[Daily practice of a FACT-team: results of an experience sampling study]. / De dagelijkse praktijk van een FACT-team: resultaten van een experience-samplingstudie.

BACKGROUND: Flexible assertive community treatment (FACT) teams are widespread in the Netherlands. Despite the presence of a model description and model fidelity scale, it is unclear what FACT workers actually do daily. AIM: Examination of the daily activities of FACT workers on weekdays in relation to the intended activities from the theoretical FACT framework. METHOD: Repeated momentary activity assessments were made among all employed staff (n = 54) of four FACT teams from three different organizations using the experience sampling method (ESM) yielding multiple reports on each workday for one week. 936 reports were analyzed with SPSS, providing a picture of the daily activities of FACT workers. RESULTS: Overall, employees spent 30% of their time with clients, 30% in consultation (4% with network partners), 20% on administration and 20% in travel time and personal activities (30-30-20-20). CONCLUSION: The actual time spent by FACT workers with clients does not match the expected production standards. Contact with relatives and network partners lags far behind the desired figures required for modern network-oriented care. The ESM-based results are different from actual methodologies and require careful interpretation. Applying ESM in FACT teams promises to support a quality development dialogue.

[Assertive Treatment as a regular function within mental health]. / Van bemoeizorg naar assertieve behandeling als regulier aanbod vanuit de ggz.

BACKGROUND: The setting for providing assertive treatment (AT) has changed during the last 30 years in The Netherlands from assertive community treatment (ACT) and flexible assertive community treatment (FACT) to municipalities. The provision of AT varies between municipalities. AIM: Describing the concept of AT, the nature and size of the target group, and the reasons why people with severe mental illness (SMI) do not seek treatment and the place of AT in mental health care. METHOD: We used literature en available quantitative data. RESULTS: AT regularly provided by mental health care is required in patients with SMI and social problems who do not seek treatment. When mental health care and social care collaborate on the level of the patient, treatment and handling of social problems can strengthen each other. This collaboration prevents discontinuity of care and breaking a trusting relationship because patients do not need to be transferred from social service to mental health care or vice versa. AT is on the continuum of voluntarily to compulsory care.AT provided by mental health care (usually provided by FACT-teams) is indicated for SMI patients with social problems and who do not seek treatment. The size of the target group is around 5000 - 20.000 patients in The Netherlands. Reasons not to seek help for people with SMI include within person factor, mental health related factors, or factors related to the interaction of SMI patients and mental health. We advocate for AT to become a regular part of mental health care, and for mental health care and social domain professionals to collaborate on case level. Acting this way, mental health treatment and addressing social problems can reinforce each other and discontinuity of care and breaking a trusting relationship can be prevented. AT is on the continuum of voluntary to involuntary treatment. That is why we suggest AT to be a better term than assertive outreach. CONCLUSION: It is a given fact that not all patients with SMI and social problems seek treatment. By making AT a regular part of mental health services, we prevent discontinuity of care and we fill the gap between voluntarily and compulsory care.

[Mental health in Eastern Lille: a future of network-psychiatry?] / De ggz in Oost-Lille: inspiratie voor de praktijk van netwerkzorg in de ggz.

BACKGROUND: For some time now, East Lille has been working with a relatively modern mental health care system that remarkably resembles Dutch health care with the same values and norms that we want to implement in the Netherlands as well.
AIM: Gaining inspiration to further investigate regional cooperation and 'network care' in Dutch psychiatry.
METHOD: A delegation from the board of f-act-Netherlands and ccaf paid a working visit to Lille.
RESULTS: The basis of the East Lille working method is a charter of shared values developed with all parties, clients, relatives, employees and external professionals, which is signed by every professional. In case of doubt, a change of context or the introduction of new working methods, these values are used first. CONCLUSIONS High quality mental health care develops in dialogue, in which working methods, service delivery models and interventions are linked to each other by means of network care. Through reflection, moral deliberation and appreciative auditing, care is progressively improved. These procedures guarantee a modern process of quality improvement.

[Flexible assertive community treatment (FACT) as part of a community (health) network]. / FACT als onderdeel van wijkgerichte zorg in het (zorg)netwerk.

