Department of Reintegration and Community Care, Trimbos Institute, Utrecht, the Netherlands.
Tranzo Scientific Center for Care and Welfare, Department of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands.
JAMA Psychiatry. 2021 Dec 1;78(12):1309-1318. doi: 10.1001/jamapsychiatry.2021.2880.
Although the importance of recovery-oriented care for people with severe mental illness (SMI) is widely acknowledged, essential elements such as personalization and involvement of significant others are not adequately implemented in practice.
To determine whether using resource groups (RGs) within flexible assertive community treatment (FACT) has favorable effects on empowerment and recovery-related outcomes in people with SMI.
DESIGN, SETTING, AND PARTICIPANTS: This assessor-blind, multisite randomized clinical trial was conducted from September 1, 2017, to September 30, 2020, with follow-up at 9 and 18 months. A total of 158 participants aged 18 to 65 years meeting the criteria for SMI were randomly allocated to FACT plus RG vs FACT as usual (1:1) in 20 FACT teams throughout the Netherlands. Data were analyzed from September 1, 2020, to January 31, 2021. The study was prespecified in the trial protocol and data from the intent-to-treat population were analyzed.
In the FACT plus RG condition, patients chose members from their informal and formal networks to form an RG that meets quarterly to discuss self-formulated recovery goals. The RG was integrated into the multidisciplinary support provided by the FACT team. In the FACT as-usual condition, empowerment (defined as overcoming powerlessness and gaining control of one's life) and involvement of significant others was also part of the provided care, but without the structure of the RG.
The primary outcome was self-reported empowerment, measured with the Netherlands Empowerment List.
A total of 158 participants with SMI (median age, 38 [median absolute deviation, 13] years; 93 men [58.9%]) were randomized to FACT plus RG (n = 80) or FACT as usual (n = 78) care. Intention-to-treat analyses showed that randomization to the RG condition was associated with a clinically significant increase in empowerment (Cohen d, 0.54; 95% CI, 0.21-0.86) and improved outcomes with small to medium effect sizes in terms of quality of life (Cohen d, 0.25; 95% CI, -0.07 to 0.56), personal recovery (Cohen d, 0.38; 95% CI, 0.06-0.69), quality of social contact (Cohen d, 0.24; 95% CI, -0.07 to 0.56), disability (Cohen d, 0.29; 95% CI, -0.03 to 0.60), general functioning (Cohen d, 0.30; 95% CI, -0.01 to 0.62), and social functioning (Cohen d, 0.28; 95% CI, -0.04 to 0.59). No differences between conditions were found regarding psychopathological symptoms, attachment, frequency of social contact, and employment. Compared with FACT as usual, participants who stayed with the assigned treatment in the RG condition were more satisfied with treatment at 9 (Cohen d = 0.45; t135 = -2.62; P = .009) and 18 (Cohen d = 0.41; t116 = -2.22; P = .02) months.
These findings show that working with RGs improves empowerment and other mental health outcomes in people with SMI who receive community-based mental health services. This method of network-oriented care empowers people with SMI within their own environment.
Netherlands Trial Register Identifier: NL6548.
重要性：尽管针对严重精神疾病（SMI）患者的康复导向护理的重要性已得到广泛认可，但个性化和重要他人的参与等基本要素在实践中并未得到充分实施。
目的：确定在灵活的坚定社区治疗（FACT）中使用资源小组（RG）是否对 SMI 患者的赋权和康复相关结果有有利影响。
设计、地点和参与者：这是一项评估者盲法、多站点随机临床试验，于 2017 年 9 月 1 日至 2020 年 9 月 30 日进行，随访时间为 9 个月和 18 个月。共有 158 名年龄在 18 至 65 岁之间符合 SMI 标准的参与者被随机分配到 FACT 加 RG 与 FACT 常规护理（1:1），在荷兰的 20 个 FACT 团队中进行。数据分析于 2021 年 1 月 31 日从 2020 年 9 月 1 日开始进行。该研究在试验方案中预先指定，并对意向治疗人群进行了数据分析。
干预措施：在 FACT 加 RG 条件下，患者从他们的非正式和正式网络中选择成员组成 RG，每季度开会讨论自我制定的康复目标。RG 被整合到 FACT 团队提供的多学科支持中。在 FACT 常规护理条件下，赋权（定义为克服无力感并掌控自己的生活）和重要他人的参与也是提供的护理的一部分，但没有 RG 的结构。
主要结果和措施：主要结局是自我报告的赋权，使用荷兰赋权清单进行测量。
结果：共有 158 名患有 SMI 的参与者（中位数年龄为 38 [中位数绝对偏差为 13] 岁；93 名男性[58.9%]）被随机分配到 FACT 加 RG（n=80）或 FACT 常规护理（n=78）。意向治疗分析表明，随机分配到 RG 条件与赋权的临床显著增加相关（Cohen d，0.54；95%CI，0.21-0.86），并且在生活质量（Cohen d，0.25；95%CI，-0.07 至 0.56）、个人康复（Cohen d，0.38；95%CI，0.06-0.69）、社会接触质量（Cohen d，0.24；95%CI，-0.07 至 0.56）、残疾（Cohen d，0.29；95%CI，-0.03 至 0.60）、一般功能（Cohen d，0.30；95%CI，-0.01 至 0.62）和社会功能（Cohen d，0.28；95%CI，-0.04 至 0.59）方面有小到中等效应量的改善。在精神病理症状、依恋、社会接触频率和就业方面，两种条件之间没有差异。与 FACT 常规护理相比，在 RG 条件下继续接受分配治疗的参与者在 9 个月（Cohen d=0.45；t135=-2.62；P=0.009）和 18 个月（Cohen d=0.41；t116=-2.22；P=0.02）时对治疗的满意度更高。
结论和相关性：这些发现表明，在接受基于社区的精神卫生服务的 SMI 患者中，使用 RG 可以提高赋权和其他精神卫生结果。这种以网络为导向的护理方法在患者自己的环境中赋予 SMI 患者权力。
试验注册：荷兰试验登记号：NL6548。
