ACT for Recovery: Outcomes of the New ACT model in CT

Background: Assertive Community Treatment (ACT) is known to prevent hospitalization and help individuals with severe psychiatric disabilities remain in the community, but the program has also been criticized for fostering dependence. In 2008, the CT Department of Mental Health & Addiction Services (CT DMHAS) decided to revamp its ACT programs to instill a recovery focus and an emphasis on skill-building for independent living, and adapted a fidelity scale to reflect the new goals. Methods. Following a one-year implementation period, we recruited 92 program participants from 3 different agencies to participate in an evaluation study. These individuals were interviewed at the time of referral to the study and 6 and 12 months later, and assessed with respect to mental health, substance use, quality of life, service satisfaction, and several recognized recovery domains. In addition, we collected substance use ratings from the ACT team for each participant at the same intervals. Also, we conducted focus groups with a sample of program clients at each site, and we employed administrative data to monitor the receipt of non-ACT services such as inpatient hospital care. Results: During the first year that CT ACT clients were exposed to the ACT for Recovery model, their lives improved in some domains, but in several respects they showed no progress or declined in functioning, at least initially. Qualitative data reveal that the shift in service orientation was a difficult transition for ACT staff and clients, but that some gains can be realized through the new model.