Clinicians' and clients' perspectives on the impact of assertive communitytreatment

Objective: Clients in an assertive community treatment program and their cl inicians were asked to rate clients' current difficulties in 13 quality-of- life areas to determine whether improvement in any area predicted reduction s in hospitalization and incarceration. Methods: A peer counselor interview ed 45 clients about psychiatric symptoms, substance use and abuse, medical issues, medication compliance, primary supports, social supports, vocationa l and occupational issues, housing, daily living skills, economic issues an d entitlements, legal involvement, behavioral issues, and treatment involve ment, The clients' clinicians rated the clients in these same areas. Rating s of clients' difficulties in these areas at program entry were based on co mbined ratings made at intake and after a review of clients' charts. Data o n hospitalization and incarceration were obtained from medical and police r ecords. Logistic regression analyses were used to seek predictors of declin es in admissions to hospitals and jails (referred to as institutional admis sions). Results: institutional admissions decreased after program entry; de creases were larger among clients admitted in recent years. Clients improve d significantly in all 13 quality-of-life areas based on comparisons of bot h clinicians' and clients' ratings and baseline ratings; however; clients r ated themselves as having less difficulty than their clinicians thought the y had in the areas of substance abuse, medication compliance, primary suppo rts, social supports, daily living skills, and treatment involvement, Based on clinicians' ratings, improvement in substance abuse issues predicted de clines in institutionalized admissions. Based on clients' ratings, improvem ent in social support and economic issues predicted declines. Conclusions: These findings emphasize the importance of clients' perspectives in treatme nt planning and suggest that clinicians may overlook the smaller incrementa l steps toward improvement that are valued by clients.