Impact of the Pandemic was Minor Compared to Systemic Decrease in Fidelity of Assertive Community Treatment Services- A Provincial Study in Ontario, Canada

AbstractAssertive Community Treatment (ACT) model is the gold standard in community psychiatry serving people with severe mental illness. With its outreach-based design, the pandemic has profoundly affected the operations and functioning of ACT. The Dartmouth ACT Scale (DACTS) provides a standardized comprehensive and quantitative way to evaluate ACT quality. Results could inform nature of impact and identify areas for improvement. Current online survey used DACTS during the pandemic in April-May 2021. Clinical and administrative leadership of the 80 ACT teams in Ontario, Canada cross-sectionally rated ACT quality one-year pre-Covid (2018 –2019) and one-year post the start of Covid (2020–2021). The overall pre-Covid Ontario ACT DACTS fidelity was 3.65. The pandemic led to decreases in all domains of DACTS (Human Resources: −4.92%,p <  0.001, 95% CI [0.08–0.27]; Organizational Boundary: −1.03%,p <  0.013,95%CI [0.01–0.07]; and Nature of Services: −6.18%,p <  0.001, 95%CI [0.16–0.26]). These changes were accounted by expected lower face-to-face encounters, time spent with clients, reduction in psychosocial services, less interactions with hospitals and diminished workforces. The magnitude of change was modest (−3.84%,p <  0.001, 95%CI [0.09–0.19]). However, the Ontario ACT pre-Covid DACTS was substantially lower (−13.5%) when compared to that from a similar survey 15 years ago (4.22), suggestive of insidious systemic level loss ...
Source: Administration and Policy in Mental Health and Mental Health Services Research - Category: Psychiatry Source Type: research