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Successful engagement: a mixed methods study of the approaches of assertive community treatment and community mental health teams in the REACT trial

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Abstract

Background

The only randomised trial of assertive community treatment (ACT) carried out in England (the “REACT” study: randomised evaluation of assertive community treatment in North London) found no clinically significant advantage over usual care from community mental health teams (CMHTs). However, ACT clients were more satisfied and better engaged with services. To understand these findings better, we investigated the content of care and interventions offered to study participants.

Method

Quantitative data were collected to compare team structures and processes. Qualitative interviews with care co-ordinators of 40 of the 251 REACT study participants (20 ACT, 20 CMHT clients) were carried out and thematic analysis was used to explore differences in the approaches of the two types of team.

Results

CMHTs scored low for ACT model fidelity and ACTTs scored high or ACT-like. All staff cited client engagement as their primary aim, but ACT approaches were less formal, more frequent and more successful than CMHTs’. Two aspects of ACT appeared important for engagement: small case loads and the team approach. Successful client engagement appeared to be associated with greater staff satisfaction.

Conclusions

The findings from this study assist in understanding why the ACT approach is more acceptable to clients deemed by CMHTs as “hard to engage”. The key elements of ACT that facilitate client engagement may not be easily replicated within CMHTs due to their larger, varied caseloads.

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Acknowledgments

We would like to acknowledge the funding received for this study from Camden and Islington Health Authority. We wish to thank all the staff of Camden and Islington NHS Foundation Trust who took part. Conflict of interest The authors declare that they have no competing interests.

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Authors and Affiliations

  1. Dept. of Mental Health Sciences, Royal Free Campus, University College London, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK

    Helen Killaspy, Barbara Pierce & Michael King

  2. Camden and Islington NHS Foundation Trust, St. Pancras Hospital, London, UK

    Helen Killaspy, Sonia Johnson, Paul Bebbington, Fiona Nolan & Michael King

  3. Dept. of Mental Health Sciences, Bloomsbury Campus, University College London, London, UK

    Sonia Johnson & Paul Bebbington

  4. Centre for Outcomes Research and Effectiveness, University College London, London, UK

    Stephen Pilling & Fiona Nolan

Authors
  1. Helen Killaspy
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  2. Sonia Johnson
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  3. Barbara Pierce
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  4. Paul Bebbington
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  5. Stephen Pilling
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  6. Fiona Nolan
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  7. Michael King
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Corresponding author

Correspondence to Helen Killaspy.

Additional information

Harvey Whiteford served as a guest editor for the manuscript and was responsible for all editorial decisions, including the selection of reviewers. The policy applies to all manuscript with authors from the editor’s institution.

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Killaspy, H., Johnson, S., Pierce, B. et al. Successful engagement: a mixed methods study of the approaches of assertive community treatment and community mental health teams in the REACT trial. Soc Psychiat Epidemiol 44, 532–540 (2009). https://doi.org/10.1007/s00127-008-0472-4

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  • DOI: https://doi.org/10.1007/s00127-008-0472-4

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