Assertive outreach teams in London: models of operation. Pan-London Assertive Outreach Study, part 1.
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.
Wright
Christine
C
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
Burns
Tom
T
James
Peter
P
Billings
Joanne
J
Johnson
Sonia
S
Muijen
Matt
M
Priebe
Stefan
S
Ryrie
Iain
I
Watts
Joanna
J
White
Ian
I
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