[Implementation of intensive follow-up in the community: lessons to be considered].
OBJECTIVE
To examine various issues concerning the implementation of a program for assertive community treatment (ACT).


METHODS
In-depth interviews were conducted with participants of an ACT project implemented in the 1970s. A quality analysis was undertaken, assessing the issues that prevented the expansion of such an approach as well as issues to be considered in future implementation of ACT.


RESULTS
Social, cultural, organizational, professional, and economic factors were identified that will continue to play decisive roles in the integration of such a program. The ACT implementation in question occurred at the same time as the shift to community psychiatry, without having been linked to that approach. Currently, social factors such as self-help groups and parents foster the implementation of such programs. The organizational factors include the importance of linking ACT to existing health care services, as well as adapting ACT to these services. The association of this type of project with a research team did not ensure a successful implementation. A third factor is the psychiatrist's training and motivation with respect to the practice of this approach. Finally, economic issues are playing a larger role in the implementation of this approach.


CONCLUSIONS
This study relates different issues regarding the implementation of an ACT. The results represent assumptions that need to be confirmed by assessing ACT implementation in Quebec as well as in the rest of Canada.
Benoit
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F
Université de Montréal, Québec. frederic.benoit@sympatico.ca
Lesage
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D003156:Community Mental Health Services / Q000191:economics / Q000639:trends*; D003362:Cost-Benefit Analysis / Q000639:trends; D005544:Forecasting; D006284:Health Plan Implementation / Q000191:economics / Q000639:trends*; D006801:Humans; D001523:Mental Disorders / Q000191:economics / Q000534:rehabilitation*; D010348:Patient Care Team / Q000191:economics / Q000639:trends*; D011785:Quality Assurance, Health Care / Q000191:economics / Q000639:trends; D011792:Quebec