ABSTRACT
OBJECTIVE: The purpose of the study was to determine whether use of inpatient services at a state hospital was reduced by implementation of an assertive community treatment program among persons in one of the hospital's catchment areas who were at high risk for rehospitalization. METHODS: Bed-day utilization by program participants during the fiscal year before the program was implemented (1986) and three subsequent fiscal years was compared with utilization by persons in catchment areas not served by the program. For the 66 program participants, hospital use during the year before program intake was compared with use in the year after intake using t tests. RESULTS: Utilization of bed-days by persons in the program's catchment area was reduced by 28 percent in the third fiscal year after program implementation, compared with an increase of 15 percent among persons in the hospital's other catchment areas. In the year after the program was implemented, participants were hospitalized a mean of 27.7 days, compared with a mean of 80 days in the year before the program. CONCLUSIONS: The assertive community treatment program significantly reduced use of inpatient days and improved continuity of care.
Subject(s)
Bed Occupancy/economics , Community Mental Health Services/economics , Hospitalization/economics , Mental Disorders/rehabilitation , Adult , Affective Disorders, Psychotic/economics , Affective Disorders, Psychotic/psychology , Affective Disorders, Psychotic/rehabilitation , Chronic Disease , Continuity of Patient Care/economics , Cost Control , Female , Follow-Up Studies , Hospitals, Psychiatric/economics , Hospitals, State/economics , Humans , Length of Stay/economics , Male , Mental Disorders/economics , Mental Disorders/psychology , Patient Readmission/economics , Schizophrenia/economics , Schizophrenia/rehabilitation , Schizophrenic PsychologyABSTRACT
Discusses historical, policy, and research perspectives on assertive community treatment (ACT) and their relationship to 5 commentaries accompanying our recent article (Bond et al., 1990). Collectively, the commentaries focused on self-help groups, missing the point of the study. Further, the commentaries contained several misconceptions centering on a confusion between deliberate sampling based on policy-driven considerations and self-selection into voluntary organizations. In the time since the Stein and Test (1980) demonstration, programs based on ACT principles have become one of the dominant approaches to community mental health services, especially for consumers who do not readily use office-based treatment. The research foundation is robust and is rapidly evolving. Some community psychologists may be responding to outdated and inaccurate stereotypes of mental health services.
Subject(s)
Assertiveness , Behavior Therapy/methods , Community Mental Health Services , Behavior Therapy/history , Community Mental Health Services/organization & administration , Health Policy , Health Services Research , History, 20th Century , Humans , Self-Help Groups/history , United StatesABSTRACT
Evaluated a large-city adaptation of the assertive community treatment (ACT) model (Stein & Test, 1980). Outcomes were examined after 1 year for 82 clients, averaging over 17 lifetime psychiatric hospitalizations, randomly assigned either to ACT or to a drop-in (DI) center. After 1 year, 76% of the ACT clients and only 7% of DI clients were involved in the respective programs. The ACT team averaged 2 home and community visits per week to each client. ACT clients averaged significantly fewer state hospital admissions and state hospital days than did DI clients. ACT clients reported greater satisfaction with program services, fewer contacts with the police, and less difficulty with practical problems associated with psychiatric readmission. More ACT clients were known to have stable community housing. Annual per-client treatment costs for ACT were estimated to be $1,500 less than for DI.
Subject(s)
Assertiveness , Behavior Therapy/methods , Community Mental Health Services , Mental Disorders/therapy , Adolescent , Adult , Aged , Analysis of Variance , Chicago , Community Mental Health Services/statistics & numerical data , Female , Hospitals, Psychiatric/statistics & numerical data , Humans , Male , Middle Aged , Patient Participation , Patient Readmission/economics , Program Evaluation , Random Allocation , Urban PopulationABSTRACT
This study compared outcomes for demographically matched clients four months after their admission to two short-term crisis programs. The programs provided crisis housing and case management services as alternatives to psychiatric hospitalization for clients with severe and persistent mental illness. One program met housing needs by purchasing shelter in hotels and boarding houses, and the other provided lodging in an eight-bed crisis house. In both programs, two-thirds of the clients avoided hospitalization during four-month follow-up, and both programs were effective in stabilizing clients' housing and financial situations. Clients in the purchase-of-housing program showed an increase in substance abuse problems at follow-up. Average client costs were similar in the two programs. A critical program difference was the substantially higher staff turnover in the crisis house, which was later replaced with scattered-site crisis housing.