Research on field-based services

Models for reform in the delivery of mental health care to populations with complex clinical problems

Alberto Santos, Scott W. Henggeler, Barbara J. Burns, George W. Arana, Neil Meisler

Research output: Contribution to journalReview article

54 Citations (Scopus)

Abstract

Objective: Clinical services for psychiatrically impaired populations have only recently been studied with scientifically valid designs to explore innovations in structure, accessibility, and financing. Health systems reform in the United States has provided the impetus for better defining clinically effective and cost-sensitive models for mental health services. This article reviews assertive community treatment, used for adults with severe mental illnesses, and multisystemic therapy, used for adolescents with serious emotional disturbances, as examples of service system innovations that have been studied with controlled clinical trial designs and have demonstrated efficacy in treating difficult and costly clinical populations. Method: The authors reviewed the published controlled clinical trials of assertive community treatment and multisystemic therapy, focusing on the clinical and administrative elements that distinguish them from traditional service systems. Results: A qualitative assessment of these two approaches suggests that they share common elements, with important implications for mental health policy. Specifically, the use of an ecological model of behavior applied to mental health patients is critical to both systems. In addition, therapeutic principles emphasizing pragmatic (outcome-oriented) treatment approaches, home-based interventions, and individualized goals are key elements of their success. Most important, both systems embody a therapeutic philosophy demanding therapist accountability, in which personnel are rewarded for clinical outcomes and therapeutic innovation rather than for following a prescribed plan. Conclusions: As empirically tested approaches, assertive community treatment and multisystemic therapy provide a scientific foundation for continued reform and serve to illustrate critical elements in designing new community treatment initiatives for behavioral as well as medical conditions.

Original languageEnglish (US)
Pages (from-to)1111-1123
Number of pages13
JournalAmerican Journal of Psychiatry
Volume152
Issue number8
DOIs
StatePublished - Jan 1 1995

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Mental Health
Delivery of Health Care
Community Mental Health Services
Research
Population
Controlled Clinical Trials
Therapeutics
Affective Symptoms
Social Responsibility
Mentally Ill Persons
Mental Health Services
Health Policy
Costs and Cost Analysis
Health

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Research on field-based services : Models for reform in the delivery of mental health care to populations with complex clinical problems. / Santos, Alberto; Henggeler, Scott W.; Burns, Barbara J.; Arana, George W.; Meisler, Neil.

In: American Journal of Psychiatry, Vol. 152, No. 8, 01.01.1995, p. 1111-1123.

Research output: Contribution to journalReview article

Santos, Alberto ; Henggeler, Scott W. ; Burns, Barbara J. ; Arana, George W. ; Meisler, Neil. / Research on field-based services : Models for reform in the delivery of mental health care to populations with complex clinical problems. In: American Journal of Psychiatry. 1995 ; Vol. 152, No. 8. pp. 1111-1123.
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