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Community Mental Health Journal

, Volume 48, Issue 2, pp 138–149 | Cite as

Fidelity to Assertive Community Treatment Program Standards: A Regional Survey of Adherence to Standards

  • Glen E. Randall
  • Patricia A. Wakefield
  • David A. Richards
Original Paper

Abstract

In 2004, the Ontario government approved revised program standards for the operation of Assertive Community Treatment (ACT) programs in the province. This paper reports on results from The 2005 Survey of ACT Programs in Ontario. We provide a profile of ACT programs in the province and identify respondents’ perceptions of the extent to which the revised program standards have been complied with and are thought to be essential for the effective operation of an ACT program. Program Coordinators completed surveys for 56 (85%) of the 66 ACT programs in existence at the time. None of the Program Coordinators reported that their ACT program was fully compliant with all program standards and only 4% of ACT programs were identified as being fully compliant with more than 75% of the program standards. Conclusions are provided and the broader implications of lower fidelity to program standards are discussed.

Keywords

Health policy Mental health services Assertive community treatment Program standards Fidelity 

Notes

Acknowledgments

This research was funded by a grant from the Arts Research Board, McMaster University. We would like to thank research associates Darlene Kindiak and Joanne Menchions and research assistants, Cheryl Gustafson, and Michael Schatte for their assitance with this study, along with all of the ACT Program Coordinators who particiapted in the study. We are also grateful for the contributions of the anonymous reviewers.

