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Implementing Assertive Community Treatment Programs in Rural Settings

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Abstract

The authors present a controlled evaluation of a rural adaptation of the assertive community treatment (ACT) model for clients with serious and persistent mental illness (SPMI). Four community mental health settings adopted an ACT model, while a fifth site blended ACT principles with those of the Rhinelander model, another approach to case management for persons with SPMI. A broad array of client and system outcomes were evaluated at 6, 12, and 24 months into the intervention. Twelve-month findings alerted us to potential problems in implementing the treatment model in study year 1; the implementation was qualitatively evaluated and weaknesses were addressed at the beginning of the second treatment year. Small, positive findings at 24 months suggested that the mid-study course correction may have had an impact. We present these findings along with descriptive data on the challenges of implementing complex services models. We give particular attention to describing implementation barriers to mental health services provision that are uniquely rural.

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REFERENCES

  • Bachrach, L. (1983). Psychiatric services in rural areas: A sociological overview. Hospital & Community Psychiatry, 3, 215–226.

    Google Scholar 

  • Bachrach, L. (1993). Continuity of care and approaches to case management for long-term mentally ill patients. Hospital & Community Psychiatry, 44, 465–468.

    Google Scholar 

  • Baker, F. & Intagliata, J. (1984). Rural community support services for the chronically mentally ill. Journal of Rural Community Psychology 5, 3–14.

    Google Scholar 

  • Bergland, B. (1988). Rural mental health: Report of the National Action Commission on the Mental Health of Rural Americans. Journal of Rural Community Psychology, 9, 29–39.

    Google Scholar 

  • Bond, G.R. (1991). Variations in an assertive outreach model. New Directions in Mental Health Services, 52, 65–80.

    Google Scholar 

  • Bond, G.R., McDonel, E.C., Miller, L., & Pensec, M. (1991). Assertive community treatment and reference groups: An evaluation of their effectiveness for young adults with serious mental illness and substance abuse problems. Psychosocial Rehabilitation Journal, 15(2), 31–44.

    Google Scholar 

  • Bond, G.R., McGrew, J.H., & Fekete, D. (1995). Assertive outreach for frequent users of psychiatric hospitals. A meta-analysis. The Journal of Mental Health Administration, 22, 4–16.

    Google Scholar 

  • Bond, G.R., Miller, L.D., Krumwied, R.D., & Ward, R.S. (1988). Assertive case management in three CMHCs: A controlled study. Hospital & Community Psychiatry, 39, 411–418.

    Google Scholar 

  • Burns, B.J., & Santos, A.B. (1995). Assertive Community Treatment: An update of randomized trials. Psychiatric Services, 46(7), 669–675.

    Google Scholar 

  • Chu, C., Klein, H., & Lange, M. (1982) Symptomology differentials between rural and urban schizophrenics. International Journal of Social Psychiatry, 28, 251–255.

    Google Scholar 

  • Davis, L.F., & Ziegler, J.A. (1989). Working with people who are chronically mentally ill in rural areas: Developing a community resource team. Psychosocial Rehabilitation Journal, 12, 81–85.

    Google Scholar 

  • DeLeon, P.H. (1989). Rural America: Unique opportunities for health care delivery and health services research. American Psychologist, 44, 1298–1306.

    Google Scholar 

  • Diamond, R.J., & Van Dyke, D. (1985). Rural community support programs: The experience in three Wisconsin counties. In L.I. Stein & M.A. Test (Eds.), The Training in Community Living Model: A decade of experience (pp. 49–63). New Directions for Mental Health Services 26.

  • Eaton, W.M. (1974). Residence, social class, and schizophrenia. Journal of Health and Social Behaviors, 15, 289–299.

    Google Scholar 

  • Elkin, B., & Boyer, P. (1987). Practice skills and personal characteristics that facilitate practitioner retention in rural mental health settings. Journal of Rural Community Psychology, 8(2), 30–39.

    Google Scholar 

  • Essock, S.M., & Kontos, N. (1995). Implementing assertive community treatment teams. Psychiatric Services, 46, 679–683.

    Google Scholar 

  • Feldman, S. (1991). Management mental health services: Ideas and issues. In S. Feldman (Ed.), Managed mental health services. Springfield, IL: Charles C. Thomas.

