Clinical significance of assertive community treatment among adolescents

Soc Psychiatry Psychiatr Epidemiol. 2019 Apr;54(4):445-453. doi: 10.1007/s00127-018-1613-z. Epub 2018 Oct 11.


Purpose: The efficacy of assertive community treatment for children and adolescents is proven in the United States, but remains controversial in Europe. Moreover, most studies showing positive outcomes of assertive community treatment are limited to statistically significant differences and do not consider whether the treatment is also subjectively clinically meaningful for the patient. Using a naturalistic sample, the present study aims to assess statistical and clinical significance of an assertive community treatment unit for adolescents in Europe.

Methods: Linear mixed-effects models and reliable change indices were used to respectively assess the statistical and clinical significance of assertive community treatment in 179 adolescents (mean age = 15.76, SD = 1.76) with severe mental illnesses.

Results: Difficulties related to mental health (measured by the Health of the Nation Outcome Scales for Children and Adolescents, HoNOSCA) and overall functioning (measured by the Global Assessment of Functioning scale) statistically improved (all ps < 0.001) from admission to discharge. Additionally, a considerable proportion of patients (from 14% to 21%) clinically recovered to functional levels.

Conclusion: Our results support the fact that assertive community treatment can have convincing and positive clinical outcomes in European settings.

Keywords: Adolescents; Assertive community treatment; HoNOSCA; Reliable change index; Treatment efficacy.

MeSH terms

  • Adolescent
  • Community Mental Health Services / methods
  • Community Mental Health Services / statistics & numerical data*
  • Europe
  • Female
  • Hospitalization / statistics & numerical data*
  • Humans
  • Linear Models
  • Male
  • Mental Disorders / psychology
  • Mental Disorders / therapy*
  • Minimal Clinically Important Difference*
  • Outcome Assessment, Health Care / statistics & numerical data*
  • Treatment Outcome