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Prediction of Outcome from the Dartmouth Assertive Community Treatment Fidelity Scale

Published online by Cambridge University Press:  07 November 2014

Gary R. Bond  and
Michelle P. Salyers
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Abstract

Background: Assertive community treatment (ACT) is an intensive and comprehensive treatment for clients with severe mental illness (SMI) who do not readily benefit from clinic-based services. Monitoring the implementation of such programs is critical, because better-implemented programs have been found to be effective in improving client outcomes.

Objective: We tested the hypothesis that fidelity to the ACT model would be positively correlated with improved client outcomes, as measured by reduction in psychiatric hospital use.

Methods: A scale measuring fidelity of program implementation, the Dartmouth ACT Scale, was examined in 10 newly formed ACT teams. Using the team as the unit of measure, the mean reduction in state hospital days for a 1-year period before and after program admission was calculated. Mean effect size in reduction in hospital days was used as the outcome measure in a correlational design.

Results: Pre/post comparisons showed a 43% reduction in hospital days for 317 clients (t=8.61, P<.001). The Pearson correlation between DACTS fidelity and reduction of state hospitaldays was .49, P=.08, one-tailed.

Conclusion: Several possible reasons are offered for why the study hypothesis was not confirmed. However, even if predictive validity of the Dartmouth ACT Scale is limited, it continues to be a useful tool for program monitoring and for providing corrective feedback.

Type
Original Research
Information
CNS Spectrums , Volume 9 , Issue 12 , December 2004 , pp. 937 - 942
Copyright
Copyright © Cambridge University Press 2004

