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


OBJECTIVE
To compare high-fidelity US ACT teams with a UK team.


METHODS
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.
Fiander
Matthew
M
Department of Psychiatry, St George's Hospital Medical School, London, UK. mfiander@sghms.ac.uk
Burns
Tom
T
McHugo
Gregory J
GJ
Drake
Robert E
RE
D003156:Community Mental Health Services / Q000458:organization & administration*; D017831:Diagnosis, Dual (Psychiatry); D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D001523:Mental Disorders / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D015397:Program Evaluation / Q000379:methods*; D011446:Prospective Studies; D013808:Therapeutic Community; D013997:Time Factors; D006113:United Kingdom; D014481:United States