Adaptation And Assessment Of The Family-based Assertive Community Treatment Model For The Treatment Of Schizophrenia:a Preliminary Study

Background:Assertive community treatment (ACT) is a worldwide well-established, evidence-based model for providing treatment services to people with severe mental illness. However, the success of reform and opening-up, the quickly socioeconomic transition, and the carrying out of National Mental Health Law all suggested that now is a special time for China to develop integrated and innovative community-based mental health care programs in the context of Chinese culture.Study Ⅰ:First Adaptation and Assessment of the Family-based Assertive Community Treatment Model in China-A Pilot StudyObjective:To develop the first family-based ACT program which fit the Chinese condition, implement this program in the communities of Changsha (a Chinese mid-size city), and evaluate the feasibility of this program.Method:Patients with schizophrenia, matched for age, gender, severity, and functioning level were assigned to an intervention (n=15) or a control (n=16) group. The control group received usual care and the intervention group received ACT services for6months. Data collected include admission days. relapse days, reemployment days, and results from Positive and Negative Symptoms Scale (PANSS), Social Disability Screening Schedule (SDSS), Personal and Social Performance Scale (PSP), and UCSD Performance-Based Skills Assessment-Brief (UPSA-B) for patients; Symptom Checklist90(SCL-90), Family Burden Interview Schedule (FBIS), and Social Support Questionnaire (SSQ) for family caregivers; and Dartmouth Assertive Community Treatment Scale (DACTS) for team fidelity.Result:1) At the end of the6-months study the DACTS showed a moderate fidelity (3.7/5).2)2patients in control group (n=16) but no one in ACT group (n=15) refused to the last assessment after the6-months intervention, which means the dropout rate is6.5%.3) There was no significant difference between the ACT intervention and control groups in any demographic or clinical characteristic.4) At the end of the6-months intervention study, the number of admissions was0(ACT):2(control) patients (1.91days/patient/month).5) The number of relapse was0(ACT):5(control) patients (3.90days/patient/month).6) The number of reemployment was4(ACT) patients(2.27days/patient/month):1(control) patients (1.35days/patient/month).7) In before-and-after comparisons, the ACT group had significantly lower PANSS total and subscale scores (p<0.01), lower total SDSS (p<0.01), and lower total PSP (p<0.01), but no significant differences between the UPSA-B total score and subscale scores. No significant difference was found in the measures for family caregivers, despite very positive informal feedback.Study Ⅱ:Assessing the effects of family-based ACT model for the treatment of schizophrenia:a12-months randomized controlled trialObjective:To use a randomized controlled trial to assess the effect of the modified family-based ACT model on admission days and other measures of outcomes in the12-month-treatment of schizophrenia.Method:Randomized controlled trial will be conducted.60eligible schizophrenia sufferers and their family caregivers will be randomly assigned to the family-based ACT group (n=30) and control group (n=30). Data will be collected at the baseline and immediately after the12-months’intervention, with the symptom and social function of patients being evaluated per3months. Clinical Global Impression (CGI), Scale of Stigma for People with Mental Illness (SSPMI),Family Assessment Device (FAD)were added for the assessment of patients, while the World Health Organization Quality of Life (WHOQOL)-BREF and Perceived Devaluation and Discrimination Scale(PDD)were added for that of family caregivers In addition, Blinded method was be used for the psychiatric and psychosocial assessment in this study.Result:Reported the data at baseline and3,6month after the intervention:1) At the baseline, the duration of illness in ACT group was significant longer than that in control group (t=2.183, p=0.033). Additionally, the SDSS total score in ACT group was significant lower than that in control group (t=2.041,p=0.046). No significant differences was found in the other measurements at baseline.2)2patients in control group (n=30) but no one in ACT group (n=30) refused to the assessment after the6-months intervention.3) After6-month-intervention, the number of admissions was0(ACT):4(control) patients (1.87days/patient/month).2-related samples nonparametric test showed that the difference between two groups was significant (Z=2.051,p=0.040).4) The number of relapse was1(ACT)(0.17days/patient/month):5(control) patients (2.33days/patient/month), which is not significantly different between two groups (Z=1.747, p=0.081).5) The number of reemployment was7(ACT) patients(2.57days/patient/month):1(control) patients (0.17days/patient/month).2-related samples nonparametric test showed that the difference between two groups was significant (Z=2.546, p=0.011).6) With the duration of illness and baseline SDSS total score being controlled as the covariances, the ACT group still showed significantly lower PANSS total and subscale scores (p<0.01) and lower CGI score (p<0.01) than that of control group. However, no significant differences were found between groups in the UPSA-B total score (P=0.090) and SDSS total scores (P=0.055) after controlling for those covariancesConclusions:1) the family-based ACT program implemented in this study showed its feasibility at least in Changsha, an inner city of China. In addition, the outcome measures suggested that the ACT program not only reduced admission days but also significantly improved psychopathology and overall levels of social functioning in schizophrenic patients.2) The6-months family-based ACT program can be significantly effective in reducing admission days, increasing the reemployment days, and improving psychopathology in severe schizophrenia patients.