Skip to main content
SpringerLink
Log in

Assertive outreach for frequent users of psychiatric hospitals: A meta-analysis

  • Regular Articles
  • Published:
The journal of mental health administration Aims and scope Submit manuscript

Abstract

A meta-analysis was conducted on nine studies of an assertive outreach model for frequent users of psychiatric hospitals. Four studies used experimental or quasi-experimental designs and five used pre-post designs. Findings at one-year follow-up were examined for retention in community mental health services, psychiatric inpatient days, quality of life, and client level of functioning. Eighty-four percent of assertive outreach clients were still receiving mental health services after one year, compared to 54% of controls. In two thirds of the programs, the mean annual rate of inpatient days declined by 50% or more. The overall experimental effect size for quality of life was negligible, although changes over time for assertive outreach clients were more encouraging. Similarly, improvement in level of functioning was found for assertive outreach clients. The study examining experimental differences in level of functioning obtained a nonsignificant moderate effect.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Chamberlain R, Rapp CA: A decade of case management: A methodological review of outcome research.Community Mental Health Journal 1991;27:171–188.

    Article  PubMed  CAS  Google Scholar 

  2. Solomon P: The efficacy of case management services for severely mentally disabled clients.Community Mental Health Journal 1992;28:163–180.

    Article  PubMed  CAS  Google Scholar 

  3. Olfson M: Assertive community treatment: An evaluation of experimental evidence.Hospital and Community Psychiatry 1990;41:634–641.

    PubMed  CAS  Google Scholar 

  4. Test MA: Training in community living. In: Liberman RP (Ed.):Handbook of Psychiatric Rehabilitation. New York: Macmillan, 1992, pp. 153–170.

    Google Scholar 

  5. Stein LI, Test MA: An alternative to mental hospital treatment. I: Conceptual model, treatment program, and clinical evaluation.Archives of General Psychiatry 1980;37:392–397.

    PubMed  CAS  Google Scholar 

  6. Rosenthal R:Meta-Analytic Procedures for Social Research. Newbury Park, CA: Sage, 1984.

    Google Scholar 

  7. Lipsey MW:Design Sensitivity. Newbury Park, CA: Sage, 1990.

    Google Scholar 

  8. Witheridge TF, Dincin J, Appleby L: Working with the most frequent recidivists: A total team approach to assertive resource management.Psychosocial Rehabilitation Journal 1982;5(1):9–11.

    Google Scholar 

  9. Witheridge TF, Dincin J: The bridge: An assertive outreach program in an urban setting.New Directions for Mental Health Services 1985;26:65–76.

    PubMed  Google Scholar 

  10. Appleby L, Desai P: Residential instability: A perspective on systems imbalance.American Journal of Orthopsychiatry 1987;57:515–524.

    Article  PubMed  CAS  Google Scholar 

  11. Surles RC, McGurrin MC: Increased use of psychiatric emergency services by young chronic mentally ill patients.Hospital and Community Psychiatry 1987;38:401–405.

    PubMed  CAS  Google Scholar 

  12. Axelrod S, Wetzler S: Factors associated with better compliance with psychiatric aftercare.Hospital and Community Psychiatry 1989;40:397–401.

    PubMed  CAS  Google Scholar 

  13. Hadley TR, Culhane DP, McGurrin MC: Identifying and tracking “heavy users” of acute psychiatric inpatient services.Administration and Policy in Mental Health 1992;19:279–290.

    Article  Google Scholar 

  14. Surber RW, Winkler EL, Monteleone M, et al.: Characteristics of high users of acute psychiatric inpatient services.Hospital and Community Psychiatry 1987;38:1112–1114.

    PubMed  CAS  Google Scholar 

  15. Bond GR, Witheridge TF, Dincin J, et al.: Assertive community treatment: Correcting some misconceptions.American Journal of Community Psychology 1991;19:41–51.

    Article  PubMed  CAS  Google Scholar 

  16. Witheridge TF: The assertive community treatment worker: An emerging role and its implications for professional training.Hospital and Community Psychiatry 1989;40:620–624.

    PubMed  CAS  Google Scholar 

  17. Witheridge TF: Assertive community treatment: A strategy for helping persons with severe mental illness to avoid rehospitalization. In: Cohen NL (Ed.):Psychiatry Takes to the Street. New York: Guilford Press, 1990, pp. 80–106.

    Google Scholar 

  18. Witheridge TF: The “active ingredients” of assertive outreach.New Directions in Mental Health Services 1991; 52:47–64.

    Google Scholar 

  19. McGrew JH, Bond GR, Dietzen LL, et al.: Measuring the fidelity of implementation of a mental health program model.Journal of Consulting and Clinical Psychology. 1944;62:670–678.

