Search

Purpose Recent research on flexible assertive community treatment (FACT) for individuals with mild intellectual disabilities (MID) or borderline intellectual functioning (BIF) has shown positive results. This paper aims to identify which client variables are associated with treatment outcome of FACT. Design/methodology/approach Analyses were performed on assessments made during a six-year longitudinal study in The Netherlands. Data comprised assessments of 281 clients with at least 2 measurements. Treatment outcome was measured by the learning disability version of the Health of the Nation Outcomes Scales. Demographic variables and dynamic risk variables of the short version of the Dynamic Risk Outcome Scales were selected as potential predictor variables of outcome. Data were analysed using linear mixed models. Findings Limited awareness of the need for treatment, limited treatment motivation and cooperation, limited social skills, impulsivity and substance abuse were significantly associated with worse treatment outcome. None of the demographic variables influenced treatment outcome significantly, and neither did intelligence quotient or having a judicial or civil measure. Research limitations/implications Because of the observational design, no causal inferences can be drawn. Practical implications This study produces guidelines regarding nature and scope of the treatment supply and the competences of professionals working in FACT MID/BIF teams. Originality/value This paper encourages other countries to make assertive outreach available for people with MID/BIF on a larger scale, taking into account the acquired insights.

Individuals with mild intellectual disabilities (MID) or borderline intellectual functioning (BIF) and mental health problems or challenging behavior are difficult to reach by mainstream healthcare facilities and support organizations and frequently avoid the care they need. To improve the care for this client group in the Netherlands, the (Flexible) Assertive Community Treatment (ACT) model - originally developed for people with severe mental illness - was adapted and implemented by five organizations specialized in the care for people with MID/BIF and mental health problems or challenging behavior. After an introduction of the original ACT model and a description of the international state of the art of ACT for people with (M)ID/BIF, this paper describes the (Flexible) ACT‐MID/BIF model as developed and implemented in the Netherlands. Professionals' and clients' experiences with this new type of care are reported as well. Implications for clinical practice, policy and research are discussed.

Contains fulltext : 205950.pdf (Publisher’s version ) (Open Access) Background: Assertive community treatment (ACT) and Flexible assertive community treatment (FACT) are organisation models for intensive assertive outreach that were originally developed for individuals with severe mental illness. The models are increasingly applied to people with mild intellectual disability (MID) or borderline intellectual functioning (BIF) and challenging behaviour or mental illness. Research on these types of care for this population is limited. To gain experience in FACT MID/BIF in the Netherlands and to obtain insight in its outcomes, four organisations specialised in the treatment of individuals with MID/BIF and challenging behaviour participated in a 6-year implementation and research project. Methods: A longitudinal study was set up to investigate outcomes over time. Outcome measures concerned admissions to (mental) health care, social and psychological functioning, (risk of) challenging and criminal behaviour, social participation and client satisfaction. Data were analysed using descriptive statistics and linear mixed models. Results: Over time, clients showed improvement in their social and psychiatric functioning and living circumstances. The number of admissions to (mental) health care diminished as well as the number of contacts with police and justice, the level of social disturbance and the risk factors for challenging and criminal behaviour. Problems related to finances, work and substance abuse remained unchanged. Conclusions: The results are encouraging and give rise to continued development of and broader research on FACT MID/BIF. 8 p.

Forensische ACT (Assertive Community Treatment) en forensische FACT (Functie Assertive Community Treatment) zijn relatief nieuwe vormen van intensieve ambulante zorg voor mensen met ernstige psychiatrische aandoeningen (waaronder ook verslavings- en persoonlijkheidsproblematiek) die met het strafrecht in aanraking zijn geweest of dreigen te komen. Dit type zorg wordt sinds een aantal jaren in Nederland aangeboden door enkele speciaal daarvoor opgerichte multidisciplinaire forensische (F)ACT-teams. In de diverse teams lopen de praktijken sterk uiteen. Om de zorg voor forensischpsychiatrische patienten vanuit forensische (F)ACT teams verder te verbeteren en te standaardiseren, is er een landelijk model ontwikkeld. Het model gaat uit van een brede definitie van ‘forensisch’, een focus op re-integratie en preventie, intensieve samenwerking met de reclassering, continuiteit van zorg en inbreng van forensische expertise in de teams.