The Assertive Community Treatment Team as a Complex Dynamic System of Care

  • Charlene A. Allred
  • Barbara J. Burns
  • Susan D. Phillips
Article

Abstract

This paper presents a dynamic systems view of assertive community treatment (ACT), a recognized evidence-based treatment for adults with severe and persistent mental illness (SPMI). It is argued that because an ACT team operates as a complex adaptive system (CAS), it engages in the organizational processes of “sensemaking” and self-organization, which help to bring order to the actions of team members and sustainability of the intervention itself. Consequently, successful implementation of ACT requires that management technologies such as meaning-creation and design are used in conjunction with traditional “command and control” technologies of policies, procedures, processes, and structures.

Keywords

evidence-based practice dissemination mental health systems management systems theory 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. C.A. Allred, R.A. Anderson, R.R. McDaniel, 2000. A theoretical exploration of coordination as a complicating mechanism for adaptive survival. In Proceedings 2000: Academy of Management Annual Meeting. Toronto, Canada: OmnipressGoogle Scholar
  2. Anderson, R., McDaniel, R.R. 1999RN participation in organizational decision making and improvements in resident outcomesHealth Care Management Review24716PubMedGoogle Scholar
  3. Anderson, R.A., Allred, C.A., Sloan, F.A. 2003Effect of hospital conversion on organizational decision making and service coordinationHealth Care Management Review28141154PubMedGoogle Scholar
  4. Ashmos, D.P., Huonker, J.W., McDaniel, R.R. 1998Participation as a complicating mechanism: The effect of clinical professional and middle manager participation on hospital performanceHealth Care Management Review23220Google Scholar
  5. Berwick, D.M. 2003Disseminating innovations in health careJAMA28919691975CrossRefPubMedGoogle Scholar
  6. Bond, G.R., Drake, R.E., Mueser, K.T., Latimer, E. 2001Assertive community treatment for people with severe mental illnessDisease Management and Health Outcomes9141159Google Scholar
  7. Brown, B., Crawford, P. 2003The clinical governance of the soul: ‘Deep management’ and the self-regulating subject in integrated community mental health teamsSocial Science & Medicine566781Google Scholar
  8. Capra, F. 1996The web of lifeAnchor BooksNew YorkGoogle Scholar
  9. Carpinello, S.E., Rosenberg, L., Stone, J., Schwager, M., Felton, C.J. 2002New York State’s campaign to implement evidence-based practices for people with serious mental disordersPsychiatric Services53153155CrossRefPubMedGoogle Scholar
  10. Chen, Y., Van de Ven, A.H. 1996Learning the innovation journey: Order out of chaos?Organization Science7593614Google Scholar
  11. Chorpita, B.F., Yim, L.M., Donkervoet, J.C., Arensdorf, A., Amundsen, M.J., McGee, C., Serrano, A., Yates, A., Burns, J.A., Morelli, P. 2002Toward large-scale implementation of empirically supported treatments for children: A review and observations by the Hawaii Empirical Basis to Services Task ForceClinical Psychology: Science and Practice9165190CrossRefGoogle Scholar
  12. Cilliers, P. 1998Complexity and postmodernism: Understanding complex systems RoutledgeLondonGoogle Scholar
  13. Corrigan, P.W., Steiner, L., McCracken, S.G., Blaser, B., Barr, M. 2001Psychiatric Services5215981606CrossRefPubMedGoogle Scholar
  14. D’Aunno, T., Vaughn, T. 1995An organizational analysis of service patterns in outpatient drug abuse treatment unitsJournal of Substance Abuse72742CrossRefPubMedGoogle Scholar
  15. Dooley, K.J., Van de Ven, A.H. 1999Explaining complex organizational dynamicsOrganization Science10358372Google Scholar
  16. Friedman, P., Alexander, J., D’Aunno, T.A. 1999Organizational correlates of access to primary care and mental health services in drug abuse treatment unitsJournal of Substance Abuse Treatment167180CrossRefGoogle Scholar
