Abstract
Assertive community treatment (ACT) is a well-established treatment for adults with mental illness and has an emerging evidence base for improving mental health outcomes for adolescents. Recent studies have utilized ACT with adolescents who are difficult to engage through traditional psychiatric services. The Assertive Mobile Youth Outreach Service (AMYOS) of Children’s Health Queensland in Australia provides ACT for families of adolescents with severe and persistent mental health problems, who have been unable to engage successfully through the standard mental health support services provided by community clinics. AMYOS clinicians work flexibly to engage adolescents in an individualized plan aimed at reducing risk of harm, supporting recovery, improving overall functioning, and engagement with education and vocational pathways. This study reports outcomes for adolescents involved in the first five years of the AMYOS program. Overall, there were significant improvements over time on questionnaires of global functioning, perceived suicidality, hostility and a wide range of mental health problems, as rated by clinicians and families. There were also significant reductions in average monthly duration and number of hospital admissions during AMYOS treatment compared with 12 months prior to referral. Increases in visits to Emergency Department during treatment did not translate into hospitalization, suggesting adolescents were better monitored when at-risk. There was also increased engagement in school and standard healthcare. This provides further evidence that provision of assertive community treatment is associated with improved mental health outcomes for at-risk adolescents. Future research could include comparison groups and investigate possible mechanisms for change.
Highlights
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Assertive community treatment may help adolescents with complex mental illness.
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A prospective pre-post evaluation was conducted with adolescents in Australia.
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Adolescents involved had serious persistent mental health problems.
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There were reductions in mental health problems and perceived suicide risk.
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There was reduced mean time in hospital for mental health problems during treatment.
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References
Avenevoli, S., Swendsen, J., He, J. P., Burstein, M., & Merikangas, K. R. (2015). Major depression in the national comorbidity survey–adolescent supplement: prevalence, correlates, and treatment. Journal of the American Academy of Child & Adolescent Psychiatry, 54(1), 37–44. https://doi.org/10.1016/j.jaac.2014.10.010.
Azzopardi, P., Blow, N., Purcell, T., Brown, N., Ritchie, T., & Brown, A. (2020). Investing in the health of aboriginal and torres strait islander adolescents: a foundation for achieving health equity. Medical Journal of Australia, 212(5), 202–204. https://doi.org/10.5694/mja2.50500.
Bateman, A., & Fonagy, P. (2013). Mentalization-based treatment. Psychoanalytic Inquiry, 33(6), 595–613. https://doi.org/10.1080/07351690.2013.835170.
Bevington, D., Fuggle, P., & Fonagy, P. (2015). Applying attachment theory to effective practice with hard-to-reach youth: the AMBIT approach. Attachment & Human Development, 17(2), 157–174. https://doi.org/10.1080/14616734.2015.1006385.
Bond, G. R., & Drake, R. E. (2015). The critical ingredients of assertive community treatment. World Psychiatry, 14(2), 240–242. https://doi.org/10.1002/wps.20234.
Bond, G. R., Drake, R. E., Mueser, K. T., & Latimer, E. (2001). Assertive community treatment for people with severe mental illness. Disease Management and Health Outcomes, 9(3), 141–159. https://doi.org/10.2165/00115677-200109030-00003.
Brann, P., & Coleman, G. (2010). On the meaning of change in a clinician’s routine measure of outcome: HoNOSCA. Australian and New Zealand Journal of Psychiatry, 44(12), 1097–1104. https://doi.org/10.3109/00048674.2010.513037.
Briggs, S. R., & Cheek, J. M. (1986). The role of factor analysis in the development and evaluation of personality scales. Journal of Personality, 54, 106–148. https://doi.org/10.1111/j.1467-6494.1986.tb00391.x.
Buckingham, B., Burgess, P., Solomon, S., Pirkis, J., Eagar, K. & Soloman, S. (1998). Developing a casemix classification for mental health services. Volume 1, Main report, mental health classification and services costs project. Retrieved 17th October 2019 from https://www.amhocn.org/sites/default/files/publication_files/mh-casc_volume_1.pdf.
