Flexible Assertive Community Treatment in Rural and Remote Areas

A Qualitative Study of the Challenges and Adaptations of the Model

Bibliographic Data

ID22073442
AuthorsKristin Trane (0000-0002-3667-3325, Inland Hospital, corresponding author), Kristian Aasbrenn (University of Inland Norway), Martin Rønningen (University of Inland Norway), Sigrun Odden (0000-0002-6562-2092, Inland Hospital), Annika Lexén (0000-0002-9776-9304, Lund University), Anne Landheim (0000-0002-5961-4993, Inland Hospital), Anne Signe Landheim
Year2022
Volume10
Pages913159-913159
Publication date2022-07-22
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueFrontiers in Public Health (JOURNAL)
Journal identifiersISSN: 2296-2565 • E-ISSN: 2296-2565
PublisherFrontiers Media SA (PUBLISHER • CH)
DOI10.3389/fpubh.2022.913159
PMID35983354
OpenAlexW4286717504
LanguageEN
Citations received1
References cited70

Background: Flexible assertive community treatment (FACT) is an innovative model for providing long-term treatment to people with severe mental illness. The model was developed in the Netherlands but is now used in other countries, including Norway, which has a geography different from the Netherlands, with many rural and remote areas. Implementation of innovations is context dependent. The FACT model's potential in rural and remote areas has not been studied. Therefore, we aimed to gain knowledge regarding the challenges and modifications of the model in rural and remote contexts and discuss how they can affect the model's potential in such areas. This knowledge can improve the understanding of how FACT or similar services can be adapted to function most optimally in such conditions. We sought to address the following questions: Which elements of the FACT model do team leaders of the rural FACT teams find particularly challenging due to the context, and what modifications have the teams made to the model? Methods: Digital interviews were conducted with five team leaders from five rural FACT teams in different parts of Norway. They were selected using purposive sampling to include team leaders from some of the most rural teams in Norway. The interviews were analyzed using thematic text analysis. Results: The following three themes described elements of the FACT model that were experienced particularly challenging in the rural and remote context: multidisciplinary shared caseload approach, intensive outreach and crisis management. The following eight themes described the modifications that the teams had made to the model: intermunicipal collaboration, context-adaptive planning, delegation of tasks to municipal services, part-time employment, different geographical locations of staff, use of digital tools, fewer FACT board meetings, and reduced caseload. Conclusions: Rural and remote contexts challenge the FACT model's potential. However, modifications can be made, some of which can be considered innovative modifications that can increase the model's potential in such areas, while others might move the teams further away from the model

Assertive community treatment · Geography · Knowledge management · Mental health · Mental illness · Multidisciplinary approach · Outreach · Political science · Public relations · Qualitative research · Rural area · Sociology · Thematic analysis · Computer Science · Healthcare Decision-Making and Restraints · Medicine · Psychiatric care and mental health services · Psychology · Schizophrenia research and treatment