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CHAPTER 15 ■ Schizophrenia Spectrum and Other Psychotic Disorders
this type of treatment include mobile treatment teams and community support programs . Assertive programs of treatment are individually tailored for each client, intended to be proactive, and include the teaching of basic living skills, helping clients work with com- munity agencies, and assisting clients in developing a social support network. Vocational expectations are emphasized, and supportive work settings (i.e., shel- tered workshops) are an important part of the treat- ment program. Other services include substance abuse treatment, psychoeducational programs, fam- ily support and education, mobile crisis intervention, and attention to health-care needs. Responsibilities are shared by multiple team mem- bers, including psychiatrists, nurses, social workers, vocational rehabilitation therapists, and substance abuse counselors. Services are provided in the per- son’s home; within the neighborhood; in local restau- rants, parks, stores; or wherever assistance by the client is required. These services are available to the client 24 hours a day, 365 days a year, and ACT is considered a long-term intervention strategy. One recent study looked at the impact of a Housing First intervention (an intervention that prioritizes rapid re-housing for homeless individuals with schizophrenia) and found that when this type of intervention was combined with ACT, medication adherence improved from below 50% to 78%. Additionally, these combined interven- tions improved clients’ integration into the commu- nity, increased residential stability, and decreased criminal convictions (Rezansoff et al., 2016). ACT has been shown to reduce the number of hospitalizations and decrease costs of care. Although it has been called “paternalistic” and “coercive” by its critics, ACT has provided much-needed services and improved quality of life for many clients who are unable to manage in a less-structured environment. One limitation is that treatment programs of this kind are time and labor intensive. The Recovery Model Research provides support for recovery as an obtain- able objective for individuals with schizophrenia (Lysaker et al., 2010). Lysaker and associates state: Recovery from schizophrenia, in the sense of a state in which persons experience no difficulties associ- ated with the illness, can occur but the modal out- come seems to be one in which difficulties linked to symptoms, social function, and work appear periodi- cally but can be successfully confronted. (p. 40) Conceptual models of recovery from mental illness are presented in Chapter 10, “The Recovery Model.”
that stress has on the client’s ability to function. By providing the family with information about the illness and suggestions for effective coping, psycho- educational programs reduce the likelihood of the client’s relapse and the possible emergence of men- tal illness in previously nonaffected relatives. Mueser and associates (2001) stated that although models of family intervention with schizophrenia dif- fer in their characteristics and methods, effective treat- ment programs share a number of common features: ■■ All programs are long term (usually 9 months to 2 years or longer). ■■ They all provide the client and family with infor- mation about the illness and its management. ■■ They focus on improving adherence to prescribed medications. ■■ They strive to decrease stress in the family and improve family functioning. Asen (2002) suggested the following interventions with families of individuals with schizophrenia: ■■ Forming a close alliance with the caregivers ■■ Lowering the emotional intrafamily climate by reducing stress and burden on relatives ■■ Increasing the ability of relatives to anticipate and solve problems ■■ Reducing the expressions of anger and guilt by family members ■■ Maintaining reasonable expectations for how the ill family member should perform ■■ Encouraging relatives to set appropriate limits while maintaining some degree of separateness ■■ Promoting desirable changes in the relatives’ behaviors and belief systems Family therapy typically consists of a brief program of family education about schizophrenia and a more extended program of family contact designed to reduce overt manifestations of conflict and to improve patterns of family communication and problem-solving. The response to this type of therapy has been very dramatic. Studies have clearly revealed that a more positive outcome in the treatment of the client with schizophrenia can be achieved by including the family system in the program of care
(Caqueo-Urízar et al., 2015). Assertive Community Treatment
Assertive community treatment (ACT) is an evi- dence-based program of case management that takes a team approach in providing comprehensive, com- munity-based psychiatric treatment, rehabilitation, and support to persons with serious and persistent mental illness such as schizophrenia. Other terms for
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