Burns, T., Catty, J., Dash, M., Roberts, C., Lockwood, A., & Marshall, M. (2007). Use of intensive case management to reduce time in hospital in people with severe mental illness: systematic review and meta-regression. British Medical Journal, 335(7615), 336. https://doi.org/10.1136/bmj.39251.599259.55.
Chia, A., Assan, B., Finch, E., Stargatt, R., Burchell, P., Jones, H., & Heywood‐Smith, J. (2013). Innovations in practice: effectiveness of specialist adolescent outreach service for at‐risk adolescents. Child and Adolescent Mental Health, 18(2), 116–119. https://doi.org/10.1111/j.1475-3588.2012.00654.x.
Coldwell, C. M., & Bender, W. S. (2007). The effectiveness of assertive community treatment for homeless populations with severe mental illness: a meta-analysis. American Journal of Psychiatry, 164(3), 393–399. https://doi.org/10.1176/appi.ajp.164.3.393.
Díaz-Caneja, C. M., Pina-Camacho, L., Rodríguez-Quiroga, A., Fraguas, D., Parellada, M., & Arango, C. (2015). Predictors of outcome in early-onset psychosis: a systematic review. npj Schizophrenia, 1, 14005. https://doi.org/10.1038/npjschz.2014.5.
Dibal, N. P., Okafor, R., & Dallah, H. (2017). Challenges and implications of missing data on the validity of inferences and options for choosing the right strategy in handling them. International Journal of Statistical Distributions and Applications, 3(4), 87–94. https://doi.org/10.11648/j.ijsd.20170304.15.
Dixon, L. (2000). Assertive community treatment: twenty-five years of gold. Psychiatric Services, 51(6), 759–765. https://doi.org/10.1176/appi.ps.51.6.759.
Field, A. (2013). Discovering statistics using IBM SPSS statistics. 4th ed. Los Angeles: Sage.
Goodman, R. (1997). The strengths and difficulties questionnaire: a research note. Journal of Child Psychology and Psychiatry, 38, 581–586. https://doi.org/10.1111/j.1469-7610.1997.tb01545.x.
Goodman, R., & Scott, S. (1999). Comparing the strengths and difficulties questionnaire and the child behavior checklist: is small beautiful? Journal of Abnormal Child Psychology, 27, 17–24. https://doi.org/10.1023/A:1022658222914.
Gowers, S. G., Harrington, R. C., Whitton, A., Lelliott, P., Beevor, A., Wing, J., & Jezzard, R. (1999). Brief scale for measuring the outcomes of emotional and behavioural disorders in children: health of the nation outcome scales for children and adolescents (HoNOSCA). The British Journal of Psychiatry, 174(5), 413–416. https://doi.org/10.1192/bjp.174.5.413.
Hall, M., Meaden, A., Smith, J., & Jones, C. (2001). Brief report: the development and psychometric properties of an observer-rated measure of engagement with mental health services. Journal of Mental Health, 10(4), 457–465. https://doi.org/10.1080/09638230124439.
Healy, K. L., & Sanders, M. R. (2018). Mechanisms through which supportive relationships with parents and peers mitigate victimization, depression and internalizing problems in children bullied by peers. Child Psychiatry & Human Development, 49(5), 800–813. https://doi.org/10.1007/s10578-018-0793-9.
Inacio, M. C., Chen, Y., Paxton, E. W., Namba, R. S., Kurtz, S. M., & Cafri, G. (2015). Statistics in brief: an introduction to the use of propensity scores. Clinical Orthopaedics and Related Research, 472, 2722–2726. https://doi.org/10.1007/s11999-015-4239-4.
Jacobson, N. S., & Truax, P. (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59(1), 12–19. https://doi.org/10.1037/0022-006X.59.1.12.
