Tommy Nordén

Resource Group Assertive Community Treatment (RACT) as a Tool of Empowerment for Clients with Severe Mental Illness: A Meta-Analysis

The aim of the current meta-analysis was to explore the effectiveness of the method here labeled Resource Group Assertive Community Treatment (RACT) for clients with psychiatric diagnoses as compared to standard care during the period 2001 – 2011. Included in the meta-analysis were 17 studies comprising a total of 2263 clients, 1291 men and 972 women, with a weighted mean age of 45.44 years. The diagnoses of 86 % of the clients were within the psychotic spectrum while 14 % had other psychiatric diagnoses. There were six randomized controlled trials and eleven observational studies. The studies spanned between 12 and 60 months, and 10 of them lasted 24 months. The results indicated a large effect-size for the ”grand total measure” (Cohen´s d = 0.80). The study comprised three outcome variables: Symptoms, Functioning, and Well-being. With regard to Symptoms, a medium effect for both randomized controlled trials and non-randomized studies was found, whereas Functioning showed large effects for both types of design. Concerning Well-being both large and medium effects were evident. The conclusions of the meta-analysis were that the treatment of clients with Resource Group Assertive Community Treatment yields positive effects for clients with psychoses and that the method may be of use for clients within the entire psychiatric spectrum.

Involving clients and their relatives and friends in psychiatric care: Case managers' experiences of training in resource group assertive community treatment

The purpose of this project was to do a qualitative study of an integrated and flexible ACT model, the Resource Group Assertive Community Treatment (RACT), as seen from the perspective of case managers in training. The resource group normally consists of the client, the case manager and other available personnel in the medical and support areas, as well as family members. Nineteen theses were randomly chosen from a set of 80 theses written by a group of Swedish trainee case managers. The exams were conducted as case studies and concerned 19 clients with psychotic problems, 11 men and 8 women. “The Empirical Phenomenological Psychological Method” was used in the analysis, which generated five overarching themes: (a) the RACT program; (b) the resource group; (c) the empowerment of the client; (d) progress in treatment; and (e) the case manager. These together constituted a “therapeutic circle,” in which methods and tools used within the RACT made it possible for the resource group to empower the clients who, as a result, experienced progress with treatment, during which the case manager was the unifying and connecting link.

Absence of Positive Results for Flexible Assertive Community Treatment. What is the next Approach

Aims were to review results of the five psychiatric studies on Flexible Assertive Community Treatment (FACT) published during 2007-2013, and to compare FACT with Resource-group Assertive Community Treatment (RACT) which specifically focuses on empowerment and rehabilitation of clients in the stable phase. During 2007 articles appeared in scientific journals arguing in favor of the need for the development of the treatment method Assertive Community Treatment (ACT). A particularly notable article was one that featured a Dutch version of ACT, namely FACT. The initiative received great sympathy given that clinical practice and research showed that both American and British versions of ACT were in need of new impulses to be able to maintain an optimal level of care. Seven years have passed since the Dutch model was international presented and five empirical studies about FACT have been published and therefore a first critical examination of FACT was conducted. The review indicated that the five empirical studies failed to show that FACT involves improvement of the clients in terms of symptoms, functioning, or well-being. The conclusions were that at present there is no evidence for FACT and that RACT with its small, flexible ACT teams, where the client him/herself is included and decides on the treatment goals, might be able to provide new impulses and a new vitality to the treatment mode of an assertive community treatment.

Resource Group ACT (RACT) – A Review of an Integrative Approach to Psychoeducation of Individual Families Involving the Patient

Abstract: The implementation of evidence-based treatment methods for patients with severe mental illness must be deeply rooted in clinical case management and an ACT service delivery model, where the patient user can be involved in shared-decision making in the cycle of “assess-plan-act-follow up-feedback”. In order to prepare and empower the client for the new role as a participating decision maker in the management of his/her own illness, various psychoeducational strategies are employed. The original ‘family unit in the community’ of the Integrated Mental Health Care program (IC) was developed step-by-step through practice-based evidence and clinical expertise to include significant others as resource persons in a so called Resource Group, and therefore the program was subsequently named as “Resource group ACT” (RACT). The service delivery by community mental health teams involving the patient by way of resource groups as well as the psychoeducational treatment conditions involving both individual patients and family groups may contribute to the understanding of how RACT added clinical effectiveness in functioning and satisfaction.

