Assertive Community Treatment Fidelity in Programs Serving Persons Who Are Homeless With Co-Occurring Mental and Addictive Disorders

Abstract

Fidelity rating of evidence-based practices ensures the implementation of interventions as intended and enhances the likelihood of replication of positive outcomes previously demonstrated. However, modifications have been necessary when a practice is adopted in settings or for populations other than those for which they were developed. This study reports fidelity findings for six programs implementing the Assertive Community Treatment model in different settings for adults who are homeless and who present with mental and addictive disorders, together with a methodology that can assist programs to achieve fidelity. Initial and final fidelity ratings using the Dartmouth Assertive Community Treatment Scale were collected from six programs. Findings indicate that while fidelity in programs can vary over time, core elements can be maintained, resulting in at least moderate fidelity in each program and modest overall increases across all programs combined with concomitant decreases in the variance of fidelity scales. The findings support previous research that fidelity change is minimal after initial fidelity is achieved during the first year of implementation, and they extend previous results to programs serving persons who are homeless and have co-occurring mental and addictive disorders. This study suggests that fidelity to evidence-based practice can be maintained for adaptation to new populations and settings. Understanding areas that are likely to be challenging to fidelity achievement and managing the variability of performance on the components of each fidelity aspect can assist the program manager and personnel to achieve and maintain adequate model fidelity.

KEYWORDS:

• Assertive Community Treatment
• fidelity
• evidence-based practices
• homeless
• co-occurring mental and addictive disorders
• Six Sigma

This study was supported by the Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services Grant Numbers TI16681, TI16605, TI16473, TI16502, TI16569, TI16485, TI16630, TI16672, TI16713, and TI18019 and through Contract Number 270-03-1000, Task Order Number 270-03-1001. The views and opinions expressed in this manuscript are those of the authors and do not necessarily reflect those of the funding institution.

The authors thank the Treatment for Homeless project staff, administrators, and evaluators who provided the data reported here. They also thank Joanne Gampel, MA, for her support, Susan Brumbaugh, PhD, for her facilitation of the workgroup and paper writing process, and Gwen Gannon, MA, for her review and comments.

Notes

∗F cannot be computed because the variances of both groups is 0.