Leonard Stein, one of the original proponents of assertive outreach, was keen to reduce the ‘pathological dependency’ he felt was implicit in the individual keyworker model. Thus developed the ‘whole team approach’; all the members of a team work with all the patients and share clinical responsibility. This aims to reduce both keyworker stress and the ‘dependency’ of the patients.

This pack, for developing assertive outreach teams, emphasises the importance of such an approach. However, many authorities in the area do not buy into this model. They argue that the road to independence is via a period of dependence and that forming individual relationships is important. On a practical level, trying to routinely rotate visits between all team members is inefficient and labour intensive. Engagement, so crucial to successful assertive outreach, can also become more difficult.

That there is any debate about this issue would be a surprise to those using this pack in isolation, as it sticks very much to the mantra that the whole team approach is the crux of successful assertive outreach. It is aimed at leaders of developing teams, and concentrates on putting issues into practice. It consists of a training pack accompanied by a video. Also included are some clear, simple handouts covering the background and core components. The emphasis is on practical issues such as the daily handover, and training sessions are suggested.

The video presents footage of two teams, both in the voluntary sector, with no medical involvement. The ‘whole team approach’ is explained and the video demonstrates the degree of communication necessary to enforce this rigorously. Team members discuss the model from their perspective and you get a feel for their enthusiasm and dedication. However, the lack of medical input is reflected in the case histories; in one, a patient is left in his room not eating or drinking for 4 days and not having seen a doctor, while the team try to engage him and his family.

This pack may be of interest to developing assertive outreach teams, but will only be relevant to those who have already made an informed decision to adopt the whole team approach. The emphasis on teams in the voluntary sector does not reflect the self-contained teams with active medical membership suggested by the government's Policy Implementation Guidelines. Assertive outreach needs to be flexible, and many teams have found in practice that, rather than sticking rigidly to the ideology of the whole team approach, a mixture of both models has evolved.