BACKGROUND: Community-based care for people with severe mental illness increasingly requires far-reaching cooperation between different domains. This cooperation must always be unique and local, and at the same time provide an answer to generic and nationally set goals.
AIM: Offering new insights on collaboration within and between domains.
METHOD: Reflection on developments in the social domain and specialist mental healthcare using relevant literature and recent (inter)national experiences.
RESULTS: It seems possible to provide better integral care by allowing FACT-teams to network together with Social Support partners (e.g. by sharing financial and/or human resources). In this process, networks of care for people with serious mental illness (SMI), develop over various phases and realize new partnerships. The model fidelity scale for FACT-teams was adjusted to facilitate that process. CONCLUSIONS The new FACT model fidelity scale is ready to allow FACT-teams to explore flexible local solutions for partnerships to realize the much-needed multi-domain integrated community care for people with SMI.

[Development of the renewed Flexible ACT scale: F-ACT fidelity 2017]. / De ontwikkeling van de vernieuwde Flexible ACT-schaal: F-ACT-s 2017.

BACKGROUND: An important model for the organisation of care for people with severe mental illness is flexible assertive community treatment (F-ACT). F-ACT combines case management with assertive crisis intervention. Quality control was implemented in 2008 using a model fidelity scale. Research has shown that the norms used for the F-ACT fidelity scale no longer correspond with current norms concerning restorative and evidence-based care, as established in treatment guidelines.
AIM: To develop a new model fidelity scale for F-ACT teams.
METHOD: Using knowledge of experts, relevant articles and feedback from professionals, researchers, interest groups and family members, a new model fidelity scale was developed: the F-ACTs 2017. The revised scale was tested by trained auditors in 21 F-ACT teams and adjusted in two pilot rounds.
RESULTS: In 2017 the final version was presented to the stakeholders and was approved by the board of auditors; the final version is currently in use. CONCLUSIONS With the availability of F-ACTs 2017, the (research) field has state-of-the-art instrument to monitor the quality of care of persons with severe mental illness. It uses field standards to evaluate the degree of model fidelity of teams that focus on patients with severe mental illness in a rapidly changing context.

[Model fidelity of flexible assertive community treatment (F-ACT) teams: five years of audit results]. / Modelgetrouwheid van flexible assertive community treatment(F-ACT)-teams: resultaten van vijf jaar auditeren.

BACKGROUND: The Flexible act (f-act) has been introduced in the Netherlands since 2004, alongside the Assertive Community Treatment (act) model. An estimate of 400 (f-)act teams concurrently provide care to approximately 70.000 people with serious mental illness. The ccaf has been assessing the model fidelity of act and f-act teams since 2009 to promote the quality and transparency of healthcare for clients with serious mental illness. OBJECTIVE To describe the state of implementation of f-act and associated trends in the Netherlands.
METHOD: Analysis of the ccaf database, which holds the data of audits conducted between 2009 and 2014.
RESULTS: The audits conducted by ccaf between 2009 and 2014 indicated an adequate implementation of f-act. The team foundations were well organized, featuring a multidisciplinary team structure, management of medication, practical support and investment in healthcare continuity, including during an admission. However, the results regarding participation and recovery were unsatisfactory. Furthermore, the results depicted a decline in the scores concerning a number of areas, including outreach and support of participation and recovery. CONCLUSIONS Although the data indicates an on average satisfactory implementation of f-act in the Netherlands, there are signs that the implementation of f-act is under pressure with relatively fewer home visits, a rising caseload and a reduced investment in recovery and participation. The findings are in accordance with the signs and arguments to adjust the emphasis on reducing hospital admissions, prioritizing the consolidation of outpatient care instead.

[The development of a guideline to improve the efficiency and effectiveness of FACT board meetings using a Delphi study]. / Delphi-studie voor de ontwikkeling van een handreiking ter bevordering van een effectief en efficiënt FACT-bordoverleg.

BACKGROUND: The FACTboard meeting structures the multidisciplinary meetings held by FACT teams, held for the 10-20% most care intensive patients. The FACT manual only provides a general outline for the FACTboard meeting, leaving out criteria specifying the methods to structure meetings. Precisely describing these criteria could improve the quality of these meetings. AIM: To develop a more detailed guideline on how to structure a FACTboard meeting by means of a Delphi study. METHOD: The panel of the Delphi study existed of 22 professions working in certified FACT teams and 8 experts in the field of FACT. Panel members individually assessed 113 items according to whether the statement should be included in the guideline. Statements rated important or essential by ≥80% of the panel members were included in the guideline. The panel members' commentary was used to shape and adjust the statements to clarify why they were regarded as important or unimportant. RESULTS: 54 statements were rated essential or important by ≥80% of the panel members. These statements pertained to the organization and structure of the FACTboard meeting and the roles and responsibilities of the team members. CONCLUSION: The developed guideline could be used by FACT and possibly ACT teams to structure the FACTboard meeting.