    Google Scholar 

  • Field, G., Allness, D., & Knoedler, W.H. (1980). The application of the Training in Community Living Program to rural areas. Journal of Community Psychology, 8, 9–15.

    Google Scholar 

  • Fraser, V.A. (1987). Adapting a psychosocial rehabilitation agency to a rural community. Psychosocial Rehabilitation Journal, 11(1), 67–71.

    Google Scholar 

  • Goldman, H.H., Skodol, A.E., & Lave, T.R. (1992). Revising Axis V for DSM-IV: A review of measures of social functioning. American Journal of Psychiatry, 149, 1148–1156.

    Google Scholar 

  • Heyman, S.R. (1986). Addressing preventive interventions in rural community psychology. Journal of Rural Community Psychology, 7(2), 7–15.

    Google Scholar 

  • Hoult, J., Reynolds, I., Charbonneau-Powis, M., Weekes, P., & Briggs, J. (1983). Psychiatric hospital versus community treatment: The results of a randomized trial. Australian and New Zealand Journal of Psychiatry, 17, 160–167.

    Google Scholar 

  • Kenkel, M.B. (1986). Stress-Coping-Support in rural communities: A model for primary prevention. American Journal of Community Psychology, 14, 457–478.

    Google Scholar 

  • Loschen, E.L. (1986). The challenge of providing quality psychiatric services in a rural settings. Quarterly Review Bulletin, 12, 376–379.

    Google Scholar 

  • Lukoff, D., Liberman, R.P., & Nuechterlein, K.H. (1992). Symptom monitoring in the rehabilitation of schizophrenic patients. In R.P. Liberman (Ed.), Handbook of psychiatric rehabilitation (pp. 56–77). New York: MacMillan Publishing Company.

    Google Scholar 

  • Lukoff, D., Nuechterlein, K.H., & Ventura, J. (1986). Appendix A. Manual for Expanded Brief Psychiatric Rating Scale (BPRS). Schizophrenia Bulletin, 12, 594–602.

    Google Scholar 

  • McDonel, E.C. (1990, December). Report of activity on rural grants. Meeting of Community Support Program Research Demonstration Grant Participants in NIMH, Bethesda, MD.

  • McDonel, E.C., Bond, G.R., & Miller, L. (1992, June). Implementing innovative case management programs for persons with serious and persistent mental illness in rural settings: Problems and issues. Meeting of Community Support Program Research Demonstration Grant Participants at NIMH, Bethesda, MD.

  • McDonel, E.C., Meyer, L., & DeLiberty, R. (1996). Implementing state-level mental health policy reforms in Indiana: Closing a state-operated psychiatric hospital and passing major mental health reform legislation. International Journal of Law and Psychiatry, 19, 239–264.

    Google Scholar 

  • McFarlane, W.R., & Stastny, P. (1987). Treatment manual for training in community living, based on the Wisconsin program of assertive community treatment. Albany, NY: Collaborative Family and Community Treatment Project, New York State Office of Mental Health.

    Google Scholar 

  • McFarlane, W.R., Stastny, P., & Deakins, S. (1992). Family-aided community treatment: A comprehensive rehabilitation and case management approach for persons with schizophrenic disorders. New Directions for Mental Health Services, 53, 43–54.

    Google Scholar 

  • McGrew, J.H., & Bond, G.R. (1995). Critical ingredients of Assertive Community Treatment: Judgments of the experts. Journal of Mental Health Administration, 22, 113–125.

    Google Scholar 

  • McGrew, J.H., Bond, G.R., Dietzen, L., & Pensec, M. (1994). Measuring the fidelity of implementation of a mental health program model. Journal of Consulting and Clinical Psychology, 62, 670–678.

    Google Scholar 

  • McGrew, J.H., Bond, G.R., Dietzen, L., McKasson, M., & Miller, L. (1995). A multisite study of client outcomes in assertive community treatment. Psychiatric Services, 46, 696–701.

    Google Scholar 

  • McGrew, J.H., Wilson, R., & Bond, G.R. (1996). Client perspectives on helpful ingredients of assertive community treatment. Psychiatric Rehabilitation Journal, 19(3), 13–21.

    Google Scholar 

  • Menolascino, F.J., & Potter, J.F. (1989). Delivery of services in rural settings to the elderly mentally retarded-mentally ill. International Journal on Aging and Human Development, 28, 261–275.

