Clinical significance of assertive community treatment among adolescents
The efficacy of assertive community treatment for children and adolescents is proven in the United States, but remains controversial in Europe. Moreover, most studies showing positive outcomes of assertive community treatment are limited to statistically significant differences and do not consider whether the treatment is also subjectively clinically meaningful for the patient. Using a naturalistic sample, the present study aims to assess statistical and clinical significance of an assertive community treatment unit for adolescents in Europe.
Linear mixed-effects models and reliable change indices were used to respectively assess the statistical and clinical significance of assertive community treatment in 179 adolescents (mean age = 15.76, SD = 1.76) with severe mental illnesses.
Difficulties related to mental health (measured by the Health of the Nation Outcome Scales for Children and Adolescents, HoNOSCA) and overall functioning (measured by the Global Assessment of Functioning scale) statistically improved (all ps < 0.001) from admission to discharge. Additionally, a considerable proportion of patients (from 14% to 21%) clinically recovered to functional levels.
Our results support the fact that assertive community treatment can have convincing and positive clinical outcomes in European settings.
KeywordsAssertive community treatment Treatment efficacy Adolescents HoNOSCA Reliable change index
Compliance with ethical standards
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
This study is part of a larger project that aims to assess the quality and efficiency of ACT for different age spans (i.e., adults and adolescents), after its implementation in the state of Vaud (Switzerland). In Switzerland, this type of treatment has been designed with the main objective of managing patients who refuse regular psychiatric care and is used as last resort. Because ACT does not necessitate an exclusive type of care, all patients followed by ACT teams were free to choose alternative treatment options. However, as soon as patients were able to invest another treatment option, the goal of reintegrating a health care system was achieved and the ACT teams withdrew from care. Each patient and his guardians were informed that routine clinical assessments were going to be made for scientific purposes and were asked for their informed consent. A refusal did not influence the proposed treatment. The study had the approval of Lausanne University Hospital Ethical Committee and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
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