Kidd, S. A., Davidson, L., & McKenzie, K. (2017). Common factors in community mental health intervention: a scoping review. Community Mental Health Journal, 53(6), 627–637. https://doi.org/10.1007/s10597-017-0117-8.
Klag, S., Fox, T., Martin, G., Eadie, K., Bergh, W., Keegan, F., & Raeburn, N. (2016). Evolve therapeutic services: a 5-year outcome study of children and young people in out-of-home care with complex and extreme behavioural and mental health problems. Children and Youth Services Review, 69, 268–274. https://doi.org/10.1016/j.childyouth.2016.08.017.
Kwok, K. H. R., Yuan, S. N. V., & Ougrin, D. (2016). Alternatives to inpatient care for children and adolescents with mental health disorders. Child and Adolescent Mental Health, 21(1), 3–10. https://doi.org/10.1111/camh.12123.
Kuhn, C., Aebi, M., Jakobsen, H., Banaschewski, T., Poustka, L., Grimmer, Y., & Steinhausen, H. C. (2017). Effective mental health screening in adolescents: should we collect data from youth, parents or both? Child Psychiatry & Human Development, 48(3), 385–392. https://doi.org/10.1007/s10578-016-0665-0.
Mantzouranis, G., Baier, V., Holzer, L., Urben, S., & Villard, E. (2019). Clinical significance of assertive community treatment among adolescents. Social Psychiatry and Psychiatric Epidemiology, 54(4), 445–453. https://doi.org/10.1007/s00127-018-1613-z.
McGorry, P., Bates, T., & Birchwood, M. (2013). Designing youth mental health services for the 21st century: examples from Australia, Ireland and the UK. The British Journal of Psychiatry, 202(s54), s30–s35. https://doi.org/10.1192/bjp.bp.112.119214.
Mellor, D. (2005). Normative data for the strengths and difficulties questionnaire in Australia. Australian Psychologist, 40, 215–222. https://doi.org/10.1080/00050060500243475.
Muskens, J. B., Herpers, P. C., Hilderink, C., van Deurzen, P. A., Buitelaar, J. K., & Staal, W. G. (2019). Intensive home treatment for adolescents in psychiatric crisis. BMC Psychiatry, 19(1), 1–7. https://doi.org/10.1186/s12888-019-2407-x.
National Centre for Classification in Health. (1998). The international statistical classification of diseases and related health problems, 10th revision, Australian modification (ICD-1O-AM). Sydney: National Centre for Classification in Health, Faculty of Health Sciences, University of Sydney.
Nordén, T., Malm, U., & Norlander, T. (2012). Resource group assertive community treatment (RACT) as a tool of empowerment for clients with severe mental illness: a meta-analysis. Clinical Practice and Epidemiology in Mental Health, 8, 144–151. https://doi.org/10.2174/1745017901208010144.
Ougrin, D., Corrigall, R., Poole, J., Zundel, T., Sarhane, M., Slater, V., & Ivens, J. (2018). Comparison of effectiveness and cost-effectiveness of an intensive community supported discharge service versus treatment as usual for adolescents with psychiatric emergencies: a randomised controlled trial. The Lancet Psychiatry, 5(6), 477–485. https://doi.org/10.1016/S2215-0366(18)30129-9.
Pirkis, J. E., Burgess, P. M., Kirk, P. K., Dodson, S., Coombs, T. J., & Williamson, M. K. (2005). A review of the psychometric properties of the Health of the Nation Outcome Scales (HoNOS) family of measures. Health and Quality of Life Outcomes, 3(1), 76. https://doi.org/10.1186/1477-7525-3-76.
Quinlan, L., Daubney, M. F. X., & Goodwin, S. (2015). Frequency of risk behaviours scale. Unpublished scale. Child and Youth Mental Health Services, Queensland Department of Health.
Reijntjes, A., Kamphuis, J. H., Prinzie, P., & Telch, M. J. (2010). Peer victimization and internalizing problems in children: a meta-analysis of longitudinal studies. Child Abuse & Neglect, 34(4), 244–252. https://doi.org/10.1016/j.chiabu.2009.07.009.
