelity and patient outcomes were assessed in 20 outpatient treatment teams. Patients with severe mental illness (n = 530) participated in the study. Outcomes were assessed 3 times using the Health of the Nation Outcome Scales (HoNOS), the Camberwell Assessment of Need Short Assessment Schedule (CANSAS), and the number of hospital days and homeless days during a 2-year follow-up period. Data were analyzed using multilevel statistics. RESULTS: High ACT model fidelity was associated with better outcomes on the HoNOS and less homeless days. Among all of the ACT ingredients, team structure was associated with better outcomes. No associations were found between ACT model fidelity, number of hospital days, and CANSAS scores. CONCLUSIONS: Our evidence supports the importance of model fidelity for improving patient outcomes.
OBJECTIVE: The implementation of assertive community treatment (ACT) varies widely. To date, the association between model fidelity and effect has not been investigated in Europe. We investigated the association between model fidelity and outcome in the Dutch mental health system. METHOD: In a prospective longitudinal study, ACT model fidelity and patient outcomes were assessed in 20 outpatient treatment teams. Patients with severe mental illness (n = 530) participated in the study. Outcomes were assessed 3 times using the Health of the Nation Outcome Scales (HoNOS), the Camberwell Assessment of Need Short Assessment Schedule (CANSAS), and the number of hospital days and homeless days during a 2-year follow-up period. Data were analyzed using multilevel statistics. RESULTS: High ACT model fidelity was associated with better outcomes on the HoNOS and less homeless days. Among all of the ACT ingredients, team structure was associated with better outcomes. No associations were found between ACT model fidelity, number of hospital days, and CANSAS scores. CONCLUSIONS: Our evidence supports the importance of model fidelity for improving patient outcomes.
Authors: W Wolfgang Fleischhacker; Celso Arango; Paul Arteel; Thomas R E Barnes; William Carpenter; Ken Duckworth; Silvana Galderisi; Lisa Halpern; Martin Knapp; Stephen R Marder; Mary Moller; Norman Sartorius; Peter Woodruff Journal: Schizophr Bull Date: 2014-04 Impact factor: 9.306
Authors: Jolanda Stobbe; André I Wierdsma; Rob M Kok; Hans Kroon; Bert-Jan Roosenschoon; Marja Depla; Cornelis L Mulder Journal: BMC Psychiatry Date: 2014-02-15 Impact factor: 3.630
Authors: Diana P K Roeg; Ien A M van de Goor; Margot C M Voogt; Marcel A L M van Assen; Henk F L Garretsen Journal: Int J Soc Psychiatry Date: 2013-11-11