References

  1. Banks, S., McHugo, G. J., Williams, V., Drake, R. E., & Shinn, M. (2001). A prospective meta-analitic approach in a mulit-site study of homelessness revention. In J. M. Herrell & R. B. Straw (Eds.), Conducting multiple site evaluations in real-world settings (Vol. 94, pp. 45–59). New Directions for Evaluation, San Francisco, CA: Jossey-Bass.Google Scholar
  2. Baronet, A. M., & Gerber, G. J. (1998). Psychiatric rehabilitation: Efficacy of four models. Clinical Psychology Review, 18, 189–228.PubMedCrossRefGoogle Scholar
  3. Bond, G. R., Drake, R. E., Mueser, K. T., & Latimer, E. (2001). Assertive community treatment for people with severe mental illness: Critical ingredients and impact on patients. Disease Management and Health Outcomes, 9(3), 141–159.CrossRefGoogle Scholar
  4. Bond, G. R., Williams, J., & Evans, L. (2000). PN-44-psychiatric rehabilitation fidelity toolkit. Cambridge, MA: Human Services Research Institute.Google Scholar
  5. Burns, B. J. (1995). Assertive community treatment—An update of randomized trials. Psychiatric Services, 46, 669–675.PubMedGoogle Scholar
  6. Deci, P. A., Santos, A. B., Hiott, D. W., Schoenwald, S., & Dias, J. K. (1995). Dissemination of assertive community treatment programs. Psychiatric Services, 46(7), 676–678.PubMedGoogle Scholar
  7. Dixon, L. (2000). Assertive community treatment: Twenty-five years of gold. Psychiatric Services, 51(6), 759–765.PubMedCrossRefGoogle Scholar
  8. Drake, R. E., & Burns, B. J. (1995). Special section on assertive community treatment—An introduction. Psychiatric Services, 46, 667–668.PubMedGoogle Scholar
  9. Henskens, R., Garretsen, H., Mulder, C. L., Bongers, I., & Kroon, H. (2005). Fidelity of an outreach treatment program for chronic crack abusers in the Netherlands to the ACT model. Psychiatric Services, 56(11), 1451–1454.PubMedCrossRefGoogle Scholar
  10. Humberstone, V., Vanderpyl, J., Saunders, K., Lurie, S., McKee, H., Deuchar, N., et al. (2008). International comparative ACT study process and data: How ACT teams compare in Toronto, Birmingham, Nashville and Auckland. The International Journal of Leadership in Public Service, 4(1), 41–55.CrossRefGoogle Scholar
  11. Isett, K. R., Burnam, M. A., Coleman-Beattie, B., Hyde, P. S., Morrissey, J. P., Magnabosco, J., et al. (2008). The role of state mental health authorities in managing change for the implementation of evidence-based practices. Community Mental Health Journal, 58, 914–921.Google Scholar
  12. Latimer, E. A. (1999). Economic impacts of assertive community treatment: A review of the literature. Canadian Journal of Psychiatry, 44(5), 443–454.Google Scholar
  13. Mancini, A. D., Moser, L. L., Whitley, R., McHugo, G. J., Bond, G. R., Finnerty, M. T., et al. (2009). Assertive community treatment: Facilitators and barriers to implementation in routine mental health settings. Psychiatric Services, 60, 189–195.PubMedCrossRefGoogle Scholar
  14. Matejkowski, J., & Draine, J. (2009). Investigating the impact of housing first on ACT fidelity. Community Mental Health Journal, 45(1), 6–11.PubMedCrossRefGoogle Scholar
  15. McGrew, J. H., Bond, G. R., Dietzen, L., & Salyers, M. (1994). Measuring the fidelity of implementation of a mental health program model. Journal of Consultingand Clinical Psychology, 62(4), 670–678.CrossRefGoogle Scholar
  16. McGrew, J. H., Bond, G. R., Dietzen, L., & Salyers, M. (1995). A multisite study of client outcomes in assertive community treatment. Psychiatric Services, 46, 696–701.PubMedGoogle Scholar
  17. McHugo, G. J., Drake, R. E., Teague, G. B., & Xie, H. (1999). Fidelity to assertive community treatment and client outcomes in the New Hampshire Dual Disorders study. Psychiatric Services, 50(6), 818–824.PubMedGoogle Scholar
  18. McHugo, G. J., Drake, R. E., Whitley, R., Bond, G. R., Campbell, K., Rapp, C. A., et al. (2007). Fidelity outcomes in the national implementing evidence-based practice project. Psychiatric Services, 58(10), 1279–1284.PubMedCrossRefGoogle Scholar
  19. Mobray, C. T., Holter, M. C., Teague, G. B., & Bybee, D. (2003). Fidelity criteria: Development, measurment, and validation. American Journal of Evaluation, 24(3), 315–340.Google Scholar
  20. Ontario Ministry of Health. (1998). Recommended standards for assertive community treatment teams. Toronto, Ontario: Ontario Ministry of Health.Google Scholar
  21. Ontario Ministry of Health. (2005). Ontario Program Standards for ACT Teams, 2nd edition, October 2004, Ministry of Health and Long-Term Care, Updated January 2005. http://www.health.gov.on.ca/english/public/pub/ministry_reports/mentalhealth/act_standards.pdf.
  22. Paulson, R. I., Post, R. L., Herinckx, H. A., & Risser, P. (2002). Beyond components: Using fidelity scales to measure and assure choice in program implementation and quality assurance. Community Mental Health Journal, 38(2), 119–128.PubMedCrossRefGoogle Scholar
  23. Randall, G. E., & Wakefield, P. A. (2005). Ontario ACT program fidelity tool. Unpublished report.Google Scholar
  24. Rapp, C. A., Bond, G. R., Becker, D. R., Carpinello, S. E., Nikkel, R. E., & Gintoli, G. (2005). The role of state mental health authorities in promoting improved client outcomes through evidence-based practice. Community Mental Health Journal, 41, 347–363.PubMedCrossRefGoogle Scholar
  25. Salyers, M. P., Bond, G. R., Teague, G. B., Cox, J. F., Smith, M. E., Hicks, M. L., et al. (2003). Is it ACT yet? Real-world examples of evaluating the degree of implementation for assertive community treatment. Journal of Behavioral Health Services, 30(3), 304–320.CrossRefGoogle Scholar
  26. Salyers, M. P., & Tsemberis, S. (2008). ACT and Recovery: Integrating evidence-based practice and recovery orientation on assertive community treatment teams. Community Mental Health Journal, 43(6), 619–641.CrossRefGoogle Scholar
  27. Singh, R. H., & Kaczmarczyk, M. M. (2008). Standards of professional practice for genetic metabolic dietitians. Genetics in Medicine, 10(4), 290–293.PubMedCrossRefGoogle Scholar
  28. Teague, G. B., Drake, R. E., & Ackerson, T. H. (1995). Evaluating use of continuous treatment teams for persons with mental illness and substance abuse. Psychiatric Services, 46(7), 689–695.PubMedGoogle Scholar
  29. White, H., Whelan, C., Barnes, J. D., & Baskerville, B. (2003). Survey of consumer and non-consumer mental health service providers on assertive community treatment teams in Ontario. Community Mental Health Journal, 39(3), 265–276.PubMedCrossRefGoogle Scholar
  30. Wright, C., Burns, T., James, P., Billings, J., Johnson, S., Muijen, M., et al. (2003). Assertive outreach teams in London: Models of operation. Pan-London assertive outreach study, part 1. British Journal of Psychiatry, 183, 132–138.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Glen E. Randall
    • 1
  • Patricia A. Wakefield
    • 1
  • David A. Richards
    • 2
  1. 1.Strategic Market Leadership and Health Services ManagementDeGroote School of Business, McMaster UniversityHamiltonCanada
  2. 2.Faculty of Business AdministrationLakehead UniversityThunder BayCanada

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