Assertive community treatment across the Atlantic: comparison of model fidelity in the UK and USA.

Journal article

BACKGROUND: The significant reductions in hospital admission demonstrated in US assertive community treatment (ACT) studies have not been replicated in the UK. Explanations cite poor UK 'model fidelity' and/or better UK standard care. No international model-fidelity comparisons exist. AIMS: To compare high-fidelity US ACT teams with a UK team. METHOD: The UK 700's ACT team (n=97) was compared with high-fidelity US ACT teams (n=73) by using two measures: a forerunner of the Dartmouth Assertive Community Treatment schedule (to assess adherence to ACT principles) and 2-year prospective activity data. RESULTS: The UK and US teams had similar high-fidelity scores. Although significant differences were found in the amount and type of activity, practice differences in areas central to ACT were not great. CONCLUSIONS: The failure of UK ACT studies to demonstrate the outcome differences of early US studies cannot be attributed entirely to the lack of ACT fidelity.

Authors: Fiander, M; Burns, T; McHugo, G; Drake, R

• Journal: British journal of psychiatry : the journal of mental science
• Volume: 182
• Issue: MAR.
• Pages: 248-254
• Publication date: 2003-03-01
• DOI: 10.1192/bjp.182.3.248
• EISSN: 1472-1465
• ISSN: 0007-1250
• Language: English
• Keywords: Prospective Studies; Community Mental Health Services; Outcome and Process Assessment (Health Care); United States; Hospitalization; Humans; Therapeutic Community; Program Evaluation; Time Factors; Diagnosis, Dual (Psychiatry); Great Britain; Mental Disorders