title: A dismantling study of assertive outreach services: comparing activity and outcomes following replacement with the FACT model.
abstract: OBJECTIVE
  Financial constraints and some disappointing research evaluations have seen English assertive outreach (AO) teams subject to remodelling, decommissioning and integration into standard care. We tested a specific alternative model of integrating the AO function from two AO teams into six standard community mental health teams (CMHT). The Flexible Assertive Community Treatment model (FACT) was adopted from the Netherlands (Van Veldhuizen, Commun Mental Health J 43(4):421-433, 2007; Bond and Drake, Commun Mental Health J 43(4):435-438, 2007). We aimed to demonstrate non-inferiority in clinical effectiveness and thereby show cost efficiencies associated with FACT.
  
  
  METHODS
  Outcomes were compared in a mirror-image study of the 12 months periods pre- and post-service change with eligible individuals from the AO teams' caseloads (n = 112) acting as their own controls. We also conducted a cost-consequence analysis of the changes. Outcome data regarding admissions, use of crisis and home treatment, frequency of contact and DNA rate were extracted from the electronic patient record.
  
  
  RESULTS
  The results show AO patients (n = 112) transferred to standard CMHTs with FACT had significantly fewer admissions and a halving of bed use (21 fewer admission and 2,394 fewer occupied bed days) whilst being in receipt of a less intensive service (2,979 fewer contacts). This was offset by significantly poorer engagement but not by increased use of crisis and home treatment services.
  
  
  CONCLUSIONS
  Enhancing multi-disciplinary CMHTs with FACT provides a clinically effective alternative to AO teams. FACT offers a cost-effective model compared to AO.
authors.affiliation: South West London and St George's Mental Health NHS Trust Service Development, Room 5, Building 14 Springfield University Hospital, 61 Glenburnie Road, London, SW17 7DJ, UK. mike.firn@swlstg-tr.nhs.uk
authors.forename: Mike
authors.initials: M
authors.lastname: Firn
authors.forename: Keelyjo
authors.initials: K
authors.lastname: Hindhaugh
authors.forename: Dieneke
authors.initials: D
authors.lastname: Hubbeling
authors.forename: Gwyn
authors.initials: G
authors.lastname: Davies
authors.forename: Ben
authors.initials: B
authors.lastname: Jones
authors.forename: Sarah Jane
authors.initials: SJ
authors.lastname: White
mesh_terms: D000328:Adult; D000368:Aged; D001509:Bed Occupancy / Q000706:statistics & numerical data*; D003156:Community Mental Health Services / Q000191:economics / Q000458:organization & administration*; D003159:Community-Institutional Relations; D003362:Cost-Benefit Analysis; D004651:Employment / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008875:Middle Aged; D009426:Netherlands; D010343:Patient Admission / Q000706:statistics & numerical data; D010348:Patient Care Team / Q000191:economics / Q000458:organization & administration; D017064:Process Assessment, Health Care / Q000379:methods; D012720:Severity of Illness Index; D012923:Social Class; D058992:Social Participation; D013808:Therapeutic Community; D016896:Treatment Outcome; D055815:Young Adult