    Article  Google Scholar 

  20. McGrew JH, Bond GR: Critical ingredients of assertive community treatment: Judgments of the experts.Journal of Mental Health Administration. In press.

  21. Bond GR: Variations in an assertive outreach model.New Directions for Mental Health Services 1991;52:65–80.

    PubMed  Google Scholar 

  22. Stein LI, Diamond RJ: A program for difficult-to-treat patients.New Directions for Mental Health Services 1985;26:29–39.

    PubMed  Google Scholar 

  23. Higenbottam JA, Bond GR: What Does an Assertive Community Treatment Team Do? Paper presented at the annual meeting of the International Association of Psychosocial Rehabilitation Services, Oakland, CA, May 7, 1992.

  24. Dincin J: Psychiatric rehabilitation.Schizophrenia Bulletin 1975;1:131–148.

    Google Scholar 

  25. McDonel EC, Bond GR, Fekete DM, et al.: Rural Assertive Community Treatment Project. NIMH Demonstration Project. Work in progress, 1993.

  26. Hampton B: Integrated Service System Approach to Avert Homelessness: CSP Homeless Prevention Project for HMI Adults. Final report to NIMH. Chicago, IL: Illinois Department of Mental Health and Developmental Disabilities, 1992.

    Google Scholar 

  27. Bond GR, Witheridge TF, Wasmer D, et al.: A comparison of two crisis housing alternatives to psychiatric hospitalization.Hospital and Community Psychiatry 1989;40:177–183.

    PubMed  CAS  Google Scholar 

  28. Witheridge TF: The Effectiveness of an Assertive Home-Visiting Intervention for Frequent Psychiatric Recidivists. Unpublished doctoral dissertation, Northwestern University, Evanston, IL, 1987.

    Google Scholar 

  29. Bond GR, Witheridge TF, Setze PJ, et al.: Preventing rehospitalization of clients in a psychosocial rehabilitation agency.Hospital and Community Psychiatry 1985;36:993–995.

    PubMed  CAS  Google Scholar 

  30. Bond GR, Witheridge TF, Dincin J, et al.: Assertive community treatment for frequent users of psychiatric hospitals in a large city: A controlled study.American Journal of Community Psychology 1990;18:865–891.

    Article  PubMed  CAS  Google Scholar 

  31. Bond GR: Assertive community treatment of the severely mentally ill: Recent research findings. In: Davis KE, Harris R, Farmer R, et al. (Eds.):Strengthening the Scientific Base of Social Work Education for Services to the Long-Term Seriously Mentally Ill. Richmond, VA: Virginia Commonwealth University, 1989, pp. 162–195.

    Google Scholar 

  32. Dincin J: Assertive case management.Psychiatric Quarterly 1990;61:49–55.

    Article  PubMed  CAS  Google Scholar 

  33. Dincin J, Wasmer D, Witheridge TF, et al.: Impact of assertive community treatment on the use of state hospital impatient bed-days.Hospital and Community Psychiatry 1993;44:833–838.

    PubMed  CAS  Google Scholar 

  34. Bond GR, Pensec M, Dietzen L, et al.: Intensive case management for frequent users of psychiatric hospitals in a large city: A comparison of team and individual caseloads.Psychosocial Rehabilitation Journal 1991;15(1): 90–98.

    Google Scholar 

  35. Bond GR, Miller LD, Krumwied RD, et al.: Assertive case management in three CMHCs: A controlled study.Hospital and Community Psychiatry 1988;39:411–418.

    PubMed  CAS  Google Scholar 

  36. Bond GR, McDonel EC, Miller LD, et al.: 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 1991;15(2):31–43.

    Google Scholar 

  37. McGrew JH, Bond GR, Dietzen LL, et al.: A multi-site study of assertive community treatment. Under review.

  38. O’Connor-Griffin B: Measures of Quality of Life in Persons with Severe Psychiatric Disabilities. Unpublished master’s thesis, Indiana University-Purdue University at Indianapolis, 1990.

  39. Endicott J, Spitzer RL, Fleiss JL, et al.: The Global Assessment Scale: A procedure for measuring overall severity of psychiatric disturbance.Archives of General Psychiatry 1976;33:766–771.

    PubMed  CAS  Google Scholar 

  40. Goldman HH, Skodol AE, Lave TR: Revising axis V for DSM-IV: A review of measures of social functioning.American Journal of Psychiatry 1992;149:1148–1156.

    PubMed  CAS  Google Scholar 

  41. Hedges LV: Advances in statistical methods for meta-analysis.New Directions for Program Evaluation 1984;24: 25–42.

    Article  Google Scholar 

  42. Becker BJ: Synthesizing standardized mean-change measures.British Journal of Mathematical and Statistical Psychology 1988;41:257–278.

