Evidence-Based Practices: Shaping Mental Health Services Toward Recovery

Assertive Community Treatment

Implementation Tips for Public Mental Health Authorities

Studies of the effectiveness of mental health interventions have evolved to a point that researchers have been able to identify a cluster of practices that consistently demonstrate a positive impact on the lives of adults with serious and persistent mental illness and their families. These practices include:

Assertive Community Treatment
Family Education
Integrated Treatment for Co-Occurring Disorders
Illness Management and Recovery
Medication Management
Supported Employment

The goal of the Evidenced-Based Practice (EBP) Project is to provide mental health system administrators with the information and tools they need to make these practices widely available to consumers. The success of this initiative will depend on the leadership of public mental health system administrators and their ongoing oversight of projects developed in local communities. In planning for the implementation of assertive community we recommend that all members of new Assertive Community Treatment programs take part in the core Assertive Community Treatment training. In addition to basic training in Assertive Community Treatment, we suggest that each new team have at least one member receive training in each of the other evidence-based practices. These individuals can then provide cross training for other members of the team.

Creating a Vision

In the implementation of these interventions, you will first need to assemble all of the stakeholders who will be involved in each implementation initiative. This certainly will involve consumers, family members, related state/public organizations, and provider groups. It may also involve organizations not usually associated with the mental health service system such as those familiar with housing, employment, and substance abuse treatment. From the beginning, you will need to lead this group in understanding and articulating what assertive community treatment is and how it is going to be developed in your mental health service system. Articulating the vision and developing momentum around that vision are essential for the success of the project.

Align Incentives

The mental health authority has the capacity to assure that the incentives in the system will facilitate the implementation of this practice. Attention to the alignment of these incentives in a positive way is vital to the success of the implementation of each of these clinical interventions.

Unfold the Intervention

With a vision firmly in place, the process of unfolding the intervention in the service system can begin. Careful planning of this process will go a long distance in assuring a successful outcome. Implementing this intervention first in pilot or demonstration sites may be useful, both in managing problems that will inevitably arise and in giving constituents the opportunity to see that this intervention works. Multiple pilot sites are preferable to just one site. When only one site is used, idiosyncratic things can happen that give a misimpression of the model. On the other hand, when systems do a system wide ‘rollout’, it is difficult to adequately train all of the teams or provide enough side-by-side consultation and mentoring. System problems that may have been resolved easily with a few teams can cause havoc.

Sustain the Project

The challenge of assuring the project is sustained needs to be addressed as a central part of the initial planning process. There are too many examples of excellent initiatives that have had a positive beginning involving the enthusiastic support of participants only to flounder at the end of a year for lack of planning around the critical issue of the ongoing maintenance of the project. The public mental health authority can use strategies (e.g. rules, contracts etc) to address this issue and assure that it us attended to in such a way that the project will continue to grow and develop.

The materials in this section those likely to affect costs. We encourage you to share this section, and other Assertive Community Treatment implementation materials, with those individuals in your mental health system whose expertise you will need in setting up appropriate rules and financial structures along with those providers who may be affected by the implementation of Assertive Community Treatment, and consumers and their families.

We have divided “Tips for Mental Health System Administrators” into two parts:

The Assertive Community Treatment Model
Part 1 describes assertive community treatment and the outcomes it is expected to produce. This section also discusses the resources and processes needed to implement and support assertive community treatment programs.

The Lewin Group’s Assertive Community Treatment Literature Review
Part 2 is a copy of a report prepared by the Lewin Group. It provides an extensive discussion of variations in the practice of assertive community treatment that will help you understand the basis for the sometimes conflicting information you may hear about Assertive Community Treatment.

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