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      Flexible ACT & Resource-group ACT: Different Working Procedures Which Can Supplement and Strengthen Each Other. A Response#

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          Abstract

          This article is a response to Nordén and Norlander’s ‘Absence of Positive Results for Flexible Assertive Community Treatment. What is the next approach?’[ 1], in which they assert that ‘at present [there is] no evidence for Flexible ACT and… that RACT might be able to provide new impulses and new vitality to the treatment mode of ACT’. We question their analyses and conclusions. We clarify Flexible ACT, referring to the Flexible Assertive Community Treatment Manual (van Veldhuizen, 2013) [ 2] to rectify misconceptions. We discuss Nordén and Norlander’s interpretation of research on Flexible ACT. The fact that too little research has been done and that there are insufficient positive results cannot serve as a reason to propagate RACT. However, the Resource Group method does provide inspiration for working with clients to involve their networks more effectively in Flexible ACT.

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          FACT: a Dutch version of ACT.

          Peter Veldhuizen (2007)
          Assertive Community Treatment (ACT) is a well-defined service delivery model for the care and treatment of the most severely mentally ill in the community. We have opted for a Dutch version named 'Function' ACT or FACT. In a FACT team, ACT is one of the functions that the team can perform. For more stable long-term patients FACT provides coordinated multidisciplinary treatment and care by individual case management. Unstable patients at risk of relapse are followed with assertive outreach care by the same team, working with a shared caseload for this subgroup. This article describes the service model and everyday practice in FACT.
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            Flexible Assertive Community Treatment, Severity of Symptoms and Psychiatric Health Service Use, a Real life Observational Study

            Marjan Drukker, Ellen Visser, Sjoerd Sytema … (2013)
            Background: Introduction of Flexible Assertive Community Treatment (FACT) may be associated with increased remission rates and changes in patterns of care. The present paper reports on differences in psychosocial functioning and health care use between patients in FACT and two groups of patients not currently provided with a specific model of community service. Methods: The ongoing "Pharmacotherapy Monitoring and Outcome Survey" provided routine outcome measures of patients using antipsychotics in the north of the Netherlands. Level of psychosocial functioning was assessed using the Health of the Nations Outcome Scales (HoNOS) and matched with psychiatric health care consumption obtained from the Psychiatric Case Register. Patients who never received FACT, patients ever in FACT but not at assessment date, and patients in FACT were identified. Data were subjected to multilevel linear regression analysis. Results: Data showed that most patients in FACT also had non-FACT episodes after the start of FACT. Furthermore, patients in FACT displayed higher levels of psychosocial functioning and used more outpatient care than the other two groups. Conclusions: Patients in FACT receive more outpatient care and have better psychosocial functioning. However, causal inferences cannot be derived from these data. In addition, membership of a FACT-team in this setting did not last indefinitely.
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              A real-life observational study of the effectiveness of FACT in a Dutch mental health region

              Marjan Drukker, Myrte Maarschalkerweerd, Maarten Bak … (2008)
              Background ACT is an effective community treatment but causes discontinuity of care between acutely ill and currently stable patient groups. The Dutch variant of ACT, FACT, combines both intensive ACT treatment and care for patients requiring less intensive care at one time point yet likely to need ACT in the future. It may be hypothesised that this case mix is not beneficial for patients requiring intensive care, as other patient groups may "dilute" care provision. The effectiveness of FACT was compared with standard care, with a particular focus on possible moderating effects of patient characteristics within the case mix in FACT. Methods In 2002, three FACT teams were implemented in a Dutch region in which a cumulative routine outcome measurement system was in place. Patients receiving FACT were compared with patients receiving standard treatment, matched on "baseline" symptom severity and age, using propensity score matching. Outcome was the probability of being in symptomatic remission of psychotic symptoms. Results The probability of symptomatic remission was higher for SMI patients receiving FACT than for controls receiving standard treatment, but only when there was an unmet need for care with respect to psychotic symptoms (OR = 6.70, p = 0.002; 95% CI = 1.97 – 22.7). Conclusion Compared to standard care, FACT was more rather than less effective, but only when a need for care with respect to psychotic symptoms is present. This suggests that there is no adverse effect of using broader patient mixes in providing continuity of care for all patients with severe mental illness in a defined geographical area.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Clin Pract Epidemiol Ment Health
                Journal ID (iso-abbrev): Clin Pract Epidemiol Ment Health
                Journal ID (publisher-id): CPEMH
                Title: Clinical Practice and Epidemiology in Mental Health : CP & EMH
                Publisher: Bentham Open
                ISSN (Electronic): 1745-0179
                Publication date (Electronic): 27 February 2015
                Publication date Collection: 2015
                Volume: 11
                Pages: 12-15
                Affiliations
                [1 ]CCAF (Certification Centre for ACT and FACT), Utrecht, The Netherlands
                [2 ]Innovations in Mental Health Care, Maastricht University and Mondriaan (Mental Health Service), The Netherlands
                [3 ]Reintegration and Community Care, Trimbos Institute, Utrecht, The Netherlands
                [4 ]Public Mental Health, Epidemiological and Social Psychiatric Research institute, Erasmus MC; Parnassia Psychiatric Institute, The Netherlands
                Author notes
                [* ]Address correspondence to this author at the CCAF, PO Box 543, 3440 AM Woerden, The Netherlands, Tel: +31653233193; E-mail: remmersvv@ 123456hotmail.com
                [#]

                A commentary article in response to ‘Absence of Positive Results for Flexible Assertive Community Treatment. What is the next approach?’ (T. Nordén & T. Norlander in Clinical Practice & Epidemiology in Mental Health, 2014: 10, 87-91.)

                Article
                Publisher ID: CPEMH-11-12
                DOI: 10.2174/1745017901511010012
                PMC ID: 4353123
                SO-VID: 6d32d83d-ee77-4b12-91d8-3f21324ee6f9
                Copyright © © Veldhuizen et al.; Licensee Bentham Open.
                License:

                This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

                History
                Date received : 18 December 2014
                Date revision received : 22 December 2014
                Date accepted : 22 December 2014
                Categories
                Subject: Article

                ScienceOpen disciplines: Neurology
                Keywords: act,community care,fact,flexible act,ract,resource act
                Data availability:
                ScienceOpen disciplines: Neurology
                Keywords: act, community care, fact, flexible act, ract, resource act

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