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Community Mental Health Journal

, Volume 48, Issue 4, pp 463–470 | Cite as

Family Support in Assertive Community Treatment: An Analysis of Client Outcomes

  • Tamaki Sono
  • Iwao Oshima
  • Junichiro Ito
  • Masaaki Nishio
  • Yuriko Suzuki
  • Kentaro Horiuchi
  • Nobuyuki Niekawa
  • Masayo Ogawa
  • Yutaro Setoya
  • Kazumi Tsukada
Original Paper

Abstract

Assertive Community Treatment (ACT) is an outreach-based case management model that assists people with severe mental illness through an intensive and integrated approach. In this program, a multidisciplinary team provides medical and psychosocial services. The purpose of this study was to examine the effectiveness of the following two ACT intervention strategies: “replacement” (supporting the clients) versus “backup” (supporting family members who provide care to clients). Admission days, psychiatric symptoms, quality of life, self-efficacy, and service satisfaction ware evaluated as outcome variables. To identify effective methods of supporting family members, clients living with family were divided into two groups based on the amount and types of services received—the backup group and the replacement group. ANCOVA was used to compare the outcomes between the two groups. The replacement group displayed significantly better psychiatric symptoms, social functioning, self-efficacy, and service satisfaction scores. No differences in admission days or quality of life were found. Clients provided more support directly to clients themselves than to family members was found to have better client outcomes in improving psychiatric symptoms, social functioning, and self-efficacy, resulting in higher levels of service satisfaction. This indicates that society should reduce the responsibility of the family and share responsibility for the care of people with mental illness to effectively improve outcomes for people with mental illnesses.

Keywords

Assertive community treatment (ACT) Family Process Outcome 

Notes

Acknowledgments

This research was part of a project supported by grant H14-Kokoro-009 and H17-Kokoro-006 from the Ministry of Health, Labor, and Welfare of Japan. I am grateful to the members of the ACT clinical team, research team, and the clients who made the evaluation possible. I would also like to thank Norito Kawakami and Wakate Kai, who were important advisors during the work.

