Critical ingredients of assertive community treatment: judgments of the experts

Twenty experts on assertive community treatment (ACT) rated the importance of 73 program elements, also indicating ideal model specifications (e.g., minimum time commitment for psychiatrist) when appropriate. Interexpert agreement on ratings of importance was high (intraclass r = .94), although there was less agreement for some areas--for example, team structure (intraclass r = .70). Survey responses suggested several areas of increasing emphasis (e.g., vocational and addictions specialists) and of decreasing emphasis (e.g., the avoidance of office visits). Two subgroups of experts were identified--those who advocated large multidisciplinary teams (100 or more clients) and day and evening shifts, and those who advocated smaller, often generalist, teams (approximately 50 clients). Experts also reported ideal staffing for an ACT team. The most frequently identified disciplines were psychiatrist, nurse, and social worker. Implications for mental health policy--for example, quality assurance and program standards--are discussed.