Employment Rates in Flexible Assertive Community Treatment Teams in The Netherlands: An Observational Study.

We determined the proportions of clients treated in Flexible Assertive Community Treatment teams who were unemployed and gained employment and who were employed and lost employment. Secondly, we explored the demographical and clinical factors associated with employment. Data were collected during routine outcome monitoring. We calculated differences in employment rates over a year and explored differences in demographic characteristics at baseline between patient groups. Logistic regression analysis was used to estimate the role of clinical predictor variables on employment status. Over time, 10% remained employed, 5% lost their employment, 3% gained employment and 82% remained unemployed. Clients who found employment were younger, more often male, and had significantly fewer psychosocial problems and a higher subjective quality of life during follow-up than those who remained unemployed. Problems with motivation for treatment at baseline were related to losing employment or remaining unemployed. Better implementation of vocational services is very important for increasing the number of clients gaining employment.

Changes in individual needs for care and quality of life in Assertive Community Treatment patients: an observational study.

BACKGROUND: It is largely unknown which unmet needs in the Camberwell Assessment of Need Short Appraisal Schedule (CANSAS) need to be resolved in order to improve a patients' subjective quality of life (QoL). We therefore investigated the pattern of individual unmet needs over time and its relation to QoL over time. METHODS: Using data gathered from 251 patients in a Routine Outcome Monitoring procedure in Assertive Community Treatment (ACT) teams, we used paired samples tests to analyze differences in QoL total scores and the number of unmet needs between baseline and follow-up data. Ordinal regression was used to analyze the relationship between outcome in individual unmet needs and QoL. RESULTS: As well as small improvements in QoL over time in patients in contact with ACT, we found a small to moderate decrease in unmet needs over time. While a decreasing number of unmet needs was associated with an increase in QoL, outcomes in QoL and individual unmet needs were weakly related (r ≤ .165). Ordinal regression analysis showed that a better outcome in individual unmet needs related to accommodation and day-time activities was weakly related to a better outcome in QoL. CONCLUSIONS: Patients receiving ACT make small improvements in their QoL and ACT may help to solve some of their needs. QoL benefits from reducing needs for care, in particular the need for appropriate housing and meaningful daytime activities.

Defining multiple criteria for meaningful outcome in routine outcome measurement using the Health of the Nation Outcome Scales.

PURPOSE: Using the reliable and clinically significant change approach, we aimed to identify meaningful outcome indicators for the Health of the Nation Outcome Scales (HoNOS) and to combine them in a single model. We applied these indicators to the 1-year outcome of two large samples of people attending community mental health services in Italy (cohort 1) and the Netherlands (cohort 2). METHODS: Data were drawn from two studies on routine outcome assessment. The criteria for meaningful outcome were defined on both study cohorts and both language versions of the scale. The model combined (a) two criteria for adequate change (at least 4 or 8 points change), (b) two cut-offs for clinically significant change (a total score of 10 was the threshold between mild and moderate illness, 13 between moderate and severe illness), and (c) a method for classifying stable subjects in three degrees of severity (stable in mild, moderate or severe illness). Results were compared with those given by the effect size (ES) and analysis of variance and covariance (ANOVA and ANCOVA). RESULTS: For the proposed approach the outcome of cohort 1 was better than cohort 2, with 65-67% of its subjects showing a positive outcome compared to only 45-46%. The other reference methods (ES and ANOVA), however, showed a greater improvement for cohort 2. ANCOVA indicated that the differences were due to regression to the mean (RTM) which showed opposite effects across the two cohorts. CONCLUSIONS: The proposed approach proved valuable and generalizable for interpreting outcome on HoNOS, scarcely influenced by the RTM effect. Its introduction could benefit outcome evaluation and management.

Symptomatic and functional remission and its associations with quality of life in patients with psychotic disorder in Assertive Community Treatment teams.

