Evidence-Based Practices: Shaping Mental Health Services Toward Recovery

Assertive Community Treatment

Assertive Community Treatment Fidelity Scale

This section is intended to help guide your administration of the Assertive Community Treatment (ACT) Fidelity Scale. With a few minor modifications, this scale is the Dartmouth Assertive Community Treatment Scale (DACTS) developed by Teague, Bond, and Drake (1998). In this document you will find the following:

1. Introduction: This gives an overview of ACT and a who/what/how of the scale. Plus there is a checklist of suggestions for before, during, and after the fidelity assessment that should lead to the collection of higher quality data, more positive interactions with respondents, and a more efficient data collection process.
   
2. Item-Level Protocol: The protocol explains how to rate each item. In particular, it provides:

   a) A definition and rationale for each fidelity item. These items have been derived from a comprehensive review of evidence-based literature.
   
   b) A list of data sources most appropriate for each fidelity item (e.g., chart review, clinician interview, team meeting observation).
   
   c) Where appropriate, a set of probe questions to help elicit the critical information needed to score the fidelity item. These probe questions were specifically generated to help you collect information from respondents that is free from bias such as social desirability.
   
   d) Decision rules that will help you correctly score each item. As you collect information from various sources, these rules will help you determine the specific rating to give for each item.

3. Cover sheet: This form obtains background information about the study site. The data are not used in determining fidelity, but provide important information for classifying programs, such as size and duration of program, type of parent organization, and community characteristics.

4. DACTS Score Sheet: This sheet can be used or adapted for tallying the chart review.

5. Rating Sheet: The sheet provides instructions for scoring, including how to handle missing data; plus cut-off scores for full, moderate, and inadequate implementation.

   Reference: Teague, G. B., Bond, G. R., & Drake, R. E. (1998). Program fidelity in assertive community treatment: Development and use of a measure. American Journal of Orthopsychiatry, 68, 216-232.

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