ACT ACT Assertive Community Treatment: ACT DACTS ACT M-GTA ACT ACT M-GTA The purpose of this manuscript is to describe the skills that are used by the

Size: px

Start display at page:

Download "ACT ACT Assertive Community Treatment: ACT DACTS ACT M-GTA ACT ACT M-GTA The purpose of this manuscript is to describe the skills that are used by the"

なごみさかいざわ
4 years ago
Views:

1 Assertive Community Treatment: ACT DACTS M-GTA ACT M-GTA The purpose of this manuscript is to describe the skills that are used by the staff of ACT teams in Japan. Three Japanese ACT teams that had achieved relatively high scores on the DACTS were studied. The study was conducted from August to December using data collected from records, semi-structured interviews with staff, focus groups, participant observations of meetings and visit settings, and publications. The data were analyzed using M-GTA with analysis collaborators, generating specific skills, concepts, subcategories, and categories. The ACT teams in Japan, when compared to their counterparts in Britain and the US, were characterized by the less use of skills related to psychotherapy and rehabilitation and less evident team leader leadership skills. Instead, many skills in relationship building with consumers and in family support were noted because the proportion of consumers who had never been in treatment or had dropped out of previous treatment was high and because families had been viewed as caregivers of consumers, respectively. Additionally, the study revealed that the skills to adjust the environment, to minimize the use of medications as much as possible, and to enhance human resilience, similar to skills used in Britain, were well utilized. Key words : ACT, skills, resilience, M-GTA Assertive Community Treatment: ACT

2 Drake, McHugo, Clark, et al., Ziguras & Stuart, Bond, Drake, Mueser et al., Harvey, Burns, Fiander et al., Rapp & Goscha, Kenny, Calsyn, Morse DACTS Dartmouth Assertive Community Treatment Scale Evidence-Based Practices: EBP Salyers, Bond, Teague, et al: DACTS Stein & Test McGrew, Bond, Dietzen, et al. Teague Teague, Bond, Drake DACTS DACTS DACTS Tool for Measurement of Assertive Community Treatment: TMACT Monroe- DeVita DACTS. DACTS ACT 1

3 1 Global Assessment of Function: GAF GAF A B A H ABC A B C A C 2 A A F ACT Non-Profit Organization: NPO NPO NPO NPO A SOS B B G T T GAF GAF

4 T G C C H C 3 A 1 A ACT A A B A B C A C A C ACT

5 A Rapp NPO A B B Substance Abuse and Mental Health Services Administration s: A C NPO 4 M-GTA,,, A NHS

6 . 1 A A C 2 A C T プロセス影響の方向家族支援変化する境界レジリアンスの開花促進ケースマネジメント 2 ACT

7 2 ACT 1 ACT ACT 2 3 [ 即効性に富んだ超職種チーム ] しなやかなチームづくり合意形成変幻自在超職種アプローチプロセス影響の方向循環 [ 実践と改革の循環ミーティング ] したたかさを培うミーティング改革の芽を生み出す [ 挑戦への環境づくり ] 環境整備分かち合い [ACT とストレングスモデルのブレンド ] 膨大な記録と文書作成実践からの理論産出 3

8 Allness & Knoedler, : Individual Treatment Team: ITT A ACT Rapp 3 4 ACT

9 [ 家と出会う ] 家の文化を理解する [ 家族と出会う ] [ 利用者と出会う ] 心を寄せ合う拒否を解く応諾を固める家族支援初期の出会い家風に溶け込むプロセス 4 SOS ACT ACT 4 5

10 生活世界の再構築支援 [ アウトリーチ活用支援 ] 危機をチャンスに切り替える [ 利用者の世界を訪れる ] こころとこころが出会う利用者の世界と出会う循環プロセス影響の方向 5

11 SOS ACT 4 6

12 [ アセスメント ] 状況確認協働活動リカバリー志向のアセスメント [ らせん型上昇 ] 目標設定 [ ホスピタリティの関係づくり ] その人らしいプラン作成お互いの人生を物語る可能性を拓く道連れ協定移行プロセス循環 6 5 7

13 [ レジリアンスを育む環境づくり ] 受容と理解家族生活の安定化家族とのチーミング家族力の発揮 [ 家族のリカバリー支援 ] 家族の休息支援家族の対話を促進する希望のある人生プロセス影響の方向 7 A NHK