    Google Scholar 

  • Mueser, K.T., Bond, G.R., & Drake, R.E. (1996). Case management for the severely mentally ill: A review of the research. Manuscript under review.

  • Morse, G. (1989). Cost-effectiveness of case management for the homeless. NIMH CSP grant #1R18MH46160.

  • Neurhing, E.M., & Ladner, R.A. (1981). Factors distinguishing urban and rural state mental hospital patients in Florida. Journal of Socialogy-Social Welfare, 8, 164–173.

    Google Scholar 

  • Olfson, M. (1990). Assertive Community Treatment: An evaluation of the experimental evidence. Hospital & Community Psychiatry, 41, 635–641.

    Google Scholar 

  • Pulaskos, J., & Dengerink, H.A. (1983). Comparison of mental health services in rural and urban Washington. Community Mental Health Journal, 19, 164–172.

    Google Scholar 

  • Santos, A.B., Deci, P.A., Lachance, K.R., Dias, J.K., Sloop, T.B., Hiers, T.G., & Bevilacqua, J.J. (1993). Providing assertive community treatment for severely mentally ill patients in a rural area. Hospital & Community Psychiatry, 44, 34–39.

    Google Scholar 

  • Sommers, I. (1989). Geographic location and mental health services utilization among the chronically mentally ill. Community Mental Health Journal, 25, 132–144. ia]National Association of State Mental Health and Program Directors Research Institute, Inc. Special Issue on Assertive Community Treatment. Outlook, 2(2), 1–17. Alexandria VA: Author.

    Google Scholar 

  • Stein, L.I., & Test, M.A. (1980). Alternatives to mental hospital treatment, I: Conceptual model, treatment program, and clinical evaluation. Archives of General Psychiatry, 37, 392–397. ei]Stein, L.I., & Test, M.A., (Eds.). (1985). The Training in Community Living Model: A decade of experience. New Directions for Mental Health Services, 26.

    Google Scholar 

  • Teague, G.B., Drake, R.E., & Ackerson, T.H. (1995). Evaluating use of continuous treatment teams for persons with mental illness and substance abuse. Psychiatric Services, 46, 689–695.

    Google Scholar 

  • Teague, G.B., & Macias, C. (1990, December). Preliminary research findings. Meeting of Community Support Program Research Demonstration Grant Participants at NIMH, Bethesda, MD.

  • Test, M.A. (1992). Training in community living. In R.P. Liberman (Ed.), Handbook of Psychiatric Rehabilitation (pp. 153–170). New York: MacMillan Publishing Company.

    Google Scholar 

  • Test, M.A., Knoedler, W.H., & Allness, D.J. (1985). The long-term treatment of young schizophrenics in a community support program. New Directions for Mental Health Services, 26, 17–27.

    Google Scholar 

  • Test, M.A., & Stein, L.I. (1980). Alternative to mental hospital treatment, III: Social cost. Archives of General Psychiatry, 37, 409–412.

    Google Scholar 

  • Turner, J.C., & TenHoor, W.J. (1978). The NIMH Community Support Program: Pilot approach to a needed social reform. Schizophrenia Bulletin, 4, 319–348.

    Google Scholar 

  • Wagenfeld, M.O., Goldsmith, H., Stiles, D., & Manderscheid, R.W. (1988). Inpatient mental health services in metropolitan and nonmetropolitan counties. Journal of Rural Community Psychology, 9, 13–28.

    Google Scholar 

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Authors and Affiliations

  1. Indiana University, Bloomington

    Elizabeth C. McDonel

  2. Indiana University-Purdue University, Indianapolis

    Gary R. Bond, Michelle Salyers, Dawn Fekete, Annabel Chen & John H. McGrew

  3. Swanson Community Mental Health Center, USA

    Larry Miller

Authors
  1. Elizabeth C. McDonel
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  2. Gary R. Bond
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  3. Michelle Salyers
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  4. Dawn Fekete
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  5. Annabel Chen
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  6. John H. McGrew
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  7. Larry Miller
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McDonel, E.C., Bond, G.R., Salyers, M. et al. Implementing Assertive Community Treatment Programs in Rural Settings. Adm Policy Ment Health 25, 153–173 (1997). https://doi.org/10.1023/A:1022286921362

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