Browsing by Subject "Assertive Community Treatment"

Now showing 1 - 4 of 4
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    Implicit Stigma of Mental Illness: Attitudes in an Evidence-Based Practice
    (2012-08-07) Stull, Laura Grace; McGrew, John H., 1953-; Salyers, Michelle P.; Rand, Kevin L.; Ashburn-Nardo, Leslie; Williams, Jane R.
    Stigma is a barrier to recovery for people with mental illness. Problematically, stigma also has been documented among mental health practitioners. To date, however, most research has focused on explicit attitudes regarding mental illness. Little research has examined implicit attitudes, which has the potential to reveal evaluations residing outside of conscious control or awareness. Moreover, research has tended to use a mixed sample of practitioners and programs. The extent to which both explicit and implicit stigma is endorsed by mental health practitioners utilizing evidence-based practices is unknown. The purposes of the current study were to 1) carefully examine implicit and explicit stigmatizing attitudes, or biases, among Assertive Community Treatment (ACT) staff and 2) explore the extent to which explicit and implicit biases predicted the use of treatment control mechanisms. Participants were 154 ACT staff from nine states. They completed implicit (Implicit Association Test) and explicit measures of stigma. Overall, participants exhibited positive explicit and implicit attitudes towards people with mental illness. When modeled using latent factors, implicit, but not explicit bias significantly predicted the endorsement of restrictive or controlling clinical interventions. Practitioners who perceived individuals with mental illness as relatively more dangerous and helpless (both explicit and implicit), as well as participants from Indiana and those with less education were more likely to endorse use of control mechanisms. Thus, despite overall positive attitudes toward those with mental illness for the sample as a whole, even low levels of stigma at the individual level were found to affect clinical care. Mental health professionals, and specifically ACT clinicians, should work to be aware of ways in which their biases influence how they intervene with consumers.
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    Parents Served by Assertive Community Treatment: A Needs Based Assessment
    (2013-08-29) White, Laura Morgan; McGrew, John H., 1953-; Salyers, Michelle P.; Rollins, Angela; Hazer, John
    Assertive Community Treatment (ACT) represents an effective treatment for individuals with severe mental illness. Though studies estimate that as many as half of all people with severe mental illness are parents, little is known about consumers receiving ACT services who are parents. Thus, the purpose of the present study was to 1) estimate the prevalence of parent ACT consumers, 2) identify current ACT team policies and practices for treating parent consumers, and 3) examine the perspective of parent consumers served by ACT teams. Quantitative and qualitative data were collected and analyzed via two separate studies. In study 1, eighty-two ACT providers from 76 teams across the United States and Canada were surveyed to determine the prevalence of parent ACT consumers, ACT team policies for identifying the parental status of consumers, treatment services available for parent consumers, and provider attitudes about parent consumers. Providers estimated roughly 21.6% of ACT consumers were parents. Less than half of providers (46.3%) reported formally asking about parental status during intake and only 20.7% providers belonged to ACT teams that provide special programs/services designed for parent consumers. The majority of providers (75.6%) reported negative or mixed attitudes about parents with severe mental illness. In study 2, seventeen parents with severe mental illness being served by ACT teams were interviewed about parenting, the relationship between parenting and severe mental illness, parenting needs, and suggestions for improved treatment services for parents. All parents were able to identify at least one positive aspect of parenting and most parents (76.5%) also identified negative aspects of parenting. Loss of custody emerged as a significant parenting problem, with the majority of parents (88.2%) experiencing loss of custody at least once. Given the difficulties of being a parent and having to manage a severe mental illness, parents expressed interest in several parent-focused treatment services, including family therapy, parenting skills, communication skills training, resources/finances for children, and social support groups with peers. When asked about overall satisfaction with ACT services, most participants with adult children (87.5%) reported having no unmet parent-related needs and high satisfaction (4.63 out of 5) with ACT services, whereas parents with young children (77.8%) reported having numerous unmet parenting needs and low satisfaction (3.78 out of 5) with ACT services. Thus, the age of participants’ children was a significant factor, indicating that the ACT treatment model may not be adequately serving parents of young, dependent children. Overall, findings suggest the need for more attention and focus on parent consumers, including formal identification of consumers’ parental status and improved parent-related treatment services and support
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    Re-Implementing Assertive Community Treatment: One Agency's Challenge of Meeting State Standards
    (2012-03-20) Godfrey, Jenna Lynn; Bond, Gary R.; Salyers, Michelle P.; McGrew, John H., 1953-; Horton-Deutsch, Sara L.
    Assertive Community Treatment (ACT) is a widely implemented evidence-based practice for consumers with severe mental illness. However, fidelity to the model is variable and program drift, in which programs decrease in fidelity over time, can occur. Given substantial variability in fidelity and program drift in evidence-based practices, a study to examine how to re-implement ACT to high fidelity on established teams was warranted. The present study examined three teams providing moderate fidelity services prior to a state-wide policy change to the definition of ACT. Two of the teams attempted to implement ACT in accordance with state standards, while the third team served as a quasi-control for factors related to other state policy changes, such as a change to the funding mechanism. The implementation effort was examined using qualitative and quantitative measures over a 14-month period at a large, psychosocial rehabilitation center. Themes that were common across all three teams included the perceived negative impact of fee-for-service, ambiguity of stipulations and lack of guidance from the Department of Mental Health (DMH), difficulties with the managed care organization, importance of leadership within the agency, and familiarity with the services. Perceived barriers specific to the implementation of ACT standards included DMH stipulations, staff turnover, lack of resources, and implementation overload, i.e., too many changes at once. One team also had the significant barrier of a misalignment of requirements between two funding sources. Staff attitudes represented both a facilitator and a barrier to ACT implementation, while management being supportive of ACT was viewed as a major facilitator. One of the two teams seeking ACT status was rated at high fidelity within 6 months and maintained high fidelity throughout the study. The other team seeking ACT status never achieved high fidelity and decertified from ACT status after 6 months. The agency’s focus on productivity standards during the implementation effort hampered fidelity on the two teams seeking ACT status and greatly contributed to burnout on all three teams. The team achieving ACT status overcame the barriers in the short-term; however, DMH requirements may have threatened the long-term sustainability of ACT at the agency.