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Purpose This Multicenter Youth Flexible ACT Study examined the effect of Youth Flexible Assertive Community Treatment on symptomatic, social, and personal recovery outcomes of adolescents dealing with multifaceted psychiatric and social care needs who do not readily engage in regular office-based mental health services. Methods Newly admitted clients (n = 199) aged 12–24 years from 16 Youth Flexible ACT teams participated in this observational prospective cohort study. Client and practitioner questionnaires were administered every 6 months, up to 18 months. Latent growth curve analyses were conducted to examine changes in symptomatic, social, and personal recovery outcomes throughout Flexible ACT. Results Our analyses of client-reported outcomes showed a decrease in overall psychosocial difficulties, depressive symptoms, and subclinical psychosis symptoms. Moreover, outcomes showed improved social interaction with peers, quality of life, and feelings of empowerment and fewer contacts with the police/legal system. In addition, analyses of clinician-reported outcomes showed a decrease in problems related to family life, peer relationships, school/work attendance, emotional symptoms, and attentional problems. Problems related to personal finance, school and work status, substance misuse, disruptive and aggressive behavior, self-injury, and self-care and independence remained unchanged. Conclusion Our results showed that clients participating in Youth Flexible ACT improved in symptomatic, social, and personal recovery outcomes over 18 months. With its integrated approach and personalized care, this service delivery model is promising for adolescents unable to engage successfully in regular (office based) mental health support services.

According to much of suicide prevention literature the strongest risk factor predictive for suicide is previous suicide attempt or deliberate self-harm. While many assessed at Sunshine Hospital Emergency Department are deemed to be in the low to medium risk category upon discharge, longitudinal risk factors remain. In 2009 Mid West Area Mental Health Service (MWAMHS) management identified an opportunity for service development and funding was secured to employ a senior clinician to provide a post ED Assertive Linkage Service (ALS). A primarily phone based community linkage service was considered the most sustainable model. In an effort to evaluate the efficacy of the ALS intervention and ultimately inform the design of the service a program evaluation was undertaken which posed the question; Does an assertive linkage service intervention for clients presenting to the Sunshine Hospital Emergency department with deliberate self- harm improve service access, quality of life and client satisfaction? The aim of the Assertive Linkage Study was to conceptualise a social work intervention that involved assertive follow-up, support and therapeutic linkage for those who presented to the Sunshine Hospital emergency department with deliberate self-harm, suicidal ideation or suicide attempt. Demographic and clinical characteristics of patients in this cohort were identified and the impact of the intervention was measured. Many of the findings were consistent to those of other comparable studies. The sample population risk for repeat suicidal behaviours was significant and the ED representation rates were high. The needs profile of the ALS cohort was generally diverse and sometimes complex demanding a flexible and eclectic approach from the ALS clinician. Social work practice needed to be client-centred and the ALS clinician could not assume that all who presented would be receptive to or perceive the need for formal community-based support. On balance the ALS intervention appear

Initially developed in the United States, the Assertive Community Treatment (ACT) has expanded to Canada, Sweden and the UK and is being implemented in an increasing number of countries, amongst them Spain. While supported by solid scientific evidence, ACT has also being criticised for being too intrusive into the private lives of individuals with mental health problems. Recent literature suggests that a collaborative approach may be appropriate in order to resolve the ethical dilemmas posed by ACT as well as to promote social integration of people with serious mental illness. Such objectives require the active involvement within ACT teams of social workers, professionals who possess the specific skills needed to promote empathy and integration according to a bio-psychosocial approach to mental health.