title: Clinical Factors Associated with Successful Discharge from Assertive Community Treatment.
abstract: We sought to explore clinical factors associated with successful transition from Assertive Community Treatment to less intensive clinical services. Mixed-method observational follow up study of veterans discharged from three VA-affiliated ACT teams to less intensive clinical services. Of the 240 veterans in ACT, 9% (n = 21) were discharged during the study period. Among the 11 of 21 discharged veterans who enrolled in the follow up study, reason for discharge, designated by the veteran's primary clinician at the time of discharge, predicted outcomes (p = 0.02) at 9 months, with "disengagement" as a reason for discharge predicting poorer outcomes. Six of 11 veterans experienced poor outcomes at 9 months, including incarceration and substance use relapse. ACT clinicians rarely discharge clients. Many clients may experience negative clinical events following ACT discharge, and clients may be difficult to follow post-discharge. Client disengagement from ACT may indicate higher likelihood of poor outcomes following discharge to less intensive clinical services.
authors.affiliation: Desert Pacific VA Mental Illness Research, Education and Clinical Center (MIRECC), West Los Angeles VA Healthcare Center, Los Angeles, USA. ebromley@mednet.ucla.edu.|Semel Institute for Neuroscience and Human Behavior, UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, USA. ebromley@mednet.ucla.edu.|Center for Health Services and Society, 10920 Wilshire Blvd, Suite 300, Los Angeles, CA, 90024, USA. ebromley@mednet.ucla.edu.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Bromley
authors.affiliation: School of Communication and Information, Rutgers University, New Brunswick, NJ, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Mikesell
authors.affiliation: Semel Institute for Neuroscience and Human Behavior, UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, USA.
authors.forename: Fiona
authors.initials: F
authors.lastname: Whelan
authors.affiliation: Semel Institute for Neuroscience and Human Behavior, UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, USA.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Hellemann
authors.affiliation: VA Connecticut Healthcare System, West Haven, CT, USA.|Yale University School of Medicine, New Haven, USA.
authors.forename: Marcia
authors.initials: M
authors.lastname: Hunt
authors.affiliation: Cecil G. Sheps Center for Health Services Research, School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Gary
authors.initials: G
authors.lastname: Cuddeback
authors.affiliation: Durham VA Medical Center, Durham, NC, USA.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Bradford
authors.affiliation: Desert Pacific VA Mental Illness Research, Education and Clinical Center (MIRECC), West Los Angeles VA Healthcare Center, Los Angeles, USA.|Semel Institute for Neuroscience and Human Behavior, UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, USA.
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Young
mesh_terms: D000328:Adult; D003156:Community Mental Health Services / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000534:rehabilitation / Q000628:therapy*; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010351:Patient Discharge; D012917:Social Adjustment; D013997:Time Factors; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology*; D058014:Veterans Health
keywords: Assertive community treatment; Discharge planning; Serious mental illness; Veterans health