Background: While there have been several reports of Assertive Community Treatment (ACT) programs being implemented outside the U.S., their fidelity to the ACT model has not been assessed in a standardized way. Moreover, few outcomes assessments of high-fidelity programs outside the U.S. have been reported. Methods: Fidelity of an ACT program at the Douglas hospital in Montreal, Canada, was assessed using the Dartmouth ACT fidelity scale. Measures were based in part on detailed records of team member contacts with clients and others. Hospital records were used to measure hospital resource use for all 71 clients, from three years pre-admission to two years post-admission to the ACT program. Among these, 41 consenting clients and their case managers were interviewed at successive six-month intervals for up to 18 months using standardized scales. Results: The Douglas hospital program achieved a high fidelity rating of 4.04/5. Excluding the year immediately before and the year immediately after admission to account for regression to the mean, annual hospital days per client were reduced from 97 to 21. Emergency room and outpatient visits were also reduced. Net annual savings in treatment costs were estimated at CAN$390,000. Initial analyses reveal statistically significant increases in client satisfaction with services, subjective quality of life, and functioning, from baseline to six months later only, but no statistically significant changes on an empowerment scale nor on the 32-item Behavior And Symptom Identification Scale. Implications: In spite of different institutional arrangements, high-fidelity and cost-effective ACT programs can be implemented in Canada.
Learning Objectives: Obtain a greater understanding of how fidelity of an intensive community follow-up team to the ACT model influences outcomes in clientele.
Keywords: Case Management, Mental Health Services
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Douglas Hospital ACT Team
Disclosure not received
Relationship: Not Received.