Abstract
Objective: This investigation examined several adverse outcomes in clients with serious mental illness in a randomized trial of Assertive Community Treatment (ACT) versus usual care. Method: 163 subjects were randomized to one of two ACT experimental conditions (staffed by consumers or non-consumers) or usual community care. Conditions were compared on psychiatric hospitalization, emergency room visit, arrest, and homelessness, within the two-year study period. Demographic, program, and client variables were examined for significant associations with outcomes. Results: Significant differences were found between ACT and usual care in time to first arrest, but not hospitalization, homelessness or ER visits. Shorter time to first hospitalization was associated with male gender, diagnoses other than schizophrenia, high psychiatric symptomatology and lower provider case load. ER visits were associated with increased client symptomatology. Shorter times to homelessness were predicted by poorer therapeutic alliance between case manager and clients. Shorter time to first arrest was predicted by client minority status and enrollment in usual care. Conclusions: The paucity of significant main effects may have been due to a prolonged “start-up” phase of the ACT programs, poor ACT implementation, restricted availability of psychiatric hospital beds, or changes in usual care services delivered over the study period.
Similar content being viewed by others
REFERENCES
Bech, P., Larsen, J. K., & Anderson, J. (1988). The BPRS: psychometric developments. Psychopharmacology Bulletin, 24, 118-121.
Bond, G. R., McGrew, J. H., & Fekete, D. M. (1995). Assertive outreach for frequent users of psychiatric hospitals: A metaanalysis. The Journal of Mental Health Administration, 22, 4-16.
Burns, B. (1998). Links between research findings and the future of assertive community treatment: a commentary. American Journal of Orthopsychiatry, 68, 261-264.
Burns, B. J., & Santos, A. B. (1995). Assertive community treatment: An update of randomized trials. Psychiatric Services, 46, 669-675.
Chandler, D., Meisel, J., McGowen, M., Mintz, J., & Madison, K. (1996). Client outcomes in two model capitated integrated service agencies. Psychiatric Services, 47, 175-180.
Drake, R. E. (1998). Brief history, current status, and future place of assertive community treatment. American Journal of Orthopsychiatry, 68, 172-175.
Drake, R. E., McHugo, G. J., Clark, R. E., Teague, G. B., Xie, H., Miles, K., & Ackerson, T. H. (1998). Assertive community treatment for patients with co-occurring severe mental illness and substance use disorder: A clinical trial. American Journal of Orthopsychiatry, 68, 201-215.
Drake, R. E., Mueser, K. T., & McHugo, G. J. (1996). Clinician rating scales: Alcohol Use Scale (AUS), Drug Use Scale (DUS), and Substance Abuse Treatment Scale (SATS). In L. I. Sederer, & B. Dickey (Eds.), Outcomes assessment in clinical practice (pp. 113-116). Baltimore: Williams and Wilkins.
Drake, R. E., Osher, F. C., Noordsy, D. L., Hurlbut, S. C., Teague, G. B., & Beaudett, M. S. (1990). Diagnosis of alcohol use disorders in schizophrenia. Schizophrenia Bulletin, 16, 57-67.
Drake, R. E., Osher, F. C., & Wallach, M. A. (1989). Alcohol use and abuse in schizophrenia: A prospective community study. Journal of Nervous and Mental Disease, 177, 408-414.
Goldman, H. H., Gattozzi, A. A., & Taube, C. A. (1981). Defining and counting the chronically mentally ill. Hospital and Community Psychiatry, 32, 21-27.
Herinckx, H., Kinney, R., Clarke, G. N., & Paulson, R. I. (1997). Assertive community treatment versus usual care in engaging and retaining clients with severe mental illness. Psychiatric Services, 48, 1297-1306.
Horvath, A., & Greenberg, L. (1986). Development and validation of the working alliance inventory. Journal of Consulting and Clinical Psychology, 36, 223-233.
Lamb, H. R. (1997). The new state mental hospitals in the community. Psychiatric Services, 48, 1307-1310.
Luke, D. A., & Homan, S. M. (1998). Time and change: Using survival analysis in clinical assessment and treatment evaluation. Psychological Assessment, 10, 360-378.
