Comparison of ACT and standard case management for delivering integrated treatment for co-occurring disorders
Comparison of ACT and standard case management for delivering integrated treatment for co-occurring disorders
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DOI：
10.1176/appi.ps.57.2.185
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发表时间：
2006-02-01
影响因子：
3.8
通讯作者：
Swain, K
中科院分区：
文献类型：
--
作者：
Essock, SM;Mueser, KT;Swain, K
目的：严重精神和物质使用障碍并存的患者具有住院和其他不良后果的高风险。尽管心理健康和药物滥用综合治疗正在成为这类客户的标准临床方法，但提供综合治疗的最佳方法仍不清楚。方法：本研究比较了以社区为基础的病例管理的两种不同模式(自主式社区治疗和标准临床病例管理)提供的综合治疗。在两个城市地点，共有198名患有同病、无家可归或住房不稳定的患者被随机分配到两种治疗条件之一，并进行了三年的跟踪调查。结果：两种治疗条件下的参与者在多个结果领域随着时间的推移而改善，两种模型之间几乎没有发现差异。物质使用的减少比单独考虑时间的预期要大。在制度化比率较高的地点，接受标准病例管理的客户更有可能被制度化。然而，在制度化率较低的部位，两种治疗条件下的制度化率没有发现差异。结论：综合治疗可以通过自信的社区治疗或通过标准的临床病例管理成功地提供。
Objective: Clients with co-occurring severe mental and substance use disorders are at high risk of institutionalization and other adverse outcomes. Although integrated mental health and substance abuse treatment is becoming a standard clinical approach for such clients, the optimal method for delivering integrated treatment remains unclear. Method: This study compared integrated treatment delivered within two different models of community-based case management ( assertive community treatment and standard clinical case management). A total of 198 clients in two urban sites who had co-occurring disorders and were homeless or unstably housed were randomly assigned to one of two treatment conditions and were followed for three years. Results: Participants in both treatment conditions improved over time in multiple outcome domains, and few differences were found between the two models. Decreases in substance use were greater than would be expected given time alone. At the site that had higher rates of institutionalization, clients who received standard case management were more likely to be institutionalized. However, in the site that had lower rates of institutionalization, no differences in the rate of institutionalization were found between the two treatment conditions. Conclusions: Integrated treatment can be successfully delivered either by assertive community treatment or by standard clinical case management.