Psychiatr Serv 46:669-675, July 1995
© 1995 American Psychiatric Association
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PS 1995; 46:669-675
Copyright © 1995 by American Psychiatric Association
Assertive community treatment: an update of randomized trials
BJ Burns and AB Santos
Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA.
OBJECTIVE: Results of randomized clinical trials of assertive community
treatment for seriously mentally ill patients published between 1990 and
1994 are reviewed to synthesize the state of knowledge about this research
and to clarify continuing research directions. METHODS: Randomized trials
of interventions that used treatment principles and practices consistent
with the Program for Assertive Community Treatment model or close
adaptations whose results were published since 1990 were identified by
literature searches using MEDLINE and PsychLit and by contact with
investigators of ongoing trials. RESULTS: Controlled clinical trials have
been conducted with a wide range of severely mentally ill populations,
including patients in Great Britain, patients with recent-onset
schizophrenia, veterans, dually diagnosed clients, and homeless persons.
Methodological improvements in some studies include increased attention to
monitoring the experimental and comparison interventions, as well as larger
sample sizes and longer duration of the clinical trials than in earlier
efficacy trials. Strong positive effects of assertive community treatment
on hospital days and on patient and family satisfaction were found. Gains
in functional outcomes, such as employment, may require interventions
specifically targeted to these outcomes. CONCLUSIONS: Questions about the
role of assertive community treatment as time-limited treatment, as an
adjunct to other services and treatment, or as a comprehensive and
continuous service system for adults with severe mental illness require
further research. The growing research base should provide valuable
information on costs, outcomes, and indications for assertive community
treatment that can be evaluated by policy-makers.
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