Outcomes of Assertive Community Treatment for Adolescents with Complex Mental Health Problems Who are Difficult to Engage

Abstract

Assertive community treatment (ACT) is a well-established treatment for adults with mental illness and has an emerging evidence base for improving mental health outcomes for adolescents. Recent studies have utilized ACT with adolescents who are difficult to engage through traditional psychiatric services. The Assertive Mobile Youth Outreach Service (AMYOS) of Children’s Health Queensland in Australia provides ACT for families of adolescents with severe and persistent mental health problems, who have been unable to engage successfully through the standard mental health support services provided by community clinics. AMYOS clinicians work flexibly to engage adolescents in an individualized plan aimed at reducing risk of harm, supporting recovery, improving overall functioning, and engagement with education and vocational pathways. This study reports outcomes for adolescents involved in the first five years of the AMYOS program. Overall, there were significant improvements over time on questionnaires of global functioning, perceived suicidality, hostility and a wide range of mental health problems, as rated by clinicians and families. There were also significant reductions in average monthly duration and number of hospital admissions during AMYOS treatment compared with 12 months prior to referral. Increases in visits to Emergency Department during treatment did not translate into hospitalization, suggesting adolescents were better monitored when at-risk. There was also increased engagement in school and standard healthcare. This provides further evidence that provision of assertive community treatment is associated with improved mental health outcomes for at-risk adolescents. Future research could include comparison groups and investigate possible mechanisms for change.