title: A comparison of the implementation of assertive community treatment in Melbourne, Australia and London, England.
abstract: OBJECTIVE
  The efficacy of Assertive Community Treatment (ACT) is well established in the USA, and to a lesser extent in Australia, whereas UK studies suggest little advantage for ACT over usual care. Implementation of ACT varies and these differences may explain variability in reported efficacy. We aimed to investigate differences in ACT implementation between Melbourne, Australia and London, UK.
  
  
  METHODS
  In a cross-sectional survey, we investigated team organisation, staff and client characteristics from four Melbourne ACT teams using almost identical methods to the Pan London Assertive Outreach studies of 24 ACT teams.
  
  
  RESULTS
  Client characteristics, staff satisfaction and burnout were very similar. Three of four Melbourne teams made over 70% of client contacts 'in vivo' compared to only one-third of comparable London teams, although all teams were rated as 'ACT-like'. Melbourne teams scored more highly on team approach. Three quarters of clients were admitted in the preceding 2 years but Melbourne clients had shorter stays.
  
  
  CONCLUSIONS
  Differences in the implementation of 'active components' of home treatment models that have been associated with better client outcomes (home visiting, team approach) may explain international differences in ACT efficacy. Existing fidelity measures may not adequately weight these important elements of the model.
authors.affiliation: Department of Psychiatry, The University of Melbourne and North Western Mental Health, Melbourne, Australia. c.harvey@unimelb.edu.au
authors.forename: C
authors.initials: C
authors.lastname: Harvey
authors.forename: H
authors.initials: H
authors.lastname: Killaspy
authors.forename: S
authors.initials: S
authors.lastname: Martino
authors.forename: S
authors.initials: S
authors.lastname: White
authors.forename: S
authors.initials: S
authors.lastname: Priebe
authors.forename: C
authors.initials: C
authors.lastname: Wright
authors.forename: S
authors.initials: S
authors.lastname: Johnson
mesh_terms: D001315:Australia / Q000453:epidemiology; D002055:Burnout, Professional; D003156:Community Mental Health Services / Q000592:standards / Q000706:statistics & numerical data; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D007902:Length of Stay; D008131:London / Q000453:epidemiology; D008503:Medical Staff / Q000523:psychology / Q000592:standards; D001523:Mental Disorders / Q000453:epidemiology / Q000628:therapy; D028642:Persons with Psychiatric Disorders / Q000523:psychology; D010348:Patient Care Team / Q000458:organization & administration*; D016896:Treatment Outcome