Background : Limited research is available on how Assertive Community Treatment (ACT) clients’ cognitions, attitudes and behaviours experienced over time during the therapeutic process and recovery, affect functioning. Aims : This prospective study investigated whether changes in 1) clients’ ratings of therapeutic alliance, sense of empowerment over their illness, attitudes toward medication and insight, 2) clinicians’ assessment of medication adherence and 3) delivered services predicted functioning of ACT clients in southern Ontario, Canada. Method : Hierarchical Linear Modelling was used to assess time-varying and invariant predictors of overall functioning, over a two-year follow-up period. Results : The study found that during each 6 month follow-up time period about 90% of clients achieved successful community tenure and overall functioning increased between baseline and year 1 and decreased between baseline and year 2. Clients’ ratings of therapeutic alliance on functioning were moderated by previous lifetime days in hospital, while change in ratings of empowerment was moderated by age and previous lifetime days in hospital. Improved insight and medication adherence predicted functioning. Number of client contacts by ACT staff was not associated with functioning. Conclusions : These findings suggest that changes in client’s cognitions, attitudes and behaviours experienced during the therapeutic process and recovery can predict client functioning.

OBJECTIVE:Assertive community treatment (ACT) studies that have used conventional, statistical growth modelling methods have not examined different trajectories of outcomes or covariates that could influence different trajectories, even though heterogeneity in outcomes has been established in other research on severe mental illness. The purpose of our study was to examine the general trend in mental health functioning of ACT clients over a 2-year follow-up time period, to discover groups of ACT clients with distinctive longitudinal trajectories of mental health functioning, and to examine if some of the key sociodemographic and illness-related factors influence group membership.METHOD:A 2-year, prospective, within-subjects study of 216 ACT clients within southern Ontario, collected functional outcome data at baseline and 12 and 24 months using the Colorado Client Assessment Record. Baseline covariates included sex, primary diagnosis, number of comorbidities, hospitalization history, and duration of illness. Growth mixture modelling (GMM) was used to examine trajectories.RESULTS:Clinical staff assessments of ACT clients showed a statistically significant improvement in functioning and 84% achieved successful community tenure. GMM analysis identified 2 classes of ACT clients: class 1 (79.63% of clients) experienced lower and stable overall functioning, and class 2 (20.37%) showed a better baseline functioning score and improvement in the overall functioning over time. Class membership was predicted by the number of comorbidities and diagnosis.CONCLUSIONS:Our study suggests general stability in overall functioning for the sampled ACT clients over 2 years, but significant heterogeneity in trajectories of functioning.

OBJECTIVE:This study used data from two Canadian early psychosis programs to assess the feasibility of using common performance measures and to assess the extent to which each program meets suggested standards for early intervention.METHODS:Data were extracted from administrative databases and supplemented by health records for 332 individuals admitted to two services in order to calculate values for 19 performance indicators for January 2000 to January 2004. Inter-rater reliability was established for data abstraction.RESULTS:The two samples had similar demographic and clinical profiles. There were no statistically significant differences in 1-, 2- and 3-year admission rates (year 1: 27% vs. 30%, P=0.625; year 2: 31% vs. 38%, P=0.248; year 3: 35% vs. 42%, P=0.260), duration of untreated psychosis (DUP) (24 vs. 28 weeks; P=0.844) and positive symptom remission at 1 year (72% vs. 78%; P=0.285). There were statistically significant differences between the two services in mean wait time (18 vs. 13 days; P=0.045), proportion of patients on second-generation anti-psychotics at 1 year (75% vs. 89%; P=0.002), and proportion of patients adherent to antipsychotic medication for a minimum of 12 months (76% vs. 83%; P=0.007).CONCLUSION:The data provides useful information on the feasibility of implementing key performance measures across early psychosis programs to assess the extent to which they are meeting standards for such services.

PURPOSE:To evaluate an emergency department's use of a mental health triage and mental health crisis counsellor for persons presenting with mental health concerns.METHOD:Mixed method (qualitative and quantitative), multiple measures.RESULTS:Significant pre- and post-intervention reductions for wait time, security incidents and hospital admissions were found. Follow ups with a community agency, medications and a psychiatrist increased post-intervention, while follow ups with detox decreased post-intervention.CONCLUSIONS:The qualitative and quantitative findings are congruent with other studies supporting the use of properly implemented mental health triage and crisis counsellors to improve the care of persons with mental health concerns.

Knowledge diffusion and utilization (KDU) have become a key focus in the health research community because of the limited success to date of research findings to inform health policies, programs and services. Yet, evidence indicates that successful KDU is often predicated on the early involvement of potential knowledge users in the conceptualization and conduct of the research and on the development of a “partnership culture”. This study describes the integration of KDU theory with practice via a case study analysis of the Consortium for Applied Research and Evaluation in Mental Health (CAREMH).

OBJECTIVE:Knowledge diffusion and utilization (KDU) have become a key focus in the health research community because of the limited success to date of research findings to inform health policies, programs and services. Yet, evidence indicates that successful KDU is often predicated on the early involvement of potential knowledge users in the conceptualization and conduct of the research and on the development of a "partnership culture". This study describes the integration of KDU theory with practice via a case study analysis of the Consortium for Applied Research and Evaluation in Mental Health (CAREMH).METHODS:This qualitative study, using a single-case design, included a number of data sources: proposals, meeting minutes, presentations, publications, reports and curricula vitae of CAREMH members.RESULTS:CAREMH has adopted the following operational strategies to increase KDU capacity: 1) viewing research as a means and not as an end; 2) bringing the university and researcher to the community; 3) using participatory research methods; 4) embracing transdisciplinary research and interactions; and 5) using connectors. Examples of the iterative process between researchers and potential knowledge users in their contribution to knowledge generation, diffusion and utilization are provided.CONCLUSIONS:This case study supports the importance of early and ongoing involvement of relevant potential knowledge users in research to enhance its utilization potential. It also highlights the need for re-thinking research funding approaches.