This Web site is a component of the SAMHSA Health Information Network

This Site Mental Health at HHS All Mental Health

About the Toolkits Illness Management and     Recovery Assertive Community     Treatment Family Psychoeducation Supported Employment Co-occuring Disorders:     Integrated Dual Diagnosis     Treatment Feedback Form Related Links EBP Toolkit Homepage  CMHS Programs:   Go to... Children's Campaign Community Support Emergency Services Financing HIV/AIDS Homelessness Managing Anxiety Mental Health Statistics Protection & Advocacy Special Programs State Planning Traumatic Events Suicide Prevention Programs Homepage  CMHS Activities:   Go to... 15+ School Violence Stigma Suicide Prevention Surgeon General

printer friendly page e-mail this page bookmark this page shopping cart  current or new account

This Web site is a component of the SAMHSA Health Information Network.

Evidence-Based Practices: Shaping Mental Health Services Toward Recovery

Assertive Community Treatment Fidelity Scale

ACT Fidelity Scale Cover Sheet

Date:

Rater(s):

Program Name (or Program Code):

Parent Agency:

Address:

Contact Person:

Telephone:

E-mail:

Sources Used:

____ Chart review

____ Team Leader interview

____ Program Staff Interview(s) (# interviewed)

____ Consumer Interview(s) (# interviewed)

Family Member Interview(s) (# interviewed)

_________________________________

_________________________________

_________________________________

Number of clinicians: ___________

Number of consumers served last year: _________

Funding source: ________________

Urban or rural? _________________

Date program was started: __________________

Back to Top

Back to Assertive Community Treatment

TOC | Previous | Next