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
Client perspectives on helpful ingredients of assertive community treatment.
This is the first published article on the helpful ingredients of ACT from the client perspective. This study had ACT clients from six assertive community treatment (ACT) programs describe features they liked best about ACT. Clients mentioned non-specific ingredients most frequently (e.g., relationships with case managers); somewhat less frequently they mentioned ingredients considered by experts as integral to the ACT model (e.g, staff availability, home visits). Although ACT services differ in many ways from traditional counseling or psychotherapy, client-identified best aspects of ACT focused more strongly on features of the helping relationship that have been found to be important for counseling in general.
Keywords: psychotherapy client satisfaction community mental health services mental disorders module 1 module 2 module 3 module 4
McGrew, J.H., Wilson, R.G., & Bond, G.R. (1996). Client perspectives on helpful ingredients of assertive community treatment. Psychiatric Rehabilitation Journal, 19(3), 13-21.
Psychosocial treatments for schizophrenia
This book chapter provides an overview of schizophrenia and the status of psychosocial treatments for schizophrenia (i.e., therapeutic relationship and supportive therapy; behavior therapy and social learning programs; cognitive behavioral therapy; structured, educational family interventions; vocational rehabilitation; case management and treatment teams). The author includes additional considerations for those with a dual diagnosis (substance use and mental disorders) as well as future directions of other treatments such as cognitive rehabilitation. The authors summarize that multiple psychosocial treatment modalities must be delivered to patients if their multidimensional needs are to be met. They conclude that these treatments are most efficacious when delivered in a continuous, comprehensive, and well-coordinated manner within a service such as assertive community treatment.
Keywords: behavior modification behavior therapy and social learning programs behavioral treatments family interventions psychological treatment psychosocial treatments psychotherapy psychsocial treatments including supportive therapy schizophrenia skills training supported employment token economy vocational rehab cognitive-behavioural therapy (cbt) module 1 module 4
Kopelowicz, A., Liberman, R.P., & Zarate, R. (2007). Psychosocial treatments for schizophrenia. In Nathan, P. E., & Gorman, J. M. A guide to treatments that work (pp.243-269). Oxford University Press, USA.
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.
Keywords: primary care primary health care chronic mental illness community mental health services service delivery systems nurses module 1 module 4
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.
The 2009 schizophrenia PORT psychosocial treatment recommendations and summary statements.
The Schizophrenia Patient Outcomes Research Team (PORT) psychosocial treatment recommendations provide a comprehensive summary of current evidence-based psychosocial treatment interventions for persons with schizophrenia. This article reports the third set of PORT recommendations that includes updated reviews in 7 areas as well as adding 5 new areas of review. Members of the psychosocial Evidence Review Group conducted reviews of the literature in each intervention area and drafted the recommendation or summary statement with supporting discussion. A Psychosocial Advisory Committee was consulted in all aspects of the review, and an expert panel commented on draft recommendations and summary statements. The review process produced 8 treatment recommendations in the following areas: assertive community treatment, supported employment, cognitive behavioral therapy, family-based services, token economy, skills training, psychosocial interventions for alcohol and substance use disorders, and psychosocial interventions for weight management. Reviews of treatments focused on medication adherence, cognitive remediation, psychosocial treatments for recent onset schizophrenia, and peer support and peer delivered services indicated that none of these treatment areas yet have enough evidence to merit a treatment recommendation, though each is an emerging area of interest. This update of PORT psychosocial treatment recommendations underscores both the expansion of knowledge regarding psychosocial treatments for persons with schizophrenia at the same time as the limitations in their implementation in clinical practice settings.
Keywords: psychotherapy family-based services schizophrenia psychosocial treatment cognitive-behavioural therapy (cbt) module 1 module 4
Dixon, L. B., Dickerson, F., Bellack, A. S., Bennett, M., Dickinson, D., Goldberg, R. W.,...& Kreyenbuhl, J. (2010). The 2009 schizophrenia PORT psychosocial treatment recommendations and summary statements.Schizophrenia Bulletin, 36(1), 48-70. doi:10.1093/schbul/sbp115
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.
Keywords: effectiveness of act module 1 intensive case management community mental health services schizophrenia/rehabilitation schizophrenic psychology 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.
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.
Keywords: primary care community mental health nurses nursing leadership residential mental health module 1 module 4
Hughes, F., & Bamford, A. (2011). Providing nursing leadership in a community residential mental health setting. Journal of Psychological Nursing, 49(7), 35-42.
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
Treating comorbid substance use disorders in schizophrenia
This literature review examines the pharmacological and psychosocial treatment approaches for people with schizophrenia and comorbid substance use disorder(s) (SUD). The results show that despite the high prevalence of comorbid SUD among people with schizophrenia, there is a considerable shortage of rigorously conducted randomized controlled treatment trials. Although there is some evidence for clozapine, and for the adjunctive use of agents such as naltrexone for comorbid alcohol dependence, the available literature largely comprises case studies, case series, open label studies and retrospective surveys. In terms of psychosocial approaches, there is reasonable consensus that integrated approaches are most appropriate. Regarding specific aspects of care, motivational interviewing, cognitive behavioral therapy, contingency management, and family interventions have an emerging supportive literature. The authors state there is no ‘one size fits all’, and a flexible approach with the ability to apply specific components of care to particular individuals, is required. Group-based therapies and longer-term residential services have an important role for some patients, but further research is required to delineate more clearly which patients will benefit from these strategies. The authors conclude that although there is growing evidence that integrated and well articulated interventions that encompass pharmacological and psychosocial parameters can be beneficial for people with schizophrenia and comorbid SUD, there remains a considerable gap in the literature available to inform evidence-based practice
Keywords: psychotherapy treating co-morbid substance use in schizophrenia pharmacotherapy psychological treatment schizophrenia alcohol cannabis cocaine heroin module 1 module 4
Lubman, D. I., King, J. A., & Castle, D. J. (2010). Treating comorbid substance use disorders in schizophrenia. International Review of psychiatry, 22(2), 191-201.
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).
Keywords: critical ingredients community services deinstitutionalization mental health personnel mental health program evaluation module 1
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: 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.
Keywords: primary care community treatment evidence based practice mentally illness health care services psychiatric nurses module 1
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
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.
Keywords: critical ingredients community mental health services deinstitutionalization psychotic disorders/rehabilitation module 1
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.
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.
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.