Fidelity in Mental Health Services: Clinical Strategies for Implementing Resource Groups

We investigated whether or not people working in the fields of psychiatry and social work who do not have experience in assessing the fidelity of resource group assertive community treatment could use a new manual for the Clinical Strategies Implementation Scale–Revised (CSI–R) in a reliable and valid fashion. Participants were 4 men and 17 women who were caregivers recruited from psychiatric and social-work clinics in Middle Sweden. The study was conducted using a combination of quantitative and qualitative techniques. The caregivers were asked to rate 2 fictional cases individually and thereafter discuss their assessments in focus groups. Results indicated acceptable values for homogeneity, criterion validity, and divergent validity. We concluded that people working in the fields of psychiatry and social work who are inexperienced in using the CSI-R can use it in a reliable and valid way with the help of the new manual, and that the procedure used to conduct the study can be used as a model for a brief educational program or seminar.

The Hourglass Model: Are There Structural Problems with the Scarcity of Positive Results for Flexible ACT?#

The aim of the present article was to discuss the commentary by van Veldhuizen, Delespaul and Mulder (2015) regarding the review by Nordén and Norlander (2014) based on five empirical articles about Flexible Assertive Community Treatment (FACT). Veldhuizen et al. agree on that there is insufficient evidence for the effectiveness of FACT. However, van Veldhuizen et al. avoid a discussion of the lack of positive results despite extensive research during several years and therefore an analysis of why FACT did not fare better is missing. According to FACT it is an advantage that one single team spans the entire chain of care and rehabilitation, but no evidence is given for such an opinion. Instead there may be difficulties for the staff to shift between psychiatric care and psychiatric rehabilitation and the clients perhaps don’t want to encounter the same professional team during all phases of care and rehabilitation.

Involving clients and their relatives and friends in psychiatric care: : Case managers' experiences of training in resource group assertive community training

The purpose of this project was to do a qualitative study of an integrated and flexible ACT model, the Resource Group Assertive Community Treatment (RACT), as seen from the perspective of case managers in training. The resource group normally consists of the client, the case manager and other available personnel in the medical and support areas, as well as family members. Nineteen theses were randomly chosen from a set of 80 theses written by a group of Swedish trainee case managers. The exams were conducted as case studies and concerned 19 clients with psychotic problems, 11 men and 8 women. “The Empirical Phenomenological Psychological Method” was used in the analysis, which generated five overarching themes: (a) the RACT program; (b) the resource group; (c) the empowerment of the client; (d) progress in treatment; and (e) the case manager. These together constituted a “therapeutic circle,” in which methods and tools used within the RACT made it possible for the resource group to empower the clients who, as a result, experienced progress with treatment, during which the case manager was the unifying and connecting link.

Involving clients and their relatives and friends in psychiatric care: Case managers' experiences of training in resource group assertive community treatment: Resource group assertive community treatment

The purpose of this project was to do a qualitative study of an integrated and flexible ACT model, the Resource Group Assertive Community Treatment (RACT), as seen from the perspective of case managers in training. The resource group normally consists of the client, the case manager and other available personnel in the medical and support areas, as well as family members. Nineteen theses were randomly chosen from a set of 80 theses written by a group of Swedish trainee case managers. The exams were conducted as case studies and concerned 19 clients with psychotic problems, 11 men and 8 women. “The Empirical Phenomenological Psychological Method” was used in the analysis, which generated five overarching themes: (a) the RACT program; (b) the resource group; (c) the empowerment of the client; (d) progress in treatment; and (e) the case manager. These together constituted a “therapeutic circle,” in which methods and tools used within the RACT made it possible for the resource group to empower the clients who, as a result, experienced progress with treatment, during which the case manager was the unifying and connecting link.