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    Adding evidence-based interventions to assertive community treatment (ACT) did not improve outcomes for patients with schizophrenia. Most patients were eligible, but few completed the interventions, highlighting feasibility challenges in engaging difficult-to-reach populations.

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    Area of Science:

    • Psychiatry
    • Mental Health Services Research
    • Clinical Psychology

    Background:

    • Assertive Community Treatment (ACT) is a key model for severe mental illness.
    • Integrating evidence-based interventions (EBIs) into ACT may enhance treatment effectiveness.
    • Feasibility of delivering these EBIs to complex patient populations requires investigation.

    Purpose of the Study:

    • To assess the feasibility and impact of adding specific EBIs to standard ACT.
    • To evaluate outcomes in patients receiving ACT with added EBIs compared to standard ACT.

    Main Methods:

    • A 24-month randomized controlled trial in The Netherlands involving 159 patients.
    • Two ACT teams: standard ACT and ACT Plus (standard ACT + psychoeducation, family interventions, individual placement and support, CBT).
    • Interventions delivered by independent psychologists and nurse practitioners.

    Main Results:

    • High eligibility rates for EBIs (65%-89%) were observed.
    • Low intervention completion rates: only 16% (12/74) of ACT Plus patients completed an intervention.
    • No significant differences in outcomes, including inpatient care use, between ACT Plus and standard ACT groups.

    Conclusions:

    • Delivering EBIs within ACT to difficult-to-engage patients presents significant feasibility challenges.
    • Treatment guidelines for schizophrenia should address the practicalities of integrating EBIs into community-based care.
    • Further research is needed to optimize the delivery of EBIs for hard-to-reach populations in mental health services.