Assertive Community Treatment in Intellectual Disabilities. 1.5 What should community services provide?
Assertive Community Treatment in Intellectual Disabilities. There was accordingly debate whether 'assertive outreach' for people who have both ID and mental health problems would be an effective service delivery model. For example, Xxxxxx et al. (2005) suggested that improvements of community care might decrease the need for some inpatient admissions and called for evaluations of assertive outreach-type community services in people with ID. This call was supported by the earlier finding of the UK-700 study that people with borderline levels of intellectual functioning spent less time in hospital if they received intensive community care compared with standard community care (Tyrer et al. 1999). It was suggested that those with lower IQ might have been helped more because they have greater problems expressing their needs and they tend to require a more assertive approach on the part of the clinicians (Xxxxxxxxx et al. 1999; Xxxxx, 2000b). A few Assertive Community Treatment-type services for people with ID have been set up in the UK, but they have varied widely in their configurations (Hassiotis et al. 2003). For example, some services favoured a “team within a team” model whereby a few professionals tried to adopt a more intensive or assertive approach whilst being part of a wider community ID team. Other services followed a separate team model. To confuse matters more, some of these Assertive Community Treatment- type services were aimed at people with ID and coexisting challenging behaviours rather than coexisting severe mental illness. Both Xxxxxx et al. (2005) and Xxxxxx et al. (2005) reported exploratory studies of what they claimed were forms of Assertive Community Treatment for people with ID. Both studies found no major differences in outcomes for service users between the group receiving more intensive services and those receiving a standard service. Problems in developing and evaluating Assertive Community Treatment-type models for people with ID have included fidelity to the original Assertive Community Treatment model and a lack of distinction between the experimental and control services (Xxxxxxx, 2006). In addition, they were typically serving persons with a wider range of mental health problems than those for whom Assertive Community Treatment was originally intended (Xxxxxxx, 2006). The first (preliminary) study (see Appendix III: i) of this MD (Res) used interviews of specialist ID clinicians involved in four UK services that claimed to be providing
