'It's Like You Do It Without Knowing That You're Doing It': Practitioner Experiences with ACT Implementation

Area of Science:

• Mental Health Services
• Psychiatric Care
• Community Psychology

Background:

• Assertive Community Treatment (ACT) is an evidence-based practice (EBP) for severe mental illness.
• Understanding the implementation of ACT is crucial for effective service delivery.
• Previous research has focused on fidelity but less on provider experiences within contextual factors.

Purpose of the Study:

• To explore the experiences of providers delivering ACT in exemplar programs.
• To understand how frontline staff perceive and implement ACT components.
• To examine the influence of organizational and contextual factors on ACT implementation.

Main Methods:

• A case study approach was used, examining three exemplar ACT programs in California.
• Interviews were conducted with 37 participants: program directors, frontline staff, and county mental health executives.
• Qualitative data analysis focused on provider perspectives and contextual influences.

Main Results:

• Frontline staff often practice ACT without explicit knowledge of its core components or fidelity monitoring.
• Provider understanding of EBP implementation is nuanced and context-dependent.
• Program director and county executive perspectives highlight the role of inner and outer contextual information in shaping implementation.

Conclusions:

• Frontline ACT providers may implement the model without full awareness of its defined components.
• Organizational context and communication significantly influence the understanding and application of ACT.
• This study has implications for improving the training and fidelity monitoring of EBPs like ACT.