Fidelity to recovery-oriented ACT practices and consumer outcomes

Area of Science:

• Mental Health Services Research
• Psychiatric Rehabilitation
• Health Services Evaluation

Background:

• Previous research indicated Assertive Community Treatment (ACT) reduces psychiatric hospital use and costs.
• The impact of ACT team fidelity on these outcomes remained largely unexamined.

Purpose of the Study:

• To investigate if outcomes of a recovery-oriented ACT initiative varied based on team fidelity.
• To assess the predictive validity of the Tool for Measurement of Assertive Community Treatment (TMACT).

Main Methods:

• Generalized estimating equations (GEE) analyzed data from 631 ACT consumers.
• Examined the relationship between TMACT fidelity scores and service utilization (state/local hospitals, EDs, crisis units, arrests).
• Subgroup analyses included consumers with any state hospital use and high-use consumers.

Main Results:

• Higher TMACT scores correlated with decreased use of state psychiatric hospitals, local psychiatric inpatient units, and crisis stabilization units (p<.01).
• No statistically significant association was found between TMACT scores and the probability of using these services.
• Marginal effects of TMACT scores on emergency department use or arrests were not significant.

Conclusions:

• The study offers preliminary evidence supporting the TMACT's predictive validity.
• Future research should explore TMACT subscales and its association with person-centered outcomes like well-being and quality of life.