What is Assertive Outreach?

Known as Assertive Community Treatment (ACT) in the United States, a huge, and largely US, literature and research base underpins this model. Assertive Outreach is not a treatment but a way of organising and delivering care via a specialised team to provide intensive, highly coordinated and flexible support and treatment for clients with longer term needs living in the community.

Specifically those referred to Assertive Outreach are people with whom mainstream mental health services have found it difficult to engage, and with histories including a severe and enduring mental illness, social chaos, high use of inpatient beds, and with multiple complex needs. To be effective teams must deliver a mix of evidence based psychosocial intervention and intensive practical support from multi-skilled and multi-disciplinary practitioners. The focus of the work must be on engagement and rapport, building up, often over the long-term, strong relationships. Effective teams aim to replicate the findings of numerous international randomised controlled trial studies comparing ACT with standard care. These outcomes for ACT are summarised as:




  Large impact on:
 
  Engagement
  Housing
  Bed use (not replicated in UK)
 

  Moderate impact on:
 
  Symptoms
  Quality of life
 

  Weak impact on:
 
  Employment
  Substance use
  Jail and legal problems
  Social adjustment
 
Assertive Outreach team features
 
  • Delivery by a discrete multi-disciplinary team able to provide a full range of interventions.
  • Most services provided directly by team not brokered out.
  • Low staff to client ratios (maximum 1:12).
  • Most interventions provided in community settings.
  • Emphasis on engagement and maintaining contact with clients.
  • Caseloads shared across clinicians, staff know and work with the entire caseload although a CPA care coordinator is allocated and responsible.
  • Highly coordinated intensive service with brief daily handover meetings and weekly
    clinical review meetings.
  • Availability out-of -hours and a seven day a week service with capacity to manage crises and increase contact to daily according to need.
  • Time-unlimited service whilst there is evidence of benefit, or continuity of care according to need.


Further reading:
 
Burns. T. and Firn. M. (2002) Assertive Outreach  in Mental Health. A Manual for Practitioners. Oxford University Press, Oxford.

Department of Health (2001). The Mental Health Policy Implementation Guide. DoH, London.

Marshall. M and Lockwood. A. (1998) Assertive Community Treatment for People with Severe Mental Disorders (Cochrane Review). The Cochrane Library (3).