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References

REFERENCES

1.Stein, LI, Test, MA. Alternative to mental hospital treatment. I. Conceptual model, treatment program, and clinical evaluation. Arch Gen Psychiatry. 1980;37:392–397.Google Scholar
2.Drake, RE, Goldman, HH, Leff, HS, et al.Implementing evidence-based practices in routine mental health service settings. Psychiatr Serv. 2001;52:179–182.Google Scholar
3.Phillips, SD, Bums, BJ, Edgar, ER, et al.Moving assertive community treatment into standard practice. Psychiatr Serv. 2001;52:771–779.Google Scholar
4.Surgeon General. Surgeon General's Report on Mental Health. Washington, DC: US Government Printing Office; 2000.Google Scholar
5.Lehman, AF, Steinwachs, DM. Translating research into practice: the Schizophrenia Patient Outcomes Research Team (PORT) treatment recommendation. Schizophr Bull. 1998;24:1–10.Google Scholar
6.Allness, DJ, Knoedler, WH. The PACT Model of Community-Based Treatment for Persons with Severe and Persistent Mental Illness: A Manual for PACT Start-Up. 2nd ed. Arlington, VA: National Alliance for the Mentally Ill; 2003.Google Scholar
7.Bedell, JR, Cohen, NL, Sullivan, A. Case management: the current best practices and the next generation of innovation. Community Ment Health J. 2000;36:179–194.Google Scholar
8.Bond, GR, Drake, RE, Mueser, KT, Latimer, E. Assertive community treatment for people with severe mental illness: Critical ingredients and impact on patients. Disease Management and Health Outcomes. 2001;9:141–159.Google Scholar
9.Latimer, EA. Economic impacts of assertive community treatment: a review of the literature. Can J Psychiatry. 1999;44:443–454.Google Scholar
10.Marshall, M, Creed, F. Assertive community treatment: is it the future of community care in the UK? Int Rev Psychiatry. 2000;12:191–196.Google Scholar
11.Marshall, M, Lockwood, A. Assertive community treatment for people with severe mental disorders (Cochrane Review). Updated quarterly ed. Oxford, UK: Update Software; 1998.Google Scholar
12.Mueser, KT, Bond, GR, Drake, RE, Resnick, SG. Models of community care for severe mental illness: A review of research on case management. Schizophr Bull. 1998;24:37–74.Google Scholar
13.Rapp, CA, Goscha, RJ. The principles of effective case management of mental health services. Psychiatr Rehabil J. 2004;27:319–333.Google Scholar
14.Ziguras, S, Stuart, G. A meta-analysis of the effectiveness of mental health case management over 20 years. Psychiatr Serv. 2000;51:1410–1421.Google Scholar
15.McGrew, JH, Bond, GR. Critical ingredients of assertive community treatment: judgments of the experts. J Ment Health Adm. 1995;22:113–125.Google Scholar
16.Bond, GR. Variations in an assertive outreach model. New Dir Ment Health Serv. 1991;52:65–80.Google Scholar
17.Bond, GR, Evans, L, Salyers, MP, Williams, J, Kim, HK. Measurement of fidelity in psychiatric rehabilitation. Ment Health Serv Res. 2000;2;75–87.Google Scholar
18.Ganju, V. Implementation ot evidence-based practices in state mental health systems: implications for research and effectiveness studies. Schizophr Bull. 2003;29:125–131.Google Scholar
19.Torrey, WC, Drake, RE, Dixon, L, et al.Implementing evidence-based practices for persons with severe mental illnesses. Psychiatric Services. 2001;52:45–50.CrossRefGoogle ScholarPubMed
20.Mowbray, CT, Holder, M, Teague, GR, Bybee, D. Fidelity criteria: Development, measurement, and validation. American Journal of Evaluation. 2003;24:315–340.Google Scholar
21.Torrey, WC, Finnerty, M, Evans, A, Wyzik, P. Strategies for leading the implementation of evidence-based practices. Psychiatr Clin North Am. 2003;26:883–897.Google Scholar
22.McGrew, JH, Bond, GR, Dietzen, L, Salyers, M. Measuring the fidelity of implementation of a mental health program model. J Consult Clin Psychol. 1994;62:670–678.Google Scholar
23.Teague, GB, Drake, RE, Ackcrson, TH. Evaluating use of continuous treatment teams for persons with mental illness and substance abuse. Psychiatr Serv. 1995;46:689–695.Google ScholarPubMed
24.McHugo, GJ, Drake, RE, Teague, GB, Xie, H. The relationship between model fidelity and client outcomes in the New Hampshire Dual Disorders Study. Psychiatr Serv. 1999;50:818–824.Google Scholar
25.Teague, GB, Bond, GR, Drake, RE. Program fidelity in assertive community treatment: development and use of a measure. Am J Orthopsycrdatry. 1998;68:216–232.Google Scholar
26.Salyers, MP, Bond, GR, Teague, GB, et al.Is it ACT yet? Real-world examples of evaluating the degree of implementation for assertive community treatment. J Behuv Health Serv Res. 2003;30:304–320.CrossRefGoogle ScholarPubMed
27.Winter, JP, Calsyn, RJ. The Dartmouth Assertive Community Treatment Scale (DACTS). A generaliiability study. Eval Rev. 2000;24:319–338.Google Scholar
28.Bond, GR. Outcome and fidelity monitoring: preliminary data from the National EBP Project. Paper presented at: annual meeting of National Association of State Mental Health Program Directors Adult Evidence-Based Practice Conference; June 28-29, 2004; Chicago, Ill.Google Scholar
29.Bond, GR, Witheridge, TF, Dincin, J, Wasmer, D, Webb, J, DeGraaf-Kaser, R. Assertive community treatment for frequent users of psychiatric hospitals in a large city: a controlled study. Am J Community Psychol. 1990;18:865–891.CrossRefGoogle Scholar
30.Bond, GR, McGrew, JH, Fekete, DM. Assertive outreach for frequent users ot psychiatric hospitals: a meta-analysis. J Ment Health Adm. 1995;22:4–16.Google Scholar
31.Dincin, J, Wasmer, D, Witheridge, TF, Sobeck, L, Cook, J, Razzano, L. Impact of assertive community treatment on the use of state hospital inpatient bed-days. Hosp Community Psychiatry. 1993;44:833–838.Google Scholar
32.Witheridge, TF, Dincin, J, Applehy, L. Working with the most frequent recidivists: A total team approach to assertive resource management. Psychiatr Rehabil J. 1982;5:9–11.Google Scholar
33.Becker, BJ. Synthesizing standardized mean-change measures. Br J Math Slat Psychol.1988;41:257–278.Google Scholar
34.Lipsey, MW. Design Sensitivity. Newbury Park, Calif: Sage; 1990.Google Scholar
35.Moser, LL, DeLuca, NL, Rollins, AL, Bond, GR. Implementing evidence based psychosocial practices: lessons learned from statewide implementation of two practices. CNS Spectr. 2004;9:926–936,942.Google Scholar
36.Mueser, KT, Torrey, WC, Lynde, D, Singer, P, Drake, RE. Implementing evidence-based practices for people with severe mental illness. Behav Modif. 2003;27:387–411.Google Scholar
37.Rapp, CA. Client-centered performance management for rehabilitation and mental health services. In: Flexer, RW, Solomon, PL, eds. Community and Social Support for People with Severe Mental Disabilities. Boston, Mass: Andover; 1993; 173–192.Google Scholar