Flexible assertive community treatment for individuals with a mild intellectual disability or borderline intellectual functioning: results of a longitudinal study in the Netherlands.
L J Neijmeijer, H P L M Korzilius, H Kroon and 2 others
PMID 30991450WHAT IT FOUND
Across clients in Dutch flexible assertive community teams, admissions, social and psychological problem scores, police contacts, risk ratings, housing problems and disturbance decreased.
Work, money, substance use, global functioning and satisfaction did not improve.
Key findings
01Among 604 clients, admissions and HoNOS-LD total scores declined significantly over time.
02Risk outcomes improved, but GAF, alcohol and drug use, financial and work problems, and client satisfaction did not change.
03Follow-up was limited: a second measurement was performed in 280 cases (46.4%), a third in 79 (13.1%), and a fourth in only seven cases.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
The study had no control group, so the changes cannot be attributed to FACT rather than usual course, policy or other factors. FACT includes medication, living, work, finance, psychological, addiction and somatic care, so the contribution of any single component cannot be separated. Only 280 of 604 clients had a second measurement, and only seven had a fourth measurement. Client satisfaction had 81.5% non-response, so the unchanged satisfaction finding is weak. Recent IQ scores were missing or unknown in 34.1% of cases. The authors could not perform a non-response analysis, so harder-to-treat clients may be overrepresented among those lost to follow-up. The study did not analyse which client subgroups benefited more or less. Some outcomes, including GAF, substance use, work, finances and satisfaction, did not improve.
Declared interests
The authors declared no conflicts of interest. The project was funded partly by the Dutch Ministry of Safety and Justice.
The easy way to misread this
Do not read the significant declines as proof that flexible assertive community treatment works. There was no control group, and the teams delivered medication, living, work, finance, psychological, addiction and somatic care together, so the contribution of any single component cannot be separated.