Implementing high-fidelity evidence-based practice (ACT) through a collaborative quality measurement and improvement model

Valid implementation of complex evidence-based practices in the community requires protracted attention to fidelity. Useful measures of fidelity need to go beyond examination of structural features to assess the strength of critical intervention processes, and expert assessment and consultation are typically required on a recurring basis. At the same time, there are limited resources dedicated to assessment and improvement of quality in publicly funded behavioral healthcare; program monitoring can be infrequent and poorly linked to quality improvement. To address these challenges, a state mental health authority, researchers, and providers are collaborating in implementation of a train-the-trainers, peer-based quality improvement and outcomes evaluation model. Key staff members in a statewide assertive community treatment network are trained in dissemination and application of a new fidelity measure, the Tool for Measurement of ACT (TMACT), a more process-sensitive successor to the Dartmouth ACT Scale (DACTS), a widely-used measure of ACT fidelity. Fidelity information for the 31 sites statewide is linked with historical and concurrent data derived from state- and program-level administrative and clinical databases, permitting examination of critical dimensions of fidelity in relation to outcomes in hospitalization, crisis and emergency services, criminal justice involvement, and status in functional areas, as well as consumer responses to a recovery-oriented survey. The presentation will highlight preliminary findings of this initiative, including results of analysis of fidelity and outcome and their relationship, selected features of the fidelity measurement process, and early stages of implementation of the collaborative quality improvement process.