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Implementing assertive community treatment programs in rural settings

E C McDonel1, G R Bond, M Salyers

  • 1Indiana University at Bloomington, USA.

Administration and Policy in Mental Health
|September 4, 1998
PubMed
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This study evaluated a rural adaptation of assertive community treatment (ACT) for serious and persistent mental illness (SPMI). Mid-study adjustments led to small, positive outcomes, highlighting rural implementation challenges.

Area of Science:

  • Psychiatry
  • Mental Health Services Research
  • Rural Health

Background:

  • Assertive Community Treatment (ACT) is a model for serious and persistent mental illness (SPMI).
  • Adapting complex service models like ACT to rural settings presents unique challenges.
  • Evaluating interventions in diverse community mental health settings is crucial.

Purpose of the Study:

  • To evaluate a rural adaptation of the ACT model for clients with SPMI.
  • To identify and address implementation challenges in a rural context.
  • To assess client and system outcomes of the adapted ACT model.

Main Methods:

  • Controlled evaluation of an adapted ACT model across four rural community mental health sites.
  • One site blended ACT with the Rhinelander model.

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  • Outcomes measured at 6, 12, and 24 months, with qualitative implementation evaluation.

    • Main Results:

    • Initial implementation challenges identified at 12 months led to mid-study adjustments.
    • Small, positive client and system outcomes observed at 24 months.
    • Descriptive data highlight specific barriers to rural mental health service implementation.

    Conclusions:

    • Adaptation and mid-course correction of the ACT model may improve outcomes in rural SPMI care.
    • Addressing rural-specific implementation barriers is essential for complex mental health service models.
    • Further research is needed to optimize ACT delivery in underserved rural areas.