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      Involving clients and their relatives and friends in psychiatric care: Case managers' experiences of training in resource group assertive community treatment

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          Abstract

          The purpose of this project was to do a qualitative study of an integrated and flexible ACT model, the Resource Group Assertive Community Treatment (RACT), as seen from the perspective of case managers in training. The resource group normally consists of the client, the case manager and other available personnel in the medical and support areas, as well as family members. Nineteen theses were randomly chosen from a set of 80 theses written by a group of Swedish trainee case managers. The exams were conducted as case studies and concerned 19 clients with psychotic problems, 11 men and 8 women. “The Empirical Phenomenological Psychological Method” was used in the analysis, which generated five overarching themes: (a) the RACT program; (b) the resource group; (c) the empowerment of the client; (d) progress in treatment; and (e) the case manager. These together constituted a “therapeutic circle,” in which methods and tools used within the RACT made it possible for the resource group to empower the clients who, as a result, experienced progress with treatment, during which the case manager was the unifying and connecting link.

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          FACT: a Dutch version of ACT.

          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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            Evidence-based practices for services to families of people with psychiatric disabilities.

            Family psychoeducation is an evidence-based practice that has been shown to reduce relapse rates and facilitate recovery of persons who have mental illness. A core set of characteristics of effective family psychoeducation programs has been developed, including the provision of emotional support, education, resources during periods of crisis, and problem-solving skills. Unfortunately, the use of family psychoeducation in routine practice has been limited. Barriers at the level of the consumer and his or her family members, the clinician and the administrator, and the mental health authority reflect the existence of attitudinal, knowledge-based, practical, and systemic obstacles to implementation. Family psychoeducation dissemination efforts that have been successful to date have built consensus at all levels, including among consumers and their family members; have provided ample training, technical assistance, and supervision to clinical staff; and have maintained a long-term perspective.
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              Integrated care in schizophrenia: a 2-year randomized controlled study of two community-based treatment programs.

              To evaluate the efficacy of two community-based programs that combined antipsychotic medication, family interventions and social skills training. A randomized controlled trial with 2 years follow-up. The study included 84 patients with schizophrenic disorders, continuously managed in terms of care and treatment, and regularly assessed. Analysis was by intention-to-treat. Between-program comparisons showed significantly improved social function and consumer satisfaction in favour of the program 'Integrated Care' (IC) at the 2-year follow-up. The main clinically important differences between the two treatment programs studied were the procedures for shared decision making and patient empowerment in IC. The implementation of IC in clinical practice can improve social recovery and increase consumer satisfaction for patients with schizophrenic disorders. We identified specific procedures that might be added to improve the effectiveness of any program for severely mental ill people.
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                Author and article information

                Journal
                Psych J
                Psych J
                pchj
                Psych Journal
                Blackwell Publishing Ltd
                2046-0252
                2046-0260
                June 2012
                10 June 2012
                : 1
                : 1
                : 15-27
                Affiliations
                [1 ]Evidens Research and Development Center Göteborg, Sweden
                [2 ]Department of Psychology, Karlstad University Karlstad, Sweden
                Author notes
                Prof Torsten Norlander, Department of Psychology, Karlstad University, SE-651 88 Karlstad, Sweden. Email: torsten.norlander@ 123456kau.se

                Re-use of this article is permitted in accordance with the Terms and Conditions set out at http://wileyonlinelibrary.com/onlineopen#OnlineOpen_Terms

                10.1002/pchj.1
                3832238
                24294489
                Copyright © 2012 Institute of Psychology, Chinese Academy of Sciences and Blackwell Publishing Asia Pty Ltd

                Re-use of this article is permitted in accordance with the Creative Commons Deed, Attribution 2.5, which does not permit commercial exploitation.

                Categories
                Original Articles

                resource group, ract, optimal treatment, case manager, act

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