title: Fidelity to recovery-oriented ACT practices and consumer outcomes.
abstract: OBJECTIVE
  A previous study of a recovery-oriented assertive community treatment initiative (PACT) in Washington State found reductions in state psychiatric hospital use and related costs for PACT participants, especially in the first six months after enrollment and for consumers who were high users of the state psychiatric hospital before ACT enrollment. This study examined whether these outcomes varied by team fidelity to recovery-oriented ACT practices.
  
  
  METHODS
  Generalized estimating equations (GEE) were used to examine the relationship between scores on the Tool for Measurement of Assertive Community Treatment (TMACT), a recently developed tool for assessing fidelity to recovery-oriented ACT, and the use of state hospitals, local hospitals, emergency departments, local crisis stabilization units, and arrests for 631 PACT consumers. These relationships were also examined for PACT consumers with any state hospital use (N=450) and those considered high users of the state hospital (≥ 96 days in two years before PACT enrollment).
  
  
  RESULTS
  TMACT scores were associated (p<.01) with a decrease in the amount of use but not the probability of using state psychiatric hospitals, local hospital psychiatric inpatient units, and local crisis stabilization units. The marginal effects of higher TMACT scores on the probability and use of emergency departments or arrests were not statistically significant.
  
  
  CONCLUSIONS
  This study provides preliminary evidence for the predictive validity of the TMACT. Future research should examine the subscale structure of the TMACT as well as the association between TMACT fidelity and consumer well-being, quality of life, and other important person-centered outcomes.
authors: Cecil G. Sheps Center for Health Services Research, University of North Carolina (UNC), Chapel Hill. Dr. Cuddeback is also with the School of Social Work, UNC, 325 Pittsboro St., CB#3550, Chapel Hill, NC 27599, USA. gcuddeba@email.unc.edu
authors: Gary S
authors: GS
authors: Cuddeback
authors: Joseph P
authors: JP
authors: Morrissey
authors: Marisa E
authors: ME
authors: Domino
authors: Maria
authors: M
authors: Monroe-DeVita
authors: Gregory B
authors: GB
authors: Teague
authors: Lorna L
authors: LL
authors: Moser
mesh_terms: D000328:Adult; D003156:Community Mental Health Services / Q000191:economics / Q000592:standards*; D005260:Female; D019983:Guideline Adherence; D006778:Hospitals, Psychiatric / Q000191:economics / Q000706:statistics & numerical data*; D006783:Hospitals, State / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000191:economics / Q000534:rehabilitation*; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D016896:Treatment Outcome; D014861:Washington