Place-Based FACT: Treatment Outcomes and Patients' Experience with Integrated Neighborhood-Based Care.

Locating specialized mental healthcare services in the neighborhood of people with severe mental illnesses (SMI) has been suggested as a way of improving treatment outcomes by increasing patient engagement and integration with the local care landscape. The current mixed methods study aimed to examine patient experience and treatment outcomes in three Flexible Assertive Community Treatment (FACT) teams that relocated to the neighborhood they served, compared to seven teams that continued to provide FACT as usual from a central office. Routine Outcome Measurement (ROM) and care use data were analyzed to compare change in treatment outcomes for patients in place-based FACT (n = 255) and FACT as usual (n = 833). Additionally, retrospective in-depth interviews were conducted with twenty patients about their experience with place-based FACT. Quantitative analysis showed mental health admission days decreased more in place-based than FACT as usual, although this difference was small. Both groups showed improved quality of life, psychosocial functioning, and symptomatic remission rates, and decreased unmet and overall needs for care. There was no change over time in met needs for care, employment, and daily activities. Qualitative analysis showed that patients experienced place-based FACT as more accessible, a better safety net, a more personal approach, better integrated with other forms of care, involving their social network, and embedded in their neighborhood and daily environment. This study showed that location and integration matter to patients, and the long term impact of place-based FACT on treatment outcomes should be explored.

Same, same but different: Attention bias for food cues in adults and adolescents with anorexia nervosa.

OBJECTIVE: Attention processing for food may be biased in people with Anorexia Nervosa (AN). However, previous studies have had inconsistent results. This is likely to be due to indirect assessment of attention, which does not inform on the underlying attention processes, and/or the heterogeneity of participants across studies, testing either adults or adolescents with AN, that is, people at very different developmental and illness stages. METHOD: Eye-tracking was employed as a direct assessment of attention during a visual probe task with food versus non-food pictures. Attention bias for food was measured in 39 adults and 34 adolescents with AN and in 53 adults and 31 adolescents without AN. RESULTS: All participants had a direction bias for food, specifically for high-calorie food. However, adults with AN subsequently avoided maintaining attention on food versus non-food cues, compared to adults without AN. Adolescents with or without AN demonstrated increased attention maintenance on food versus non-food cues, and, contrary to our hypothesis, did not differ in their attention bias for food cues. Accordingly, adults with AN differed significantly from adolescents with AN in attention maintenance for food cues: while adolescents with AN showed significantly increased attention maintenance on food stimuli, adults avoided maintaining attention on food cues. DISCUSSION: Adults with AN may apply attention strategies to facilitate restrictive eating. This strategy is absent in adolescents with AN. This difference in food-related attention bias between adolescents and adults with AN suggests that attention biases develop over time as the illness progresses.

Test-retest reliability of attention bias for food: Robust eye-tracking and reaction time indices.

This study assessed internal reliability and test-retest reliability of attention bias scores for food derived from the dot probe task. A visual dot probe task with food and non-food pictures (presented for 3000 ms) was administered to 53 healthy women on two occasions. Attention bias scores for food were calculated based on manual response latencies (reaction time bias) and concurrent assessment of eye-movements (direction bias and dwell-time bias). Subjective hunger and blood glucose levels were measured on both testing occasions. Dietary restraint and eating disorder symptoms were assessed during the second session. Results showed that direction bias had poor internal and test-retest reliability. Dwell time bias had excellent internal and acceptable test-retest reliability. Reaction time bias had acceptable internal and good test-retest reliability. Exploratory correlational analyses found that hunger, blood glucose, dietary restraint and eating disorder symptoms were not consistently significantly correlated with indices of attention bias for food. Overall, these findings contradict previous studies that reported low reliability of attention bias indices derived from the visual dot probe task. The implications are that a longer stimulus presentation time (i.e. ≥ 3000 ms), the use of eye-tracking and the use of appetizing stimuli can yield reliable attention bias scores for food. However, the interpretation of dot-probe scores of attention bias for food based on a dot probe task with 3000 ms presentation time and the score's relationship to theoretically relevant constructs such as hunger, eating restraint and eating disorder symptoms, require further clarification.