The TMACT: a new tool for measuring fidelity to assertive community treatment

Fidelity assessment is important for implementation of evidence-based practices (EBPs), including assertive community treatment (ACT).

The TMACT, an enhanced fidelity tool, was developed and pilot-tested to better assess critical ACT structures and processes.

Ten ACT teams were administered the TMACT and the long-standing ACT fidelity measure, the Dartmouth Assertive Community Treatment Scale (DACTS), at baseline, 6, 12, and 18 months.

Overall, fidelity scores for all 10 teams were relatively high. Six teams showed improvement, concluding with high TMACT scores at 18 months. Four teams with significantly lower total scores had experienced turnover and organizational barriers. TMACT ratings were higher in core ACT practices than in recovery practices and EBPs. TMACT scores rose steadily but were significantly lower than DACTS scores, which remained unchanged.

The TMACT sets higher performance standards through enhanced assessment of recovery-orientation, EBPs, and teamwork and is more sensitive to change than the DACTS.