Comparison of assertive community treatment programs in urban Massachusetts and rural North Carolina

In this pilot study, we compared teams in rural North Carolina (NC) and urban Massachusetts (MA) to examine the how sites vary the implementation of the Assertive Community Treatment (ACT) model to respond to state and local circumstances. We analysed and compared data on: client characteristics using the NC-TOPPS and a modified survey in MA; Regional Demographics and; Team Characteristics. Issues such as driving distances, lack of qualified clinical staff, scarcity of physicians, and more limited oversight created impediments to fidelity in rural NC, despite higher per patient funding. ACT is now national, but variability in implementation of the model remains

Chronic Medical Conditions among Jail Detainees in Residential Psychiatric Treatment: A Latent Class Analysis

Studies of incarcerates with serious mental illnesses have found elevated rates of chronic medical conditions such as asthma and diabetes, and of infectious diseases such as tuberculosis compared with general population rates. This study explored the pattern of chronic medical conditions in a sample of adult detainees in psychiatric treatment in a large urban jail to develop a clinical profile encompassing the full range of medical conditions. A total of 431 male and female detainees were sampled with certainty from admissions to a residential psychiatric treatment program (overall recruitment rate = 67%). Interviews used the World Mental Health version of the Composite International Diagnostic Interview to assess psychiatric and substance use disorders per DSM-IV criteria and chronic medical conditions. Latent class analysis was conducted using 17 medical conditions as class indicators, yielding a 3-class model composed of: a latent class with a high to intermediate probability of multiple medical conditions (HMC; 12.5% of the sample); an intermediate class with a lower probability of having a smaller number of medical conditions (MMC; 43.2%); and a class with a low probability of any medical condition (44.3%). Those in the HMC class were more likely to report respiratory problems, severe headaches, musculoskeletal pain, hypertension, and arthritis, have greater functional impairment, and have a higher number of co-occurring psychiatric disorders. Being older (50+ years) and female were associated with higher odds of being in the HMC or MMC classes. The policy implications for providing medical care to incarcerates with complex mixtures of medical conditions and psychiatric disorders are considered