title: Assertive community treatment in the Netherlands: outcome and model fidelity.
abstract: OBJECTIVE
  The implementation of assertive community treatment (ACT) varies widely. To date, the association between model fidelity and effect has not been investigated in Europe. We investigated the association between model fidelity and outcome in the Dutch mental health system.
  
  
  METHODS
  In a prospective longitudinal study, ACT model fidelity and patient outcomes were assessed in 20 outpatient treatment teams. Patients with severe mental illness (n = 530) participated in the study. Outcomes were assessed 3 times using the Health of the Nation Outcome Scales (HoNOS), the Camberwell Assessment of Need Short Assessment Schedule (CANSAS), and the number of hospital days and homeless days during a 2-year follow-up period. Data were analyzed using multilevel statistics.
  
  
  RESULTS
  High ACT model fidelity was associated with better outcomes on the HoNOS and less homeless days. Among all of the ACT ingredients, team structure was associated with better outcomes. No associations were found between ACT model fidelity, number of hospital days, and CANSAS scores.
  
  
  CONCLUSIONS
  Our evidence supports the importance of model fidelity for improving patient outcomes.
authors: Department of Reintegration, Trimbos-Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands. mvugt@trimbos.nl
authors: Maaike D
authors: MD
authors: van Vugt
authors: Hans
authors: H
authors: Kroon
authors: Philippe A E G
authors: PA
authors: Delespaul
authors: Fred G
authors: FG
authors: Dreef
authors: Annet
authors: A
authors: Nugter
authors: Bert-Jan
authors: BJ
authors: Roosenschoon
authors: Jaap
authors: J
authors: van Weeghel
authors: Jeroen B
authors: JB
authors: Zoeteman
authors: Cornelis L
authors: CL
authors: Mulder
mesh_terms: D000328:Adult; D003156:Community Mental Health Services; D055317:Evidence-Based Practice; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007902:Length of Stay; D008297:Male; D008609:Mental Status Schedule; D008875:Middle Aged; D009426:Netherlands; D011446:Prospective Studies; D012559:Schizophrenia / Q000175:diagnosis / Q000628:therapy*; D012720:Severity of Illness Index; D016896:Treatment Outcome