title: Assertive outreach teams in London: models of operation. Pan-London Assertive Outreach Study, part 1.
abstract: BACKGROUND
  Assertive outreach teams have been introduced in the UK, based on the assertive community treatment (ACT) model. It is unclear how models of community care translate from one culture to another or the degree of adaptation that may result.
  
  
  OBJECTIVE
  To characterise London assertive outreach teams and determine whether there are distinct groups within them.
  
  
  METHODS
  Semi-structured interviews with team managers plus one month's prospective process of care data collection were used to test for 'model fidelity' to ACT and, by cluster analysis, to identify groupings.
  
  
  RESULTS
  Fidelity varied widely, with four teams (out of 24 studied) rated 'high fidelity' and three teams rated 'low fidelity' by US standards and 17 rated 'ACT-like'. Three clusters were identified, with voluntary sector teams being the most distinct group.
  
  
  CONCLUSIONS
  There is wide variation in the practice of assertive outreach in London. The role of the voluntary sector requires increased attention. Heterogeneity in practice is a clinical challenge but a research opportunity in distinguishing effective from redundant components of the approach.
authors.affiliation: Department of General Psychiatry, St George's Hospital Medical School and South West London and St George's Mental Health Trust, London, UK. cwright@sghms.ac.uk
authors.forename: Christine
authors.initials: C
authors.lastname: Wright
authors.forename: Tom
authors.initials: T
authors.lastname: Burns
authors.forename: Peter
authors.initials: P
authors.lastname: James
authors.forename: Joanne
authors.initials: J
authors.lastname: Billings
authors.forename: Sonia
authors.initials: S
authors.lastname: Johnson
authors.forename: Matt
authors.initials: M
authors.lastname: Muijen
authors.forename: Stefan
authors.initials: S
authors.lastname: Priebe
authors.forename: Iain
authors.initials: I
authors.lastname: Ryrie
authors.forename: Joanna
authors.initials: J
authors.lastname: Watts
authors.forename: Ian
authors.initials: I
authors.lastname: White
mesh_terms: D000328:Adult; D017028:Caregivers; D016000:Cluster Analysis; D003156:Community Mental Health Services / Q000458:organization & administration / Q000592:standards*; D003159:Community-Institutional Relations / Q000592:standards*; D006282:Health Personnel; D006760:Hospitalization; D006801:Humans; D008131:London; D008605:Mental Health Services / Q000145:classification; D008962:Models, Theoretical; D010348:Patient Care Team / Q000458:organization & administration / Q000592:standards*; D011996:Records; D012017:Referral and Consultation; D011795:Surveys and Questionnaires