Successful engagement: a mixed methods study of the approaches of assertive community treatment and community mental health teams in the REACT trial
Abstract
Background The only randomised trial of assertive community treatment (ACT) carried out in England (the "REACT" study: randomised evaluation of assertive community treatment in North London) found no clinically significant advantage over usual care from community mental health teams (CMHTs). However, ACT clients were more satisfied and better engaged with services. To understand these findings better, we investigated the content of care and interventions offered to study participants.Method Quantitative data were collected to compare team structures and processes. Qualitative interviews with care co-ordinators of 40 of the 251 REACT study participants (20 ACT, 20 CMHT clients) were carried out and thematic analysis was used to explore differences in the approaches of the two types of team.Results CMHTs scored low for ACT model fidelity and ACTTs scored high or ACT-like. All staff cited client engagement as their primary aim, but ACT approaches were less formal, more frequent and more successful than CMHTs'. Two aspects of ACT appeared important for engagement: small case loads and the team approach. Successful client engagement appeared to be associated with greater staff satisfaction.Conclusions The findings from this study assist in understanding why the ACT approach is more acceptable to clients deemed by CMHTs as "hard to engage". The key elements of ACT that facilitate client engagement may not be easily replicated within CMHTs due to their larger, varied caseloads.
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- Authors
- Killaspy, H., Johnson, S., Pierce, B., Bebbington, P., Pilling, S., Nolan, F., & King, M.
- Affiliations
- The Royal Free Hospital (GB)
- St Pancras Hospital (GB)
- University College London (GB)
- Corresponding author
- Killaspy, Helen
- Venue
- Social Psychiatry and Psychiatric Epidemiology
- Published
- 2008-11-27
- Volume
- 44
- Issue
- 7
- Pages
- 532-540
- ISSN
- 0933-7954 (ISSN-L)
- 1433-9285
- OpenAlex
- W2095081860
- Cited by
- 55
- References
- 22
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 1 · 2023: 2 · 2021: 2 · 2020: 2 · 2019: 1 · 2018: 4 · 2017: 1 · 2016: 5 · 2015: 2 · 2014: 9 · 2013: 6 · 2012: 4
- FWCI
- 5.19
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Social Psychiatry and Psychiatric Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Health Sciences › Health Professions › General Health Professions › Mental Health and Patient Involvement
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- assertive community treatment, community mental health teams, customer engagement, REACT trial, team approach, staff satisfaction, model fidelity, mental health service delivery
- MeSH terms
- Assertiveness, Attitude of Health Personnel, Behavior Therapy, Mental Disorders, Community Mental Health Services, Humans, London, Patient Care Team, Professional-Patient Relations, Surveys and Questionnaires, Randomized Controlled Trials as Topic, Outcome Assessment, Health Care, Qualitative Research
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