ASSERTIVE COMMUNITY TREATMENT VERSUS USUAL CARE IN ENGAGING AND RETAINING CLIENTS WITH SEVERE MENTAL-ILLNESS

Objective: Two assertive community treatment teams were compared with a usual-care control condition based on their ability to engage and re tain clients with serious and persistent mental illness in community-b ased mental health services. Methods: Clients were randomly assigned t o one of two assertive community treatment teams (N=116) or to usual c are (N=58). Survival analysis was used to compare clients' length of e ngagement and retention in service in the two treatment conditions and in usual care. Cox regression analyses were conducted to determine wh ether demographic, program, or client variables were significantly ass ociated with length of retention in treatment. Data on these baseline variables were collected after clients made initial contact with their community mental health provider. Clients were observed for up to 870 days. Results: By the end of the observation period, the assertive co mmunity treatment teams retained 68 percent of their clients, compared with 43 percent in usual care, In both types of treatment, clients we re at greatest risk of dropping out of services during the first nine months. The risk of dropout was associated with the type of treatment. Usual-care clients were more than twice as likely as assertive commun ity treatment clients to drop out for reasons related to dissatisfacti on with treatment. Each additional night homeless during the six month s before enrollment in the study resulted in a 14 percent increase in the probability of dropout. Conclusions: Assertive community treatment learly demonstrated a greater ability than usual care services to eng age and retain clients in community mental health care.