Prediction of outcome from the Dartmouth ACT Fidelity Scale

Department of Psychology, Indiana University-Purdue University, Indianapolis, IN 46202-3275, USA.
CNS spectrums (Impact Factor: 2.71). 01/2005; 9(12):937-42.
Source: PubMed


Assertive community treatment (ACT) is an intensive and comprehensive treatment for clients with severe mental illness (SMI) who do not readily benefit from clinic-based services. Monitoring the implementation of such programs is critical, because better-implemented programs have been found to be effective in improving client outcomes.
We tested the hypothesis that fidelity to the ACT model would be positively correlated with improved client outcomes, as measured by reduction in psychiatric hospital use.
A scale measuring fidelity of program implementation, the Dartmouth ACT Scale, was examined in 10 newly formed ACT teams. Using the team as the unit of measure, the mean reduction in state hospital days for a 1-year period before and after program admission was calculated. Mean effect size in reduction in hospital days was used as the outcome measure in a correlational design.
Pre/post comparisons showed a 43 percent reduction in hospital days for 317 clients (t=8.61, P<.001). The Pearson correlation between DACTS fidelity and reduction of state hospital days was .49, P=.08, one-tailed.
Several possible reasons are offered for why the study hypothesis was not confirmed. However, even if predictive validity of the Dartmouth ACT Scale is limited, it continues to be a useful tool for program monitoring and for providing corrective feedback.

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    • "This scale was developed to evaluate the extent to which assertive outreach teams are consistent with the ACT model. The DACTS has been widely used in research and program evaluation and has shown good psychometric properties, including predictive and discriminant validity (Bond & Salyers, 2004; Salyers et al., 2003). There is evidence that higher fidelity is associated with better team performance and client outcomes (Teague, Bond, & Drake, 1998). "
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    ABSTRACT: As a response to homelessness and its relationship with mental health problems, Queensland established homeless health outreach teams. These teams were designed to provide assertive outreach to homeless people by specialist mental health practitioners. The aim of this research was to determine to what extent these teams operate within an established framework for effective assertive outreach. A secondary aim was to determine the validity of an existing fidelity measure in evaluation of homeless outreach services. The Dartmouth Assertive Community Treatment Scale (DACTS) was administered to the five Queensland Homeless Health Outreach Teams (HHOT). It was found that the teams operated in the middle range on the fidelity measure with higher fidelity in human services and services than in organizational boundaries. Overall, the larger, more metropolitan teams appeared to achieve higher fidelity than the smaller more rural teams. Low fidelity scores can, in part, be attributed to weak validity of some DACTS items in relation to homeless outreach services as provided by Queensland HHOT services and recommendations are made for revision of the instrument to make it more suitable for use with these teams.
    Full-text · Article · Dec 2014 · Advances in Mental Health
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    • "In order to secure proper implementation fidelity, assessments are needed [8] [9]. The DACT scale is the standard for fidelity assessment to the original ACT principles on service level [10]. Over time, adjustments to the scale have been suggested, for instance the TMACT scale [11]. "
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    ABSTRACT: The Clinical Strategies Implementation scale (CSI) was originally designed to be used by external reviewers in order to measure the extent to which evidence-based strategies had been implemented in the treatment of persons with schizophrenia spectrum disorders according to Resource-group Assertive Community Treatment (RACT). The present investigation had two aims: 1) to conduct a revision of CSI and to examine the revised instrument (CSI-R) in terms of interrater reliability (Study I); 2) to compare assessments of CSI-R made by experienced assessors with assessments made by students in case management (Study II) in order to determine whether the instrument has validity even when more inexperienced persons are using it. In Study I six raters, who took part in 12 to 15 cases from three outpatient community mental health teams, participated. Results indicated that internal consistency of the CSI-R was strong (alpha = 0.89) as well as correlations between individual raters’ (r between 0.80-0.98). In Study II 91 newly trained RACT praxis trainees participated. Each of them followed one case for eighteen months, i.e., the client which they had been assigned during training (n = 91). The five external auditors in the education program then independently assessed the 91 cases with the CSI-R. Results showed significant correlations between experts and trainees (rho = 0.68, p < 0.001). The conclusion was that the new CSI-R scale was shown to have acceptable internal consistency and interrater reliability and may be used for continuous self-monitoring of praxis fidelity by inexperienced raters.
    Full-text · Article · Jan 2014 · Open Journal of Medical Psychology
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    • "The Dartmouth Assertive Community Treatment Scale (DACTS) (Teague, Bond, & Drake, 1998) was created to measure the degree to which programs are following the ACT model (i.e., fidelity). While high fidelity to the ACT model may not be sufficient in itself to ensure better consumer outcomes, it can serve as an important guide to structural elements that are necessary (Bond & Salyers, 2004), and fidelity is increasingly being recognized as essential to quality assurance (Torrey et al., 2003). Research has shown that high fidelity ACT teams have better consumer outcomes in terms of hospitalizations, substance abuse, treatment retention, and housing (Latimer, 1999; McGrew, Bond, Dietzen, & Salyers, 1994; McHugo, Drake, Teague, & Xie, 1999). "
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    ABSTRACT: Staff turnover on assertive community treatment (ACT) teams is a poorly understood phenomenon. This study examined annual turnover and fidelity data collected in a statewide implementation of ACT over a 5-year period. Mean annual staff turnover across all observations was 30.0%. Turnover was negatively correlated with overall fidelity at Year 1 and 3. The team approach fidelity item was negatively correlated with staff turnover at Year 3. For 13 teams with 3 years of follow-up data, turnover rates did not change over time. Most ACT staff turnover rates were comparable or better than other turnover rates reported in the mental health and substance abuse literature.
    Full-text · Article · Dec 2009 · Administration and Policy in Mental Health and Mental Health Services Research
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