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“You Might Lose Him Through the Cracks”: Clinicians’ Views on Discharge from Assertive Community Treatment

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Abstract

Assertive Community Treatment (ACT) teams are increasingly interested in improving access to ACT through discharge of improved clients to less intensive mental health care services. We report results from a process evaluation of three teams in the VA’s ACT program, Mental Health Intensive Case Management (MHICM), that began to implement discharge. MHICM clinicians (n = 15) describe significant barriers to discharge. Clinicians support the concept of discharge but raise concerns about clients’ future stability, clients’ feelings about discharge, and other aspects of the discharge process. We propose strategies that can be used to support clinicians and clients in discharge decision-making.

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Acknowledgments

This material is based on work supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research & Development (HSR&D) Quality Enhancement Research Initiative (QUERI) grant #10-196. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government. The authors wish to acknowledge Dawn Glover, Amy N. Cohen, Stephen R. Marder, Jonathan Sherin, and Charles Nguyen for invaluable assistance with the conduct of the research. The authors would also like to thank Marcia G. Hunt, Daniel Bradford, and Gary S. Cuddeback for substantial support in conceptualizing strategies for responding to findings.

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The authors declare that they have no conflict of interest.

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Correspondence to Elizabeth Bromley.

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Bromley, E., Mikesell, L., Armstrong, N.P. et al. “You Might Lose Him Through the Cracks”: Clinicians’ Views on Discharge from Assertive Community Treatment. Adm Policy Ment Health 42, 99–110 (2015). https://doi.org/10.1007/s10488-014-0547-3

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