Recovery-Oriented ACT: Outcomes, Timing, and Fidelity

Assertive community treatment (ACT) has been a widely used intervention for persons with severe mental illness for over 30 years. One of the latest adaptations of ACT incorporates a recovery and person-centered orientation into its traditional practices. This presentation reports on an evaluation of Washington State's PACT initiative where 10 recovery-oriented ACT teams were deployed statewide. We used administrative data in a pre-post comparison group design with 450 PACT enrollees and 450 propensity-matched controls to assess the impact of the PACT initiative on use of state psychiatric hospitals, local hospital and crisis services, and arrests. We also assessed the relationship between team fidelity as measured by the new TMACT scale and PACT outcomes. Findings indicate that: (1) PACT had its greatest impact on consumers who were high users of state hospitals, reducing hospital use by 32-33 days on average at a savings of $17,000-$20,000 per person per year; (2) PACT had its greatest effects reducing hospital days during the first six months of enrollment but significant reductions were maintained during the first year of enrollment; and (3) TMACT fidelity was associated with reductions in state hospital days, use of EDs, and local crisis services. State hospital reductions on average were 3x greater than those reported for 24 randomized clinical trials (RCTs) in a recent Cochrane review. Future research will have to verify these results using an RCT approach and a broader array of outcomes to determine whether blending traditional ACT with recovery-oriented practices also promotes consumer personal growth and independence.