title: Adapting ACT to serve culturally diverse communities: a comparison of a Japanese and a Canadian ACT team.
abstract: OBJECTIVE
  The assertive community treatment (ACT) teams of Mount Sinai Hospital in Toronto and the KUINA Center, Hitachinaka, Japan, were compared with regard to ACT fidelity, organizational structure, populations served, and treatment outcomes. Ethnocultural adaptations to the ACT model made by both teams included enhanced family support and intervention, culturally and linguistically matched staff and patients when possible, culturally informed therapy, routine cultural assessments, culturally matched housing and community support, and flexible funding models.
  
  
  METHODS
  Data were gathered by chart reviews (66 patients in Toronto and 40 patients in Japan), a satisfaction measure, a standard measure of ACT fidelity, and a pre-post measure of treatment outcomes (the Brief Psychiatric Rating Scale), and hospitalization days.
  
  
  RESULTS
  Both teams achieved good fidelity to ACT and reductions in hospitalization and symptom severity. Family satisfaction scores were high.
  
  
  CONCLUSIONS
  With culturally informed adaptations, ACT can be effective in a Canadian mixed ethnocultural population and a homogeneous Japanese population.
authors.affiliation: Department of Psychiatry, Univeristy of Toronto, Mount Sinai Hospital, 260 Spadina Ave., Suite 204, Toronto, Ontario M5T 2E4, Canada. wchow@mtsinai.on.ca
authors.forename: Wendy
authors.initials: W
authors.lastname: Chow
authors.forename: Miyuki
authors.initials: M
authors.lastname: Shiida
authors.forename: Takashi
authors.initials: T
authors.lastname: Shiida
authors.forename: Akiyoshi
authors.initials: A
authors.lastname: Hirosue
authors.forename: Samuel
authors.initials: S
authors.lastname: Law
authors.forename: Molyn
authors.initials: M
authors.lastname: Leszcz
authors.forename: Joel
authors.initials: J
authors.lastname: Sadavoy
mesh_terms: D003156:Community Mental Health Services / Q000379:methods; D003431:Cross-Cultural Comparison; D054521:Cultural Competency / Q000458:organization & administration; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D001523:Mental Disorders / Q000208:ethnology / Q000628:therapy; D008875:Middle Aged; D009864:Ontario; D017060:Patient Satisfaction; D012111:Residence Characteristics; D016896:Treatment Outcome