The effectiveness of the assertive community treatment model

Abstract

This study sought to determine the benefits of an assertive community treatment model (ACT) versus a continuing day treatment program (CDTP) for the treatment of chronic mentally ill patients. The study utilized a quasi-experimental design with a matched groups comparison of outcomes achieved by patients in two community mental health centers in the South Bronx area of New York City. The study assessed outcomes in regard to hospital readmissions, quality of life, and housing and vocational rehabilitation. The four hypotheses stated that chronic mentally ill patients involved in ACT would have fewer hospital readmissions, client short-term improvement in quality of life issues, a more stability in housing, and a more stable employment situation than patients involved in CDTP.;Due to the small sample size and baseline differences between groups, non-parametric tests were the primary statistical analyses. The ACT and control groups were comparable in regard to each of the matching variables: age, gender, education, and diagnosis. However, there were strong differences between groups in regard to other key background variables (i.e., ethnicity, marital status, rate of prior hospitalization, and residential autonomy).;There were no statistically significant outcome differences between ACT and the control condition for three of the four target variables: rehospitalization, housing autonomy, or employment. ACT did show superior outcomes in regard to the attainment of some types of personal short-term goals, but was inferior in regard to others. Reasons for a lack of evidence for ACT effectiveness can be attributed to both methodological and service implementation issues. A number of method factors (i.e., baseline group differences, small sample size, brief study period) make it difficult to accurately evaluate overall ACT performance. There were also distinct differences from the original Madison, Wisconsin ACT model in the way in which this new ACT team operated to meet the needs of an inner city population. These adaptations of the model to fit an urban ethnic minority population might have compromised the New York City ACT's overall performance.