From 1995 the UK government prioritised the development of assertive outreach as part of its modernisation

of assertive outreach as part of its modernisation programme. Key components of the assertive outreach model include ‘outreach’, delivering care in the patient’s home, assertive follow-up even when patients disengage, small case-loads of 10-12 per professional, and some form of 7-day, 24-hour availability. Initial reports from the USA and Australia of dramatically reduced hospital admission rates have not been replicated in the UK, raising debates about the relative value of the assertive outreach model against ‘control group’ standard services, where these are good-quality community mental health teams. Such findings also challenge the importance of fidelity to the original assertive outreach treatment model and raise questions about which elements of the assertive outreach model in standard services are necessary. Since 1990 the UK National Health Service and Community Care Act required that mental healthcare should be provided on the basis of need, defined as ‘the requirements of individuals to enable them to achieve, maintain or restore an acceptable level of social independence or quality of life’. The routine use of outcome measures by psychiatrists has been low, leading to arguments for the development of ‘demonstration sites’, where routine outcome measurement would promote a focus on the patient’s perceptions and enable systematic needs assessment and evaluation. The Camberwell Assessment of Need (CAN) was developed explicitly to measure needs in mental health settings and the CAN Short Appraisal Schedule (CANSAS), which assesses needs ratings for each of 22 domains, was developed for routine clinical use. Research to date using the CAN has shown that the level of unmet need is the most relevant rating for patient-level use, and met need is most relevant for service-level use. Service user and staff accounts of needs differ, the service user’s account being the most reliable. The Engagement Measure rates five measures of engagement and can be used to assess changes over time. The Health of the Nation Outcome Scales (HoNOS) assess health and social functioning and has been recommended for use in routine clinical settings. Assertive outreach teams may be ideally placed to implement routine outcome measurement, as they typically work with defined case-loads over lengthy periods. The routine use of CANSAS may facilitate systematic care planning and improve outcomes. However, there is little reported research in this area of assertive outreach practice. This study was undertaken in three 2Gether NHS Foundation Trust assertive outreach teams that were developed from two community rehabilitation teams (from approximately the year 2000) following standard guidance from the Mental Health Policy Implementation Guide, with integrated psychiatry, psychology and occupational therapy input. The teams had a single operational policy, with explicit admission criteria, dedicated in-patient beds and adopted a standard care programme approach to care coordination for all patients on the team case-load. The teams scored ORIGINAL PAPERS