Lukoff, D., Liberman, R. P., & Nuechterlein, K. H. (1986). Symptom monitoring in the rehabilitation of schizophrenic patients. Schizophrenia Bulletin, 12, 578-602.
Lukoff, D., Nuechterlein, K. H., & Ventura J. (1986). Manual for the Expanded Brief Psychiatric Rating Scale. Schizophrenia Bulletin, 12, 594-602.
McGrew, J. H., Bond, G. R., Dietzen, L., McKasson, M., & Miller, L. D. (1995). A multisite study of client outcomes in assertive community treatment. Psychiatric Services, 46, 696-701.
McHugo, G. J., Drake, R. E., Teague, G. B., & Xie, H. (1999). Fidelity to assertive community treatment and client outcomes in the New Hampshire dual disorders study. Psychiatric Services, 50, 818-824.
McHugo, G. J., Hargreaves, W., Drake, R. E., Clark, R. E., Xie, H., Bond, G. R., & Burns, B. J. (1998). Methodological issues in assertive community treatment studies. American Journal of Orthopsychiatry, 68, 246-260.
Morse, G. A., Calsyn, R. J., Allen, G., Tempelhoff, B., & Smith, R. (1992). Experimental comparison of the effects of three treatment programs for homeless mentally ill people. Hospital and Community Psychiatry, 43, 1005-1009.
Mueser, K. T., Bond, G. R., Drake, R. E., & Resnick, S. G. (1998). Models of community care for severe mental illness: A review of research on case management. Schizophrenia Bulletin 24, 37-74.
Nikkel, R. E., Smith, G., & Edwards, D. (1992). A consumeroriented case management project. Hospital and Community Psychiatry, 43, 577-579.
Pandiani, J. A., Banks, S. M., & Schacht, L. M. (1998). Using incarceration rates to measure mental health program performance. The Journal of Behavioral Health Services & Research, 25, 300-311.
Paulson, R., Clarke, G. N., Herinckx, H., Kinney, R., Cutler, D., & Lewis, K. (2000). A Randomized trial of consumer vs. Non-consumer-staffed assertive community treatment programs vs. Usual care for persons with major mental illness: Two year outcomes. Unpublished manuscript, Regional Research Institute, Portland State University, Oregon.
Rosenheck, R., & Neale, M. (1998). Intersite variation in the impact of intensive psychiatric community care on hospital use. American Journal of Orthopsychiatry, 68, 191-200.
Scott, J. E., & Dixon, L. B. (1995). Assertive community treatment and case management for schizophrenia. Schizophrenia Bulletin, 21, 657-668.
Singer, J. D., & Willett, J. B. (1991). Modeling the days of our lives: Using survival analysis when designing and analyzing longitudinal studies of duration and the timing of events. Psychological Bulletin, 110, 268-290.
Solomon, P., & Draine, J. (1995a). Issues in Serving the Forensic Client. Social Work, 40, 25-33.
Solomon, P., & Draine, J. (1995b). The efficacy of a consumer case management team: 2-year outcomes of a randomized trial. The Journal of Mental Health Administration, 22, 135-146.
SPSS Version 7.5. Chicago IL: SPSS Inc. 1997.
Stylianos, S., & Goering, P. (1989). The working alliance inventory: Reliability and validity in the context of rehabilitation for clients with chronic psychiatric disorders. Paper presented at the annual meeting of the Society for Psychotherapy Research, Toronto, Canada.
Teague, G., Bond, G. R., & Drake, R. E. (1998). Program fidelity in assertive community treatment: Development and use of ameasure. American Journal of Orthopsychiatry, 68, 216-232.
Ventura, J., Green, M., & Shaner, A. (1993). Training and quality assurance on the BPRS: 'The drift busters.' International Journal of Methods in Psychiatric Research, 3, 221-224.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Clarke, G.N., Herinckx, H.A., Kinney, R.F. et al. Psychiatric Hospitalizations, Arrests, Emergency Room Visits, and Homelessness of Clients with Serious and Persistent Mental Illness: Findings from a Randomized Trial of Two ACT Programs vs. Usual Care. Ment Health Serv Res 2, 155–164 (2000). https://doi.org/10.1023/A:1010141826867
Issue Date:
DOI: https://doi.org/10.1023/A:1010141826867