Evaluating Integrated Treatment Within Assertive Community Treatment Programs: A New Measure

Abstract

Assertive community treatment (ACT) is an evidence-based practice that consists of a multidisciplinary team of professionals who provide intensive and comprehensive services to people with serious mental disorders living in the community. ACT has been shown to be effective in reducing hospital days and increasing housing stability for service recipients. However, more than half of the people in these programs typically have a co-occurring substance use disorder, and evidence for the model's effectiveness in treating dual disorders is less consistent. One reason cited for this shortcoming is the apparent failure to provide care consistent with the principles and practices of integrated dual disorders treatment, itself an evidence-based practice with demonstrated effectiveness. This is a problem of treatment fidelity, one that is addressed in a new ACT fidelity measure, the Tool for Measurement of Assertive Community Treatment (TMACT), which assesses not only the structural features of ACT but also the quality of clinical processes and services. With the TMACT, evaluators assess particular aspects of staff roles and team functioning as well as integration of critical elements of other evidence-based services, including integrated dual disorders treatment and recovery-oriented, person-centered practices. The measure is described, with particular detail provided for items that assess integrated dual disorders treatment, and a case example is presented to illustrate how the TMACT is used to guide consultation for ensuring effective integrated dual disorders treatment implementation within ACT.

Keywords:

• assertive community treatment
• integrated dual disorders treatment
• program evaluation
• severe mental illness