The effect of youth assertive community treatment: a systematic PRISMA review

Richard Vijverberg,Robert Ferdinand,Berno Van Meijel,Aartjan Beekman

doi:10.1186/s12888-017-1446-4

Abstract

BackgroundDuring the past decades deinstitutionalisation policies have led to a transition from inpatient towards community mental health care. Many European countries implement Assertive Community Treatment (ACT) as an alternative for inpatient care for “difficult to reach” children and adolescents with severe mental illness. ACT is a well-organized low-threshold treatment modality; patients are actively approached in their own environment, and efforts are undertaken to strengthen the patient’s motivation for treatment. The assumption is that ACT may help to avoid psychiatric hospital admissions, enhance cost-effectiveness, stimulate social participation and support, and reduce stigma.ACT has been extensively investigated in adults with severe mental illness and various reviews support its effectiveness in this patient group. However, to date there is no review available regarding the effectiveness of youth-ACT. It is unknown whether youth-ACT is as effective as it is in adults. This review aims to assess the effects of youth-ACT on severity of psychiatric symptoms, general functioning, and psychiatric hospital admissions.MethodA systematic literature search was conducted in PubMed, Cochrane Library, PsychINFO and CINAHL published up to March 2017. To assess methodological quality of the included studies, the Oxford Centre of Evidence-Based Medicine grading system was used.ResultsThirteen studies were included in this review. There are indications that youth-ACT is effective in reducing severity of psychiatric symptoms, improving general functioning, and reducing duration and frequency of psychiatric hospital admissions.ConclusionsThe current literature on youth-ACT is limited but promising. There are indications that youth-ACT is effective in reducing severity of psychiatric symptoms, improving general functioning, and reducing duration and frequency of psychiatric hospital admissions. The effect of youth-ACT may be comparable with the effect of ACT in adults. Similar as in adult ACT, the studies on youth-ACT found effects that vary from small to large. Randomized experimental research designs are needed to further corroborate effectiveness.

Highlights

During the past decades deinstitutionalisation policies have led to a transition from inpatient towards community mental health care
There are indications that youth-Assertive Community Treatment (ACT) is effective in reducing severity of psychiatric symptoms, improving general functioning, and reducing duration and frequency of psychiatric hospital admissions
The effect of youth-ACT may be comparable with the effect of ACT in adults

Summary

Introduction

During the past decades deinstitutionalisation policies have led to a transition from inpatient towards community mental health care. Many European countries implement Assertive Community Treatment (ACT) as an alternative for inpatient care for “difficult to reach” children and adolescents with severe mental illness. ACT has been extensively investigated in adults with severe mental illness and various reviews support its effectiveness in this patient group. Over the past decades, a transition has taken place from inpatient to community mental health care for individuals with a severe mental illness. The World Health Organization (WHO) Europe has declared assertive outreach care a necessary alternative for inpatient care. This is because treatment focuses on strengthening the patient’s autonomy by enhancing skills and coping, and by collaboration with relatives and the broader social network. In Europe, 22 out of 42 countries have policies and/or legislation requiring that individuals with severe mental disorders have access to Assertive Community Treatment or assertive outreach related services [10]

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