Schaffer, D., Gould, M. S., Brasic, J., Ambrosini, P., Fisher, P., Bird, H., & Aluwahlia, S. (1983). A children’s global assessment scale. Archives of General Psychiatry, 40, 1228–1231. https://doi.org/10.1001/archpsyc.1983.01790100074010.
Schley, C., Ryall, V., Crothers, L., Radovini, S., Fletcher, K., Marriage, K., & Yuen, H. P. (2008). Early intervention with difficult to engage, ‘high‐risk’youth: evaluating an intensive outreach approach in youth mental health. Early Intervention in Psychiatry, 2(3), 195–200. https://doi.org/10.1111/j.1751-7893.2008.00079.x.
Steinhausen, H. C. (1987). Global assessment of child psychopathology. Journal of the American Academy of Child and Adolescent Psychiatry, 26, 203–206. https://doi.org/10.1097/00004583-198703000-00014.
Strassburger, K., & Bretz, F. (2008). Compatible simultaneous lower confidence bounds for the Holm procedure and other Bonferroni‐based closed tests. Statistics in Medicine, 27(24), 4914–4927. https://doi.org/10.1002/sim.3338.
Stratton, P., Bland, J., Janes, E., & Lask, J. (2010). Developing a practicable outcome measure for systemic family therapy: the SCORE. Journal of Family Therapy, 32, 232–258. https://doi.org/10.1111/j.1467-6427.2010.00507.x.
Taddeo, D., Egedy, M., & Frappier, J. Y. (2008). Adherence to treatment in adolescents. Paediatrics & Child Health, 13(1), 19–24. https://doi.org/10.1093/pch/13.1.19.
Ventura, J., Lukoff, D., Nuechterlein, K. H., Liberman, R. P., Green, M., & Shaner, A. (1993). Brief psychiatric rating scale (BPRS) expanded version (4.0) scales, anchor points and administration manual. International Journal of Methods in Psychiatric Research, 1993b(3), 227–244.
Verma, J. P. (2019). Common assumptions in nonparametric tests. In J. P. Verma & G. Abdel-Salam (Eds.), Testing statistical assumptions in research, John Wiley & Sons, Retrieved 30th August 2020 from ProQuest Ebook Central. http://ebookcentral.proquest.com/lib/uql/detail.action?docID=5724035. https://doi.org/10.1002/9781119528388.
Vijverberg, R., Ferdinand, R., Beekman, A., & van Meijel, B. (2017). The effect of youth assertive community treatment: a systematic PRISMA review. BMC Psychiatry, 17(1), 284–302. https://doi.org/10.1186/s12888-017-1446-4.
Watterson, J. & O’Connell, M. (2019). Those who disappear: the Australian education problem that no one wants to talk about. Melbourne Graduate School of Education, The University of Melbourne. Retrieved on 23rd January 2020 from https://education.unimelb.edu.au/mgse-industry-reports/report-1-those-who-disappear.
Willis, E., Reynolds, L., & Keleher, H. (2016). Understanding the Australian health care system. 3rd ed. Chatswood, N.S.W.: Elsevier Australia a division of Reed International Books Australia Pty Ltd.
Wood, C., Baxter, A., Wright, E., Gossip, K., Leitch, E., Whiteford, H., & Scott, J. G. (2019). Review of services to inform clinical frameworks for adolescents and young adults with severe, persistent and complex mental illness. Clinical Child Psychology and Psychiatry, 24(3), 503–528. https://doi.org/10.1177/1359104519827631.
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Daubney, M.F.X., Raeburn, N., Blackman, K. et al. Outcomes of Assertive Community Treatment for Adolescents with Complex Mental Health Problems Who are Difficult to Engage. J Child Fam Stud 30, 502–516 (2021). https://doi.org/10.1007/s10826-020-01882-3
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DOI: https://doi.org/10.1007/s10826-020-01882-3