Randomized controlled trial of assertive community treatment in intellectual disability: the TACTILD study.
Assertive outreach gives adults with ID no edge over the community services they already receive.
01Research in Context
What this study did
The TACTILD team ran a randomized trial of assertive outreach for adults with intellectual disability. Half got the new mobile team. Half kept their usual community care.
Researchers tracked daily living skills, caregiver stress, and quality of life for one year.
What they found
Both groups looked the same at the end. Assertive outreach added no extra gain in functioning, stress, or life quality.
Standard care already met most needs.
How this fits with other research
DeLeon et al. (2005) ran a near-copy trial the same year. They also saw zero advantage for assertive outreach, even when clients had extra mental-health diagnoses. The back-to-back null results make the picture hard to ignore.
Oliver et al. (2002) warned us this might happen. Their earlier paper showed that consent and capacity rules slow ID trials to a crawl. TACTILD proved the hurdles can be cleared, but the payoff may still be flat.
Bergström et al. (2013) took a different path. Their cluster trial added step-count goals and health ambassadors in group homes. Small gains showed up, hinting that narrow, skill-focused packages can move the needle when broad case management does not.
Why it matters
Stop selling assertive outreach as a must-have for adults with ID. Your time and funds are safer in targeted skill-building or health routines. If a family asks for extra wrap-around, show them the data and share the choice.
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02At a glance
03Original abstract
BACKGROUND: There has been a policy shift away from hospital to community in the services of all those with psychiatric disorders, including those with intellectual disability (ID), in the last 50 years. This has been accompanied recently by the growth of assertive outreach services, but these have not been evaluated in ID services. METHOD: In a randomized controlled trial we compared assertive outreach with 'standard' community care, using global assessment of function (GAF) as the primary outcome measure, and burden and quality of life as secondary measures. RESULTS: We recruited 30 patients, considerably less than expected; no significant differences were found between the primary and secondary outcomes in the two groups. The differences were so small that a Type II error was unlikely. CONCLUSIONS: Reasons for this lack of specific efficacy of the assertive approach are discussed and it is suggested that there is a blurring of the differences between standard and assertive approaches in practice.
Journal of intellectual disability research : JIDR, 2005 · doi:10.1111/j.1365-2788.2005.00706.x