References

  1. American Psychiatric Association. (2002). Diagnostic and statistical manual of mental disorders: DSM-IV-TR (translated by S. Takanashi, Y. O., T. Someya). Tokyo: Igaku Syoin.Google Scholar
  2. American Psychiatric Association (APA), American Psychiatric Association Task Force on DSM-IV. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. American Psychiatric Association.Google Scholar
  3. Bond, G. R., & Salyers, M. P. (2004). Prediction of outcome from the Dartmouth assertive community treatment fidelity scale. CNS Spectrums, 9(12), 937–942.PubMedGoogle Scholar
  4. Horiuchi, K., Nisihio, M., Oshima, I., Ito, J., Matsuoka, H., & Tsukada, K. (2006). The quality of life among persons with severe mental illness enrolled in an assertive community treatment program in Japan: 1-year follow-up and analyses. Clinical Practice and Epidemiology in Mental Health, 2, 18.PubMedCrossRefGoogle Scholar
  5. Ito, J., Oshima, I., Nishio, M., & Kuno, E. (2009). Initiative to build a community-based mental health system including assertive community treatment for people with severe mental illness in Japan. American Journal of Psychiatric Rehabilitation, 12(3), 247–260.CrossRefGoogle Scholar
  6. Ito, J., Oshima, I., Nishio, M., Sono, T., Suzuki, Y., Horiuchi, K., et al. (2011). The effect of assertive community treatment in Japan. Acta Psychiatrica Scandinavica, 123(5), 398–401.CrossRefGoogle Scholar
  7. Jackson, H. J., Smith, N., & McGorry, P. (1990). Relationship between expressed emotion and family burden in psychotic disorders: An exploratory study. Acta Psychiatrica Scandinavica, 82, 243–249.PubMedCrossRefGoogle Scholar
  8. Kitamura, T., Yuzuriha, T., Morita, M., Ito, J., Suga, R., & Nakagawa, Y. (1990). Oxford version of BPRS: Development and validation of subscales. Archives of Psychiatric Diagnostics and Clinical Evaluation, 1(1), 101–107.Google Scholar
  9. Kolakowska, T. (1976). Brief psychiatric rating scale. Glossaries and rating instructions. Oxford: Oxford University.Google Scholar
  10. Larsen, D. L., Attkisson, C. C., Hargreaves, W. A., & Nguyen, T. D. (1979). Assessment of client/patient satisfaction: Development of a general scale. Evaluation and Program Planning, 2(3), 197–207.PubMedCrossRefGoogle Scholar
  11. Lehman, A. (1988). A quality of life interview for the chronically mentally ill. Evaluation and Program Planning, 11(1), 51–62.CrossRefGoogle Scholar
  12. Marshall, M., & Lockwood, A. (2000). Assertive community treatment for people with severe mental disorders. Cochrane Database of Systematic Reviews, 2000(2), CD001089.Google Scholar
  13. McGrew, J. H., Bond, G. R., Dietzen, L., & Salyers, M. (1994). Measuring the fidelity of implementation of a mental health program model. Journal of Consulting and Clinical Psychology, 62(4), 670–678.PubMedCrossRefGoogle Scholar
  14. McGrew, J. H., Pescosolido, B., & Wright, E. (2003). Case managers’ perspectives on critical ingredients of assertive community treatment and on its implementation. Psychiatric Services, 54(3), 370–376.PubMedCrossRefGoogle Scholar
  15. Okawa, N., Oshima, I., Cho, N., Makino, H., Oka, I., Ikebuchi, E., et al. (2001). Development of ‘self-efficacy for community life scale’ for people with Schizophrenia: Its reliability and validity. Seishin Igaku, 43(7), 727–735.Google Scholar
  16. Organization for Economic Co-operation and Development (OECD), Institute for Research and Information in Health Economics. (2008). OECD health data 2008. Paris: Organization for Economic Co-operation and Development.Google Scholar
  17. Oshima, I. (1987). A study on the family support system for the mentally disabled from the perspective of its function and resources. The Japanese Journal of Psychiatry and Neurology, 89, 204–241.Google Scholar
  18. Oshima, I., & Ito, J. (2003). Care management for people with schizophrenia: Focusing on ACT. Japanese Journal of Biological Psychiatry, 14, 29–34.Google Scholar
  19. Overall, J. E., & Gorham, D. R. (1962). The brief psychiatric rating scale. Psychological Reports, 10, 790–812.Google Scholar
  20. Phelan, M., Wykes, T., & Goldman, H. (1994). Global function scales. Social Psychiatry and Psychiatric Epidemiology, 29(5), 205–211.PubMedCrossRefGoogle Scholar
  21. Salyers, M. P., Bond, G. R., Teague, G. B., Cox, J. F., Smith, M. E., Hicks, M. L., et al. (2003). Is it ACT yet? Real-world examples of evaluating the degree of implementation for assertive community treatment. The Journal of Behavioral Health Services & Research, 30(3), 304–320.CrossRefGoogle Scholar
  22. Sono, T., Nishio, M., Suzuki, Y., Oshima, I., Fukaya, H., Horiuchi, K., et al. (2007a). Effects of assertive community treatment on families of people with severe mental illness in Japan—An analysis of self-report questionnaire using a quasi-experimental method. Australian and New Zealand Journal of Psychiatry, 41(S2), A359–A432.CrossRefGoogle Scholar
  23. Sono, T., Oshima, I., & Ito, J. (2007b). Needs for assertive community treatment of families of people with severe mental illness and their structure. Japanese Bulletin of Social Psychiatry, 16, 29–37.Google Scholar
  24. Sono, T., Oshima, I., & Ito, J. (2008). Family needs and related factors in caring for a family member with mental illness: Adopting assertive community treatment in Japan where family caregivers play a large role in community care [regular article]. Psychiatry and Clinical Neurosciences, 62, 584–590.PubMedCrossRefGoogle Scholar
  25. Stein, L. I., & Test, M. A. (1980). Alternative to mental hospital treatment. I. Conceptual model, treatment program, and clinical evaluation. Archives of General Psychiatry, 37(4), 392–397.PubMedCrossRefGoogle Scholar
  26. Tachimori, H., & Ito, H. (1999). Reliability and validity of Japanese version of client satisfaction questionnaire-8. Seishin Igaku, 41(7), 711–717.Google Scholar
  27. Teague, G. B., Bond, G. R., & Drake, R. E. (1998). Program fidelity in assertive community treatment: Development and use of a measure. The American Journal of Orthopsychiatry, 68(2), 216–232.PubMedCrossRefGoogle Scholar
  28. Test, M. A., & Stein, L. I. (1980). Alternative to mental hospital treatment. III. Social cost. Archives of General Psychiatry, 37(4), 409–412.PubMedCrossRefGoogle Scholar
  29. Vaughn, C. E., & Leff, J. P. (1976). The influence of family and social factors on the course of psychiatric illness. British Journal of Psychiatry, 129, 125–137.PubMedCrossRefGoogle Scholar
  30. Weisbrod, B. A., Test, M. A., & Stein, L. I. (1980). Alternative to mental hospital treatment. II. Economic benefit-cost analysis. Archives of General Psychiatry, 37(4), 400–405.PubMedCrossRefGoogle Scholar
  31. WHO. (1992). The international classification of diseases and health related problems tenth revision. Geneva: World Health Organization.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Tamaki Sono
    • 1
  • Iwao Oshima
    • 2
  • Junichiro Ito
    • 3
  • Masaaki Nishio
    • 4
  • Yuriko Suzuki
    • 5
  • Kentaro Horiuchi
    • 6
  • Nobuyuki Niekawa
    • 7
  • Masayo Ogawa
    • 8
  • Yutaro Setoya
    • 3
  • Kazumi Tsukada
    • 6
  1. 1.Psilocybe Inc.ShigaJapan
  2. 2.Graduate School of Social WelfareJapan College of Social WorkKiyose, TokyoJapan
  3. 3.Department of Psychiatric RehabilitationInstitute of Mental Health, National Center of Neurology and Psychiatry JapanKodaira, TokyoJapan
  4. 4.Faculty of Comprehensive WelfareTohoku Fukushi UniversitySendai, MiyagiJapan
  5. 5.Department of Adult Mental HealthNational Center of Neurology and PsychiatryKodaira, TokyoJapan
  6. 6.Kohnodai Hospital, International Medical Center of JapanIchikawa, ChibaJapan
  7. 7.Social Work Research InstituteJapan College of Social WorkKiyose, TokyoJapan
  8. 8.School of NursingUniversity of ShizuokaSuruga-ku, ShizuokaJapan

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