  17. S. Herndon 2003. SAMHSA News, 11(2).Google Scholar
  18. Holland, J.H. 1998Emergence: From chaos to order Addison-WesleyReading, MAGoogle Scholar
  19. Kauffman, S. 1993The origins of order Oxford University PressNew York, NYGoogle Scholar
  20. Madhavan, R., Grover, R. 1998From embedded knowledge to embodied knowledge: New product development as knowledge managementJournal of Marketing62112Google Scholar
  21. McDaniel, R.R. 1997Strategic leadership: A view from quantum and chaos theoriesHealth Care Management Review222137PubMedGoogle Scholar
  22. McGrew, J.H., Pescosolido, B., Wright, E. 2003Case managers’ perspectives on critical ingredients of assertive community treatment and on its implementationPsychiatric Services54370376CrossRefPubMedGoogle Scholar
  23. Mowbray, C.T., Grazier, K.L., Holer, M. 2002Managed behavioral health care in the public sector: Will it become the third shame of the states?Psychiatric Services53157170CrossRefPubMedGoogle Scholar
  24. Nicolis, G., Prigogine, I. 1989Exploring complexity FreemanSan FranciscoGoogle Scholar
  25. Phillips, S.D., Burns, B.J., Edgar, E.R., Mueser, K.T., Linkins, K.W., Rosenheck, R.A., Drake, R.E., McDonnel, H. 2001Moving assertive community treatment into standard practicePsychiatric Services52771779CrossRefPubMedGoogle Scholar
  26. Prigogine, I.Stengers, I. eds. 1984Order out of chaos: Man’s new dialogue with nature.Bantam BooksNew York, NYGoogle Scholar
  27. Rosenheck, R.A. 2001Organizational process: A missing link between research and practicePsychiatric Services5216071612CrossRefPubMedGoogle Scholar
  28. Simmonds, S., Coid, J., Joseph, P., Marriott, S., Tyrer, P. 2001Community mental health team management in severe mental illness: A systematic reviewThe British Journal of Psychiatry178497502CrossRefPubMedGoogle Scholar
  29. Simpson, D.D. 2002A conceptual framework for transferring research to practiceJournal of Substance Abuse Treatment22171182CrossRefPubMedGoogle Scholar
  30. Stacey, R.D. 1996Complexity and creativity in organization. Berrett-KoehlerSan FranciscoGoogle Scholar
  31. Stein, L.I., Santos, A. B. 1998Assertive community treatment of persons with severe mental illness W.W. NortonNew YorkGoogle Scholar
  32. Stein, L.I., Test, M.A. 1980Alternative to mental hospital treatments. I. Conceptual model, treatment programand clinical evaluationArchives of General Psychiatry37392397PubMedGoogle Scholar
  33. Thietart, R.A., Forgues, B. 1995Chaos theory and organizationOrganization Science61931CrossRefGoogle Scholar
  34. Weick, K. 1993The collapse of sensemaking in organizations: The Mann Gulch disasterAdministrative Science Quarterly38628652Google Scholar
  35. Weick, K.E. 1995Sensemaking in organizations Sage PublicationsThousand Oaks, CAGoogle Scholar
  36. Weick, K.E., Roberts, K.H. 1993Collective mind in organizations: Heedful interrelating on flight decksAdministrative Science Quarterly38357381Google Scholar
  37. Weick, K., Sutcliffe, K., Obstfeld, D. 1999Organizing for high reliability: Processes of collective mindfulnessResearch in Organizational Behavior2181123Google Scholar
  38. West, G.P., Meyer, G.D. 1997Communicated knowledge as a learning foundationThe International Journal of Organizational Analysis152558Google Scholar
  39. Zimmerman, B., Dooley, K. 2001Mergers versus emergers: Structural change in health care systemsEmergence36582CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2005

Authors and Affiliations

  • Charlene A. Allred
    • 1
  • Barbara J. Burns
    • 2
  • Susan D. Phillips
    • 3
  1. 1.Department of Psychiatry and Behavioral SciencesDuke University School of MedicineDurham
  2. 2.Department of Psychiatry and Behavioral SciencesDuke University School of Medicine in DurhamDurham
  3. 3.Department of Psychiatry and Behavioral SciencesDuke University School of MedicineDurham

Personalised recommendations