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Articles   |    
Use of Intervention Strategies by Assertive Community Treatment Teams to Promote Patients’ Engagement
Jennifer I. Manuel, Ph.D.; Paul S. Appelbaum, M.D.; Stephanie M. Le Melle, M.D.; Anthony D. Mancini, Ph.D.; Steve Huz, Ph.D.; Candice B. Stellato, M.S.Ed.; Molly T. Finnerty, M.D.
Psychiatric Services 2013; doi: 10.1176/appi.ps.201200151
View Author and Article Information

Dr. Manuel is affiliated with the School of Social Work, Virginia Commonwealth University, Richmond. Dr. Appelbaum, Dr. Le Melle, and Dr. Finnerty are with the Department of Psychiatry, Columbia College of Physicians and Surgeons, New York City. Dr. Finnerty is also with the Bureau of Psychiatric Services and Clinical Knowledge Enhancement Systems, New York State Office of Mental Health (NYSOMH), New York City. Dr. Mancini is with the Department of Psychology, Pace University, Pleasantville, New York. Dr. Huz is with the Division of Performance Measurement and Evaluation, NYSOMH, Albany. Ms. Stellato is with the Division of Mental Health Services and Policy Research, New York State Psychiatric Institute (NYSPI), New York City. Send correspondence to Dr. Finnerty at NYSPI, 1051 Riverside Dr., Unit 104, New York, NY 10032 (e-mail: molly.finnerty@omh.ny.gov).

Copyright © 2013 by the American Psychiatric Association

Abstract

Objective  This study explored the range of interventions and the use of more intrusive techniques by staff of assertive community treatment (ACT) teams to promote engagement, manage problem behaviors, and reinforce positive behaviors among patients. Individual and organizational characteristics that may be associated with these practices were identified.

Methods  Between January and March 2006, clinicians (N=239) from 34 ACT teams participated in a one-time survey about their intervention strategies with patients, perceptions about the ACT team environment, and beliefs about persons with severe mental illness.

Results  Significant variation existed in the types of interventions employed across teams. The less intrusive strategies, including positive inducements and verbal guidance, were the most common. Other strategies that placed limits on patients but that were still considered less intrusive—such as medication monitoring and money management—were also common. Clinicians who reported working in more demoralized climates and having negative perceptions of mental illness were more likely to endorse leveraged or intrusive interventions.

Conclusions  The findings of this study suggest significant variation across teams in the use of intervention strategies. Both perceptions of a demoralized organizational climate and stigmatizing beliefs about mental illness were correlated with the use of more intrusive intervention strategies. Future research on the role and appropriateness of more intrusive interventions in mental health treatment and the impact of such interventions on patient outcomes is warranted.

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Table 1Characteristics of 239 ACT staffa
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a ACT, assertive community treatment

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Table 2Use of therapeutic interventions by ACT staff membersa
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a ACT, assertive community treatment. Use of interventions was rated on a 4-point scale, from 1, never, to 4, often.

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Table 3Estimated effects of characteristics of ACT staff on use of intervention strategiesa
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a ACT, assertive community treatment

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b The reference group was staff with bachelor’s and associate’s degrees and some college and high school.

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c The reference group was Caucasian, non-Hispanic staff.

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d The reference group was general staff.

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e Included family, employment, substance abuse, and peer specialists

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* p<.05, **p<.01, ***p<.001

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