<?xml version="1.0" encoding="UTF-8"?><xml><records><record><source-app name="Biblio" version="7.x">Drupal-Biblio</source-app><ref-type>32</ref-type><contributors><authors><author><style face="normal" font="default" size="100%">Stuen, HK</style></author></authors></contributors><titles><title><style face="normal" font="default" size="100%">Community Treatment Orders in an Assertive Community Treatment setting: a qualitative study of patients, care providers and responsible clinicians</style></title></titles><keywords><keyword><style  face="normal" font="default" size="100%">ACT</style></keyword><keyword><style  face="normal" font="default" size="100%">Community Treatment Order</style></keyword></keywords><dates><year><style  face="normal" font="default" size="100%">2019</style></year><pub-dates><date><style  face="normal" font="default" size="100%">06/2019</style></date></pub-dates></dates><urls><web-urls><url><style face="normal" font="default" size="100%">https://hdl.handle.net/10037/16695</style></url></web-urls></urls><publisher><style face="normal" font="default" size="100%">UiT - Norges arktiske universitet (Open Access)</style></publisher><pub-location><style face="normal" font="default" size="100%">Tromsø</style></pub-location><isbn><style face="normal" font="default" size="100%">978-82-7589-649-8</style></isbn><language><style face="normal" font="default" size="100%">eng</style></language><abstract><style face="normal" font="default" size="100%">&lt;p&gt;This study is part of the national research-based evaluation of the 12 first assertive community treatment (ACT) teams in Norway. ACT is a model for multidisciplinary community-based treatment teams that aim to provide a full range of medical, psychosocial and rehabilitation services to people with severe mental illness. Over 30% of the patients treated in the ACT teams were subject to community treatment orders (CTOs) at intake during the teams&amp;rsquo; first year of operation. CTOs, which is a legal tool to compel patients with severe mental illness to adhere to outpatient treatment, have been widely used since the Norwegian Mental Health Care Act was implemented in 1961. Previous studies have shown that patients consider CTOs as a more restrictive intervention than clinicians do. Many patients experience CTOs as disempowering, and many patients feel that clinicians&amp;rsquo; one-sided focus on medication impedes their recovery processes. In this qualitative study, Stuen and colleagues investigated how patients, ACT providers and responsible clinicians experienced CTOs and CTO decision making within the context of the relatively newly established ACT teams. Stuen and colleagues show that patients have mixed views of CTOs. However, the ACT team&amp;rsquo;s availability, the flexible combination of interventions, continued care, support and possibility to make choices were described as important improvements compared to traditional office-based mental health services. Several of the participants described a gradual transition toward regarding the CTO as an acceptable solution, provided that they received other services they found beneficial. For clinicians, CTO decisions involve dilemmas and difficult professional judgements, and they highlighted the opportunities the multidisciplinary team provided for discussions and shared responsibility for follow-up care. The ACT model&amp;rsquo;s structured approach, the daily team meetings and the sharing of ideas about how to handle clinical problems allowed for more flexibility and, they believed, more voluntary options.&lt;/p&gt;</style></abstract><work-type><style face="normal" font="default" size="100%">Article collection</style></work-type><label><style face="normal" font="default" size="100%">TUD</style></label></record><record><source-app name="Biblio" version="7.x">Drupal-Biblio</source-app><ref-type>17</ref-type><contributors><authors><author><style face="normal" font="default" size="100%">Stuen, HK</style></author><author><style face="normal" font="default" size="100%">Landheim, A</style></author><author><style face="normal" font="default" size="100%">Rugkåsa, J</style></author><author><style face="normal" font="default" size="100%">Wynn, R</style></author></authors></contributors><titles><title><style face="normal" font="default" size="100%">How clinicians make decisions about CTOs in ACT: a qualitative study</style></title><secondary-title><style face="normal" font="default" size="100%">International Journal of  Mental Health Systems</style></secondary-title></titles><keywords><keyword><style  face="normal" font="default" size="100%">ACT</style></keyword><keyword><style  face="normal" font="default" size="100%">Community Treatment Order</style></keyword><keyword><style  face="normal" font="default" size="100%">CTO</style></keyword></keywords><dates><year><style  face="normal" font="default" size="100%">2018</style></year><pub-dates><date><style  face="normal" font="default" size="100%">11/2018</style></date></pub-dates></dates><urls><web-urls><url><style face="normal" font="default" size="100%">https://ijmhs.biomedcentral.com/articles/10.1186/s13033-018-0230-2</style></url></web-urls></urls><volume><style face="normal" font="default" size="100%">12</style></volume><language><style face="normal" font="default" size="100%">eng</style></language><abstract><style face="normal" font="default" size="100%">&lt;h3&gt;BACKGROUND:&lt;/h3&gt;&lt;p&gt;The first 12 Norwegian assertive community treatment (ACT) teams were piloted from 2009 to 2011. Of the 338 patients included during the teams&amp;#39; first year of operation, 38% were subject to community treatment orders (CTOs). In Norway as in many other Western countries, the use of CTOs is relatively high despite lack of robust evidence for their effectiveness. The purpose of the present study was to explore how responsible clinicians reason and make decisions about the&amp;nbsp;continued use of CTOs, recall to hospital and the&amp;nbsp;discontinuation of CTOs within an ACT setting.