title: Implementation of assertive community treatment in Australia: model fidelity, patient characteristics and staff experiences.
abstract: The impact of variable implementation of the Assertive Community Treatment (ACT) model on patient outcomes is increasingly recognised. We conducted the first study of four established Australian ACT teams, examining team composition, processes and model fidelity, using previously validated questionnaires. Demographic and clinical details of patients and their own experiences of ACT were gathered from staff. Associations between burnout and work experiences were examined. All teams were ACT-like (mean DACTS score = 3.7, SD = 0.3) with few significant patient differences between teams, except diagnosis (schizophrenia 61-93%, co-morbid substance abuse 16-33%) and proportion living alone (23-72%). Clinicians were fairly satisfied, but inter-team differences in staffing profile and experience emerged and one team scored highly on emotional exhaustion. Increased burnout was associated with greater stress due to taking a team approach. Inter-team differences suggested that attention to effective team working and leadership, as well as model fidelity, may be warranted.
authors.affiliation: Department of Psychiatry, The University of Melbourne & North Western Mental Health, Psychosocial Research Centre, 130 Bell Street, Coburg, VIC, 3058, Australia. c.harvey@unimelb.edu.au
authors.forename: Carol
authors.initials: C
authors.lastname: Harvey
authors.forename: Helen
authors.initials: H
authors.lastname: Killaspy
authors.forename: Salvatore
authors.initials: S
authors.lastname: Martino
authors.forename: Sonia
authors.initials: S
authors.lastname: Johnson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001291:Attitude of Health Personnel; D001315:Australia; D002055:Burnout, Professional; D003156:Community Mental Health Services / Q000458:organization & administration*; D003430:Cross-Sectional Studies; D005260:Female; D006284:Health Plan Implementation; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D001523:Mental Disorders / Q000523:psychology / Q000628:therapy*; D008875:Middle Aged; D010348:Patient Care Team; D010361:Patients; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult
references.citation: Br J Psychiatry. 1986 Aug;149:137-44
references.pmid: 3779274
references.citation: Hosp Community Psychiatry. 1990 Aug;41(8):927-8
references.pmid: 2401486
references.citation: Arch Gen Psychiatry. 1980 Apr;37(4):392-7
references.pmid: 7362425
references.citation: J Psychosom Res. 1997 Jul;43(1):51-9
references.pmid: 9263931
references.citation: Aust N Z J Psychiatry. 1994 Sep;28(3):438-45
references.pmid: 7893238
references.citation: J Behav Health Serv Res. 2003 Jul-Sep;30(3):304-20
references.pmid: 12875098
references.citation: Br J Psychiatry. 1998 Nov;173:423-7
references.pmid: 9926060
references.citation: Epidemiol Psychiatr Sci. 2011 Jun;20(2):151-61
references.pmid: 21714362
references.citation: Psychiatr Serv. 2001 Dec;52(12):1598-606
references.pmid: 11726749
references.citation: Eval Rev. 2000 Jun;24(3):319-38
references.pmid: 10947520
references.citation: J Rehabil Res Dev. 2007;44(6):813-25
references.pmid: 18075939
references.citation: Br J Psychiatry. 2003 Aug;183:148-54
references.pmid: 12893668
references.citation: Br J Psychiatry. 2003 Aug;183:139-47
references.pmid: 12893667
references.citation: BMJ. 2006 Apr 8;332(7545):815-20
references.pmid: 16543298
references.citation: Br J Psychiatry. 1999 Dec;175:501-3
references.pmid: 10789344
references.citation: Psychiatr Serv. 2007 Oct;58(10):1279-84
references.pmid: 17914003
references.citation: Acta Psychiatr Scand. 2007 Aug;116(2):105-12
references.pmid: 17650271
references.citation: J Consult Clin Psychol. 1994 Aug;62(4):670-8
references.pmid: 7962870
references.citation: Lancet. 1999 Jun 26;353(9171):2185-9
references.pmid: 10392982
references.citation: Am J Orthopsychiatry. 1998 Apr;68(2):216-32
references.pmid: 9589760
references.citation: Soc Psychiatry Psychiatr Epidemiol. 2009 Jul;44(7):532-40
references.pmid: 19039510
references.citation: Acta Psychiatr Scand. 1999 May;99(5):360-7
references.pmid: 10353452
references.citation: Psychiatr Serv. 1997 Mar;48(3):335-46
references.pmid: 9057235
references.citation: Can J Occup Ther. 2005 Dec;72(5):265-79
references.pmid: 16435587
references.citation: Br J Psychiatry. 2003 Mar;182:248-54
references.pmid: 12611789
references.citation: BMJ. 2007 Aug 18;335(7615):336
references.pmid: 17631513
references.citation: Br J Psychiatry. 2003 Aug;183:132-8
references.pmid: 12893666
references.citation: Adm Policy Ment Health. 2006 Sep;33(5):529-35
references.pmid: 16767508
references.citation: Psychol Med. 2002 Apr;32(3):383-401
references.pmid: 11989985