[Assertive Community Treatment for patients with a first episode psychosis. Model fidelity and specific adaptations for particular target groups]

Abstract

Background: Assertive Community Treatment (ACT) is an evidence-based treatment model, which has been frequently discussed and investigated and which has been used mainly with patients suffering from 'severe mental illness'. It is a pro-active type of treatment involving a multidisciplinary team who provide outreaching and intensive care (treatment, rehabilitation and support). Increasingly, the act model is being used with other target groups such as patients with a first episode psychosis. Frequently act is not being implemented strictly in accordance with the original model. As a result, various combinations of elements of act are being presented.

Aim: Primarily to find out whether the original components of act can be varied in such a way that it combines the best possible treatment procedures for the target group of patients suffering from a first episode psychosis.

Method: Model fidelity was measured and patients and their carers were asked to state to what extent the care provided met their care requirements. The results were used for adaptations of the original model. However, it was assumed from the outset that any variations on the essential elements of the act model could undermine the fundamental principles of act and affect its efficacy. We therefore adhered to the original model as strictly as possible, looking particularly at the care requirements of patients and carers and examining which elements of the model could be used to improve the care of patients with a first episode psychosis.

Results and conclusion: Results show that it is possible to implement the original act model successfully and that patients and caregivers are satisfied with the model. There is strong evidence that the implementation of elements of the act in specific combinations can increase the efficacy of the act when it is applied to special groups of patients, such as those with a first episode psychosis. However, considerable care and caution are called for when act is being adapted in this way for use with special groups of patients.