Bromley Elizabeth, Mikesell Lisa, Whelan Fiona, Hellemann Gerhard, Hunt Marcia, Cuddeback Gary, Bradford Daniel W, Young Alexander S
Desert Pacific VA Mental Illness Research, Education and Clinical Center (MIRECC), West Los Angeles VA Healthcare Center, Los Angeles, USA.
Semel Institute for Neuroscience and Human Behavior, UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, USA.
Community Ment Health J. 2017 Nov;53(8):916-921. doi: 10.1007/s10597-017-0083-1. Epub 2017 Jan 23.
We sought to explore clinical factors associated with successful transition from Assertive Community Treatment to less intensive clinical services. Mixed-method observational follow up study of veterans discharged from three VA-affiliated ACT teams to less intensive clinical services. Of the 240 veterans in ACT, 9% (n = 21) were discharged during the study period. Among the 11 of 21 discharged veterans who enrolled in the follow up study, reason for discharge, designated by the veteran's primary clinician at the time of discharge, predicted outcomes (p = 0.02) at 9 months, with "disengagement" as a reason for discharge predicting poorer outcomes. Six of 11 veterans experienced poor outcomes at 9 months, including incarceration and substance use relapse. ACT clinicians rarely discharge clients. Many clients may experience negative clinical events following ACT discharge, and clients may be difficult to follow post-discharge. Client disengagement from ACT may indicate higher likelihood of poor outcomes following discharge to less intensive clinical services.
我们试图探究与从积极社区治疗成功过渡到强度较低的临床服务相关的临床因素。对从三个退伍军人事务部附属的积极社区治疗团队出院并转向强度较低临床服务的退伍军人进行了混合方法观察性随访研究。在接受积极社区治疗的240名退伍军人中，9%（n = 21）在研究期间出院。在参与随访研究的21名出院退伍军人中的11名中，退伍军人的主治医生在出院时指定的出院原因预测了9个月时的结果（p = 0.02），以“脱离接触”作为出院原因预测结果较差。11名退伍军人中有6名在9个月时经历了不良结果，包括监禁和药物使用复发。积极社区治疗的临床医生很少让患者出院。许多患者在积极社区治疗出院后可能会经历负面临床事件，并且患者出院后可能难以随访。患者从积极社区治疗中脱离接触可能表明转至强度较低的临床服务后出现不良结果的可能性更高。