&lt;/p&gt;&lt;h4&gt;METHODS:&lt;/h4&gt;&lt;p&gt;Semi-structured interviews with eight responsible clinicians combined with patient case files and observations of treatment planning meetings. The data were analysed using a modified grounded theory approach.&lt;/p&gt;&lt;h4&gt;RESULTS:&lt;/h4&gt;&lt;p&gt;The participants emphasized that being part of a multidisciplinary team with shared caseload responsibility that provides intensive services over long periods of time allowed for more nuanced assessments and more flexible treatment solutions on CTOs. The treatment criterion was typically used to justify the need for CTO. There was substantial variation in the responsible clinicians&amp;#39; legal interpretation of dangerousness, and some clinicians applied the dangerousness criterion more than others.&lt;/p&gt;&lt;h4&gt;CONCLUSIONS:&lt;/h4&gt;&lt;p&gt;According to the clinicians, many patients subject to CTOs were referred from hospitals and high security facilities, and decisions regarding the continuation of CTOs typically involved multiple and interacting risk factors. While patients&amp;#39; need for treatment was most often applied to justify the need for CTOs, in some cases the&amp;nbsp;use of CTOs was described as a tool to contain dangerousness and prevent harm.&lt;/p&gt;</style></abstract><issue><style face="normal" font="default" size="100%">51</style></issue><label><style face="normal" font="default" size="100%">TUD</style></label></record><record><source-app name="Biblio" version="7.x">Drupal-Biblio</source-app><ref-type>17</ref-type><contributors><authors><author><style face="normal" font="default" size="100%">Stuen, HK</style></author><author><style face="normal" font="default" size="100%">Landheim, A</style></author><author><style face="normal" font="default" size="100%">Rugkåsa, J</style></author><author><style face="normal" font="default" size="100%">Wynn, R</style></author></authors></contributors><titles><title><style face="normal" font="default" size="100%">Responsibilities with conflicting priorities: a qualitative study of ACT providers' experiences with community treatment orders</style></title><secondary-title><style face="normal" font="default" size="100%">BMC Health Services Research (Open Access)</style></secondary-title></titles><keywords><keyword><style  face="normal" font="default" size="100%">ACT</style></keyword><keyword><style  face="normal" font="default" size="100%">Community Treatment Order</style></keyword></keywords><dates><year><style  face="normal" font="default" size="100%">2018</style></year><pub-dates><date><style  face="normal" font="default" size="100%">04/2018</style></date></pub-dates></dates><urls><web-urls><url><style face="normal" font="default" size="100%">https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-018-3097-7</style></url></web-urls></urls><volume><style face="normal" font="default" size="100%">290</style></volume><language><style face="normal" font="default" size="100%">eng</style></language><abstract><style face="normal" font="default" size="100%">&lt;h4&gt;BACKGROUND:&lt;/h4&gt;&lt;p&gt;Patients with severe mental illness may be subjected to Community Treatment Orders (CTOs) in order to secure that the patients adhere to treatment. Few studies have investigated the use of CTOs within an Assertive Community Treatment (ACT) setting, and little is known about how the tension between the patients&amp;#39; autonomy and the clinicians&amp;#39; responsibility to act in the patients&amp;#39; best interest are resolved in practice. The aim of this study was to explore the service providers&amp;#39; experiences with CTOs within an ACT setting.&lt;/p&gt;&lt;h4&gt;METHODS:&lt;/h4&gt;&lt;p&gt;The study was based on reviews of case files of 15 patients, eight individual qualitative in depth interviews and four focus group interviews with service providers involved in ACT and decisions related to CTOs. A modified grounded theory approach was used to analyze the data.&lt;/p&gt;&lt;h4&gt;RESULTS:&lt;/h4&gt;&lt;p&gt;The main theme &amp;#39;responsibility with conflicting priorities&amp;#39; emerged from data analysis (case file reviews, individual interviews and focus group interviews). The balance between coercive approaches and the emphasis on promoting patient autonomy was seen as problematic. The participants saw few alternatives to CTOs as long-term measures to secure ongoing treatment for some of the patients. However, participants perceived the ACT model&amp;#39;s comprehensive scope as an opportunity to build rapport with patients and thereby better meet their needs. The team approach, the ACT providers&amp;#39; commitment to establish supportive relationships and the frequent meetings with patients in their home environment were highlighted. The ACT approach gave them insight into patients&amp;#39; everyday lives and, in some cases a greater sense of security when considering whether to take patients off CTOs.&lt;/p&gt;&lt;h4&gt;CONCLUSIONS:&lt;/h4&gt;&lt;p&gt;Many of the participants viewed CTOs as helpful in securing long-term treatment for patients. CTO decision-making was described as challenging and complex and presented the providers with many dilemmas. The ACT approach was considered as helpful in that it afforded comprehensive, patient-centered support and opportunities to build rapport.&lt;/p&gt;</style></abstract><issue><style face="normal" font="default" size="100%">1</style></issue><label><style face="normal" font="default" size="100%">TUD</style></label></record></records></xml>