14 6 8 変化する境界人と人としてのかかわり素の関係影響の方向影響の方向 8 : 3 ACT

15 ACT ACT

16 : ACT ACT DACTS EBP ACT United States Department of Health and Human Services Administration Byrne, Birchwood, Trower, et al. ACT

17 1 SOS 2 SOS

18 3

19 4 Person-Centered 5

20 6 EBP Robert Wood Johnson Global Assessment of Function: GAF ACT

21 Individual Treatment Team: ITT ITT A B C D ITT NHK Allness, D.J., & Knoedler, W.H. (,). The Pact Model of Community-Based Treatment for Persons with Severe and Persistent Mental Illness: A manual for PACT startup. The National Alliance for the Mentally Ill (NAMI). P Bond, G.R., Drake, R.E., Mueser, K.T. et al. (). Assertive community treatment for people with severe mental illness: Critical ingredients and impact on patients. Disease Management & Health Outcome,, -. Byrne, S., Birchwood, M., Trower, P.E., et al. (). A Case Book of Cognitive Behavior Therapy for Command Hallucination: A Social Rank Theory Approach. Psychology Press. Drake, R.E., McHugo, G.J., Clark, R.E., et al. (). Assertive community treatment for patients with co-occurring severe mental illness and substance use disorder. A clinical trial. American Journal of Orthopsychiatry, ( ), -. Harvey, K., Burns, T., Fiander, M., et al. (). The effective of intensive case management on the relative of patients with severe mental illness. Psychiatric Service, ( ), -. Kenny, D., Calsyn, R., Morse, G. (). Evaluation of treatment programs for persons with severe mental illness: Moderate and mediator effects. EVALUATION REVIEW, ( ), -. M-GTA McGrew, J.H., Bond, G.R., Dietzen, L., et al. (). Measuring the fidelity of implementation of a mental health program model, Journal of Consulting Clinical Psychology,, -. Monroe-DeVita, M. () Tools for measurement of Assertive Community Treatment (TMACT) PROTOCOL. Washington State Pilot Version Rought- Edited. / /. Washington State. Rapp, C.A., & Goscha, A.R. (). The principle of effective case management of mental health services. Psychiatric Rehabilitation Journal, ( ), -.

22 Salyers M.P. Bond G.R. Teague G.R. et al. (). Is it ACT yet? Real-world examples of evaluating the degree of implementation for Assertive Community Treatment. The Journal of Behavioral Health Services & Research. ( ), -. Stein, L.L., & Test, M.A. (). Alternative to mental hospital treatment: Conceptual model, treatment program, and clinical evaluation. Arch Gen Psychiatry, -. Substance Abuse and Mental Health Services Administration s (SAMHA) : Center for Mental Health Services (CMHS) : The Robert Wood Johnson Foundation (RWJF) (). Assertive Community Treatment Implementation Resource Kit Draft Version Teague, G.B. Bond G.R., Drake, R.E. (). Program fidelity in assertive community treatment: Development and use of a measure. Am J Orthopsychiatry, ( )- United States Department of Health and Human Services Administration SAMHSA S National Mental Health Information Center: Center for Mental Health Services. (). About Evidenced-Based Practices KITs: Shaping Mental Health Services Toward Recovery. mentalhealth.samhsa.gov/cmhs/communitysupport/ toolkits/about.asp (/ / ). Washington State. (). Washington State Program of Assertive Community Treatment (PACT) Program Standards (Final) - -. The Washington Institute for Mental Illness Research & Training. Ziguras, S.J. & Stuart, G.W. (). A Meta-analysis of the effective of mental health case management over years. Psychiatric Service, ( ), -.

ACT ACT ACT ACT ACT ACT ACT M-GTA ACT ACT ACT ACT ACT ACT ACT ACT Since, although Assertive Community Treatment ACT or similar programs have been seen

ACT ACT ACT ACT ACT ACT ACT M-GTA ACT ACT ACT ACT ACT ACT ACT ACT Since, although Assertive Community Treatment ACT or similar programs have been seen ACT ACT ACT ACT ACT ACT M-GTA ACT ACT ACT ACT ACT ACT ACT Since, although Assertive Community TreatmentACTor similar programs have been seen in Japan, there are many issues such as not having any legality