The Program
Assertive Community Treatment (ACT) is an evidence-based practice (EBP) designed to meet the complex needs of individuals with serious mental illness (SMI) who require high service use and struggle with functioning in areas like housing and employment. ACT teams provide intensive, flexible, and personalized services such as clinical treatment, psychiatric rehabilitation, and case management to prevent hospitalizations and justice system involvement. Services are often delivered in community settings to promote skill development. The multidisciplinary team includes psychiatric providers, nurses, substance use and employment specialists, peer support, mental health clinicians, case managers, and a team leader, all collaborating to support individuals’ recovery and self-identified goals.
Intended Audience
The intended audience is individuals who experience serious mental illness.
Implementation
Assertive Community Treatment (ACT) is typically implemented within community behavioral health agencies, providing personalized, in-person services in various community settings like homes, schools, and workplaces. ACT team members work collaboratively with hospitals, jails, and other agencies to identify participants and coordinate care. Services are flexible, with most clients receiving an average of three face-to-face interactions per week. There is no time limit on enrollment, and clients transition to less intensive care as they gain independence. ACT teams meet daily to coordinate care, with all members cross-trained to ensure a team-based approach to supporting client recovery.
Outcomes
ACT has had the following outcomes as a result of its implementation:
- Decreased hospital utilization
- Increased independent living and housing stability
- Retention in treatment
- Individual and family satisfaction
Evidence
ACT has more than 50 published empirical studies, reviews, and meta-analyses, making it one of the most well-studied service programs for people with serious mental illnesses. The program’s current fidelity tool is the Tool for measuring Assertive Community Treatment (TMACT). It builds on the Dartmouth Assertive Community Treatment Scale (DACTS) to assess the team’s structure and delivery of specialty services. DACTS is still used in some states to briefly assess ACT structure and limited areas of service and functioning. Fidelity assessments are conducted every 1-2 years by a reviewer. The reviewer conducts audits over two days and interviews staff, observes delivered services and team functioning, and reviews clinical records. Reviews utilize qualitative and quantitative data to generate fidelity scores that are incorporated into a longer written report that indicates the team’s strengths, primary areas of growth, and tangible recommendations for further training. Fidelity scores for DACTS and TMACT are on a scale of 1 to 5, with 5 representing high fidelity. In some states, fidelity scores may be used internally for quality improvement or funding renewal.
Additional Resources