social treatment for schizophrenia - act Flashcards
(29 cards)
1
Q
what does ACT stand for?
A
- assertive community treatment
2
Q
what is assertive community treatment (ACT)
A
- intensive and integrated approach for community mental health
- targets outpatients with serious functioning difficulties
- focuses on areas like work, social relationships, independence, money management, and physical health
- designed for those with severe mental illness symptoms
3
Q
how is assertive community treatment (ACT) linked to deinstitutionalisation
A
- ACT developed in response to the closing of psychiatric hospitals in the 1970s
- deinstitutionalisation led to many patients being discharged
- strong community support was needed for these individuals
- originally called Training in Community Living, later renamed Program of Assertive Community Treatment (PACT)
- developed by Stein and Test in the early 1970s
4
Q
what makes assertive community treatment (ACT) a model of exemplary mental health practice
A
- regarded as a model of exemplary mental health practice (Dixon, 2000)
- accepted and implemented worldwide
- provides concrete help for community integration of clients with severe mental illness (SMI)
- helps individuals, including those with schizophrenia, integrate into the community
5
Q
what is the focus of assertive community treatment (ACT) for schizophrenia
A
- used for clients with difficulty meeting personal goals, getting along with others, and living independently
- particularly effective for patients with frequent relapses and hospitalisations
- helps improve community integration and social functioning for individuals with schizophrenia
6
Q
what is the care programme approach (CPA)
A
- treatment process for people with complex mental health conditions
- ensures individuals receive the right treatment for their needs
- focuses on providing appropriate care and support
7
Q
what are the four stages of the care programme approach (CPA)
A
- assessment – health and social needs are assessed
- care plan – a plan is created to meet health and social needs
- key worker appointed – usually a social worker or nurse, acts as first contact with CMHT
- reviews – treatment is regularly reviewed, and care plan changes can be made if needed
8
Q
what is the team approach in ACT
A
- multi-disciplinary team focuses on keeping patients in contact with services
- aims to reduce hospital admissions and improve social functioning and quality of life
- team includes psychiatrists, nurses, social workers, employment specialists, and substance abuse counsellors
- team meets daily to discuss, problem-solve, and plan treatment
- the entire team shares responsibility for each client, contributing their expertise as needed
9
Q
what is the holistic approach in ACT
A
- provides integrated support in areas like medications, physical health care, housing, finances, employment, and social relationships
- focuses on everything critical to an individual’s success in living
- aims to address the whole person, not just mental health symptoms
10
Q
what are the low client-staff ratios in ACT
A
- ensures adequate individualisation of services
- a 10:1 ratio is commonly used, but may vary based on individual needs
- allows for more personalised care and attention for each patient
11
Q
what is the locus of contact in the community in ACT
A
- 80% or more of contacts should be outside the office, often in the client’s home
- ‘in vivo’ contact in natural settings where clients live, work, and interact
- makes assessments more valid and skills are more likely to generalise to real-life situations
12
Q
what is the medication management in ACT
A
- top priority in ACT
- careful assessments of diagnosis and target symptoms
- well-reasoned choices of medications
- appropriate dosing and duration of therapy
- management of side effects
- follows evidence-based practice guidelines
13
Q
what is the focus on everyday problems in living in ACT
A
- ACT teams focus on ordinary daily activities and chores
- addresses pressing needs like securing housing, meeting appointments, cashing cheques, and shopping
- aims to improve practical life skills and daily functioning for clients
14
Q
what is the rapid access in living in ACT
A
- responds quickly to client emergencies, even after regular hours
- proactive working helps anticipate trouble and prevent crises
- reduces emergency callouts by addressing issues before they escalate
15
Q
what is assertive outreach in ACT
A
- involves persistent engagement with reluctant clients
- continues contact even if clients miss appointments
- no automatic termination of contact after missed appointments
- ensures ongoing support, especially in initial stages and beyond
16
Q
what is individualised services in ACT
A
- treatments and supports are individualised to meet clients’ needs and preferences
- clients are a heterogeneous population with diverse needs
- ACT teams have broad knowledge of community resources and funding
- increases options for clients, such as choosing where they live
17
Q
what is time-unlimited services in ACT
A
- clients do not graduate from the program when their situation stabilises
- continue receiving ACT assistance on a lifelong basis
- promotes development of long-term, stable, and trusting therapeutic relationships
- based on studies showing that clients regressed after leaving short-term programs
- some believe the principle should be modified for clients showing substantial improvement
18
Q
other things (s)
A
- one of the most extensively researched community care models
- evidence shows ACT is consistent across many studies and reviews
- proven to be effective in managing care of people with severe mental illness in the community
19
Q
what are the benefits of targeting ACT at high users of in-patient care (other things)
A
- can substantially reduce hospital care costs
- helps improve outcomes for patients
- increases patient satisfaction with treatment and support
20
Q
what did bond et al. (2001) find about the effectiveness of ACT (supporting)
A
- based on 25 randomised controlled trials
- ACT is highly successful in engaging clients in treatment
- substantially reduces hospital use
- increases housing stability
- moderately improves symptoms and subjective quality of life
21
Q
what did marshall and lockwood (1998) find about ACT (supporting + CA)
A
- found improved employment and patient satisfaction
- CA: no significant differences in mental state
- no significant differences in social functioning
22
Q
other things: staff (s)
A
- provides increased continuity of care over time
- reduces staff burnout
- patients work with large multidisciplinary teams
- responsibility is shared, improving support and outcomes
23
Q
who does ACT specifically target
A
- individuals with the most complex and severe problems
- those who do not respond well to less intensive treatments
- frequent users of emergency psychiatric services
- especially those with high use of inpatient care
24
Q
when are complaints about ACT services more common (w)
A
- more common in ACT programs with low fidelity
- occurs when services deviate from the standard ACT model
25
what do some clients think about ACT services (w)
- a **small minority** (11% in one study) find ACT too **intrusive or confining**
- some believe it may **foster dependency**
26
what ethical criticism did gomory (2001) make about ACT (opposing)
- argued ACT programs can be **coercive or paternalistic**
- not based on **client choice**
- patients may **surrender responsibility** for decisions
- raises ethical concerns about **personal control and autonomy**
- based mainly on **anecdotes and theoretical arguments**, not empirical evidence
27
how flexible is ACT across different client backgrounds (s)
- ACT is **very flexible** across a wide range of clients
- effective regardless of **age, gender, education, or cultural background**
- no background factors have been shown to **limit its effectiveness**
28
how does ACT help clients with hospitalisation and daily life (s)
- helps clients **avoid hospitalisation**, including **involuntary commitments**
- enables clients to **live more normal lives** outside of inpatient care
29
what does research say about client satisfaction with ACT (s)
- ACT leads to **greater client satisfaction** than standard services
- satisfaction is **similar across genders, age, and background**