    Google Scholar 

  43. Carrion PG, Swann A, Kellert-Cecil H, et al.: Compliance with clinic attendance by outpatients with schizophrenia.Hospital and Community Psychiatry 1993;44:764–767.

    PubMed  CAS  Google Scholar 

  44. McQuistion HL, D’Ercole A, Kopelson E: Urban street outreach: Using clinical principles to steer the system.New Directions for Mental Health Services 1991;52:17–27.

    PubMed  Google Scholar 

  45. Mowbray CT, Cohen E, Bybee D: The challenge of outcome evaluation in homeless services: Engagement as an intermediate outcome measure.Evaluation and Program Planning 1993;16:337–346.

    Article  Google Scholar 

  46. Frank RG, Jackson CA, Lynch FL: The structure of economic incentives in the Robert Wood Johnson/HUD program on chronic mental illness.Journal of Mental Health Administration 1993;20:20–31.

    PubMed  CAS  Google Scholar 

  47. Franklin JL, Solovitz B, Mason M, et al.: An evaluation of case management.American Journal of Public Health 1987;77:674–678.

    Article  PubMed  CAS  Google Scholar 

  48. Lehman AF Burns BJ: Severe mental illness in the community. In: Spilker B (Ed.):Quality of Life Assessment in Clinical Trials. New York: Raven Press, 1990, pp. 357–366.

    Google Scholar 

  49. Becker DR, Drake RE: Individual placement and support: A community mental health center approach to vocational rehabilitation.Community Mental Health Journal. 1994;30:193–206.

    Article  PubMed  CAS  Google Scholar 

  50. Levstek DA, Bond GR: Housing cost, quality, and satisfaction among formerly homeles persons with serious mental illness in two cities.Innovations and Research 1993;2(3):1–8.

    Google Scholar 

  51. Santos AB, Deci PA, Lachance KR, et al.: Providing assertive community treatment for severely mentally ill patients in a rural area.Hospital and Community Psychiatry 1993;44:34–39.

    PubMed  CAS  Google Scholar 

  52. Macias C, Kinney R, Farley OW, et al.: The role of case management within a community support system: Partnership with psychosocial rehabilitation.Community Mental Health Journal. 1994;30:323–339.

    Article  PubMed  CAS  Google Scholar 

  53. Test MA: Programs of Assertive Community Treatment: Twenty Years of Research. Paper presented at the conference on Building Social Work Knowledge for Effective Mental Health Services and Policies, sponsored by NIMH, Bethesda, MD, April 6, 1992.

  54. Smith ML, Glass GV: Meta-analysis of psychotherapy outcome studies.American Psychologist 1977;32: 752–760.

    Article  PubMed  CAS  Google Scholar 

  55. Heller K: Personal communication, November, 1993.

  56. Stein LI: Innovating against the current.New Directions for Mental Health Services 1992;56:5–22.

    PubMed  Google Scholar 

  57. Plum TB, Lawther S: How Michigan established a highly effective statewide community-based program for persons with serious and persistent mental illness.Outlook 1992;2(2):2–5.

    Google Scholar 

  58. Koyanagi C, Manes J, Surles R, et al.: On being very smart: The mental health community’s response in the health care reform debate.Hospital and Community Psychiatry 1993;44:537–542.

    PubMed  CAS  Google Scholar 

  59. Curtis JL, Millman EJ, Struening E, et al.: Effect of case management on rehospitalization and utilization of ambulatory care services.Hospital and Community Psychiatry 1992;43:895–899.

    PubMed  CAS  Google Scholar 

  60. Hornstra RK, Bruce-Wolfe V, Sagduyu K, et al.: The effect of intensive case management on hospitalization of patients with schizophrenia.Hospital and Community Psychiatry 1993;44:844–847.

    PubMed  CAS  Google Scholar 

  61. Lipsey MW, Wilson DB: The efficacy of psychological, educational, and behavioral treatment: Confirmation from meta-analysis.American Psychologist 1993;48:1181–1209.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychology, Indiana University-Purdue University at Indianapolis, LD 3124, 402 N. Blackford St., 46202-3275, Indianapolis, IN

    Gary R. Bond Ph.D. (Professor), John H. McGrew Ph.D. (assistant professor of psychology) & Dawn M. Fekete (doctoral student in psychology)

Authors
  1. Gary R. Bond Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. John H. McGrew Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dawn M. Fekete
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Preparation of this article was supported by the Research Scientist Development Award KO2 MH00842 from the National Institute of Mental Health.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bond, G.R., McGrew, J.H. & Fekete, D.M. Assertive outreach for frequent users of psychiatric hospitals: A meta-analysis. The Journal of Mental Health Administration 22, 4–16 (1995). https://doi.org/10.1007/BF02519193

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02519193

Keywords

Search

Navigation