Evidence-Based Practices: Shaping Mental Health Services Toward Recovery

Special Populations Appendix

A review of the literature addressing the range of populations for which assertive community treatment has demonstrated efficacy or effectiveness, including geographic location, institutional setting, age, race, ethnicity, gender, and sexual orientation.

Assertive community treatment began in Mendota, Wisconsin nearly 30 years ago. A vital part of the history of assertive community treatment is a tradition of rigorous research and evaluation. The accumulated body of research on assertive community treatment shows this treatment approach to be effective in various settings and with consumers with diverse demographic characteristics.

Since its inception, assertive community treatment programs have been implemented in 35 states and in Canada, England, Sweden, and Australia [1-4]. Programs operate in rural communities as well as in urban areas [5-8]. Assertive community treatment has also been implemented successfully in community mental health systems and in the VA system [9].

There has been increasing interest in using assertive community treatment as a jail diversion program or with individuals who are involved in other ways with the criminal justice system. When working with the criminal justice system, conflicts may arise between ethical responsibilities to consumers and obligations to report consumers’ behaviors to criminal justice entities. It is particularly important that programs working with criminal justice populations establish clear boundaries between their clinical role and their commitment to criminal justice agencies [10].

Studies of assertive community treatment have demonstrated positive outcomes in consumer populations where the most common diagnoses are schizophrenia, schizoaffective disorder, and bipolar disorder. Substantial functional impairment is another common characteristic of consumers in studies of assertive community treatment [1-4]. Benefits have also been documented for consumers with co-occurring substance abuse disorders [11-12]. This approach to treatment, however, may not be as effective as conventional treatments for individuals with personality [13].

The effectiveness of assertive community has been documented in programs with consumers from diverse ethnic backgrounds, males and females, and a wide range of age groups [14]. Although the relative effectiveness of assertive community treatment for individuals in different demographic groups has not been specifically established, no adverse effects have been noted.

Some consumer factors have not been systematically examined in the literature. For example, no current studies have examined sexual orientation and how that might affect outcomes in assertive community treatment programs.

References

Calsyn RJ, Morse GA, Klinkenberg DA et al.: The impact of assertive community treatment on the social relationships of people who are homeless and mentally ill. Community Mental Health Journal 34: 579-593, 1998

Chandler D, Meisel J, McGowen M, et al.: Client outcomes in two model capitated integrated service agencies. Psychiatric Services 47: 175-180, 1996

Dixon L, Stewart B, Krauss N, et al.: The participation of families of homeless persons with severe mental illness in an outreach intervention. Community Mental Health Journal 34: 251-259, 1998

Hadley TR, Roland T, Vasko S et al.: Community treatment teams: an alternative to state hospital. Psychiatric Quarterly 68: 77-90, 1997

Mueser KT, Bond GR, Drake RE, et al.: Models of community care for severe mental illness: a review of research on case management. Schizophrenia Bulletin 24: 37-74, 1998

Rapp, C.: The active ingredients of effective case management: a research synthesis. Community Mental Health Journal 34: 363-380, 1998

McDonel EC, Bond GR, Salyers M, et al.: Implementing assertive community treatment programs in rural settings. Administration and Policy in Mental Health 25: 153-173, 1997

Santos AB, Deci PA, Dias JK, et al.: Providing assertive community treatment for severely mentally ill patients in a rural area. Hospital and Community Psychiatry 44: 34-39, 1993

Rosenheck RA, Neale M, Baldino R, et al.: Intensive Psychiatric Community Care; A New Approach to Care for Veterans with Serious Mental Illness in the Department of Veterans Affairs, 1997, Northeast Program Evaluation Center: West Haven, CT.

Solomon P, Draine J: One-year outcomes of a randomized trial of case management with seriously mentally ill clients leaving jail. Evaluation Review 19: 256-274, 1995

Drake R, McHugo GJ, Clark, RE et al.: Assertive community treatment for patients with co-occurring severe mental illness and substance use disorder: a clinical trial. American Journal of Orthopsychiatry 68: 201-213, 1998

Teague GR, Drake RE, Ackerson T: Evaluating use of continuous treatment teams for persons with mental illness and substance abuse. Psychiatric Services 46: 689-695, 1995

Weisbrod BA, Test MA, and Stein LI: Alternative to mental hospitalization treatment II: economic benefit-cost analysis. Archives of General Psychiatry 37: 400-405, 1980

Bond GR, McDonel EC, Miller LD et al.: Assertive community treatment and reference groups: an evaluation of their effectiveness for young adults with serious mental illness and substance abuse problems. Psychosocial Rehabilitation Journal 15: 31 43, 1991

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