OBJECTIVES: The aims of the present study were (1) to determine the proportion and characteristics of patients treated in Assertive Community Treatment teams who achieve symptomatic remission (SR) and/or functional remission (FR) and (2) to explore the association between both types of remission and (3) their bearing on quality of life (QoL). METHODS: Data comprised assessments from 278 patients who were repeatedly assessed using the Positive and Negative Syndrome Scale to assess SR, the Health of the Nation Outcome Scales to assess FR, and a shortened version of the Manchester Short Assessment to assess QoL. χ(2) Tests and a logistic regression analysis were used to analyze the relation between patient and treatment characteristics and achieving SR or FR. A Kruskal-Wallis test, Mann-Whitney U tests, and a logistic regression analysis were used to analyze the relationship between remission status and QoL. RESULTS: After a mean treatment duration of 2.4 years, 26% met the criteria for SR and 30% for FR. Prescription of antipsychotic medication was associated with achieving both SR and FR. Approximately half of the patients who achieved SR also achieved FR. Achieving FR was associated with better QoL. Patients in SR did not have better QoL than did patients not in SR. CONCLUSIONS: Remission of symptoms in patients treated in Assertive Community Treatment teams was not a prerequisite for FR or vice versa. FR, not SR, was associated with better QoL.

Duration of assertive community treatment and the interpretation of routine outcome data.

OBJECTIVE: Statistical inferences based on routine outcome monitoring data are susceptible to biases. Because this process may be influenced by differences in attrition and treatment duration, we wished to gain an insight into the relationship between treatment duration and clinical outcome. METHOD: We enrolled 569 assertive community treatment (ACT) team patients. As part of a six-monthly routine outcome monitoring (ROM) procedure, we used the Global Assessment of Functioning (GAF) scale, the Health of the Nation Outcome Scales (HoNOS), and a scale to assess their treatment motivation and satisfaction with services. Duration of ACT showed that treatment duration was short for 292 patients [≤ three ROM assessments; 11.6 months (SD = 6.1)], medium for 191 [four to six ROM assessments; 26.9 months (SD = 7.3)], and long for 86 [≥ seven ROM assessments; 44.06 months (SD=7.1)]. Chi-square and ANOVA were used to compare patient characteristics and baseline values across different treatment duration groups, and structural equation modelling was used to unravel interdependencies between the baseline and outcome variables. RESULTS: More patients receiving long-term ACT were diagnosed with a psychotic disorder and/or substance abuse than those whose treatment was shorter. Patients whose treatment lasted longer had worse baseline GAF and HoNOS scores than those whose treatment was shorter. Structural equation modelling showed that the interdependencies between determinants and outcome variables (concerning the relationships between both identical and non-identical variables over time) were different for each of the treatment duration categories. CONCLUSIONS: Patients in ACT teams with different treatment durations constitute distinguishable groups with different outcomes. This should be taken into account when using outcome data for benchmarking purposes.

Confabulation behavior and false memories in Korsakoff's syndrome: role of source memory and executive functioning.

AIMS: Confabulation behavior is common in patients with Korsakoff's syndrome. A distinction can be made between spontaneous and provoked confabulations, which may have different underlying cognitive mechanisms. Provoked confabulations may be related to intrusions on memory tests, whereas spontaneous confabulations may be due to executive dysfunction or a source memory deficit. METHODS: In 19 chronic Korsakoff patients, spontaneous confabulations were quantified by third-party rating (Likert scale). Provoked confabulations were assessed using the Dalla Barba Confabulation Battery. Furthermore, assessment of executive function was performed using an extensive neuropsychological battery. False memories (i.e. intrusions) and source memory were measured using twoparallelversions of a word-list learning paradigm (a modification of the Rey Auditory Verbal Learning Test). RESULTS: There were deficits in source memory, in which patients incorrectly assigned previously learned words to an incorrect word list. Also, Korsakoff patients had extensive executive deficits, but no relationship between the severity of these deficits and the severity of confabulation or intrusions on a memory task was found. CONCLUSION: The present findings provide evidence for a dissociation between spontaneous confabulation, provoked confabulation and false memories.