Community Mental Health Journal

, Volume 46, Issue 4, pp 342–350 | Cite as

Fidelity and Recovery-Orientation in Assertive Community Treatment

  • Sean A. KiddEmail author
  • Lindsey George
  • Maria O’Connell
  • John Sylvestre
  • Helen Kirkpatrick
  • Gina Browne
  • Lehana Thabane
Original Paper


There has been increasing commentary about the degree to which Assertive Community Treatment (ACT) teams provide recovery-oriented services, often centered around the question of the use of coercion. The present study was designed to contribute to this discussion through an examination of recovery-oriented service provision and ACT fidelity among 67 teams in the province of Ontario, Canada. The findings indicated a moderate to high degree of recovery orientation in service provision, with no significant relationship between ACT fidelity and consumer and family/key support ratings of recovery orientation. A significant relationship was found, however, between the ‘nature of services’ domain of the Dartmouth Assertive Community Treatment Scale (DACTS) and ratings of recovery orientation provided by staff and ACT coordinators. These findings extend the existing dialogue regarding the evaluation of ACT intervention process factors and indicate that current measures of fidelity may not be adequately addressing dimensions of recovery-oriented service provision.


Assertive community treatment Fidelity Recovery 


  1. Angell, B., Mahoney, C. A., & Martinez, N. I. (2006). Promoting treatment adherence in assertive community treatment. Social Service Review, 80, 485–526.CrossRefGoogle Scholar
  2. Anthony, W. (2004). Bridging the gap between values and practice. Psychiatric Rehabilitation Journal, 28, 105.CrossRefPubMedGoogle Scholar
  3. Bond, G. R., Drake, R. E., Mueser, K. T., & Latimer, E. (2001). Assertive community treatment for people with severe mental illness: Critical ingredients and impact on patients. Disability Management, Health Outcomes, 9, 141–159.CrossRefGoogle Scholar
  4. Bond, G. R., Drake, R. E., & Becker, D. R. (2008). An update on randomized controlled trials of evidence-based supported employment. Psychiatric Rehabilitation Journal, 31, 280–290.CrossRefPubMedGoogle Scholar
  5. Chinman, M., Allende, M., Bailey, P., Maust, J., & Davidson, L. (1999). Therapeutic agents of assertive community treatment. Psychiatric Quarterly, 70, 137–162.CrossRefPubMedGoogle Scholar
  6. Copeland, M. E. (1997). Wellness recovery action plan. Dummerston, VT: Peach Press.Google Scholar
  7. Davidson, L., O’Connell, M., Tondora, J., Lawless, M., & Evans, A. C. (2005). Recovery in serious mental illness: A new wine or just a new bottle? Professional Psychology: Research and Practice, 36, 480–487.CrossRefGoogle Scholar
  8. Davidson, L., Tondora, J., O’Connell, M., Kirk, T., Rockholz, P., & Evans, A. C. (2007). Creating a recovery-oriented system of behavioural healthcare: Moving from concept to reality. Psychiatric Rehabilitation Journal, 31, 23–31.CrossRefPubMedGoogle Scholar
  9. Deegan, P. E. (2007). The lived experience of using psychiatric medication in the recovery process and a shared decision-making program to support it. Psychiatric Rehabilitation Journal, 31, 62–69.CrossRefPubMedGoogle Scholar
  10. Dixon, L., Hackman, A., & Lehman, A. (1997). Consumers as staff in assertive community treatment programs. Administration and Policy In Mental Health, 25, 199–208.CrossRefPubMedGoogle Scholar
  11. Drake, R. E., & Deegan, P. E. (2008). Are assertive community treatment and recovery compatible? Commentary on “ACT and recovery: Integrating evidence-based practice and recovery orientation on assertive community treatment teams”. Community Mental Health Journal, 44, 75–77.CrossRefPubMedGoogle Scholar
  12. Felton, B. J., Barr, A., Clark, G., & Tsemberis, S. J. (2006). ACT team members’ responses to training in recovery-oriented practices. Psychiatric Rehabilitation Journal, 30, 112–119.CrossRefPubMedGoogle Scholar
  13. Fiander, M., Burns, T., McHugo, G. J., & Drake, R. E. (2003). Assertive community treatment across the Atlantic: Comparison of model fidelity in the UK and USA. British Journal of Psychiatry, 182, 248–254.CrossRefPubMedGoogle Scholar
  14. King, R. (2006). Intensive case management: A critical re-appraisal of the scientific evidence for effectiveness. Administration and Policy In Mental Health, 33, 529–535.CrossRefPubMedGoogle Scholar
  15. Mancini, A. D., Finnerty, M. T., & Tsemberis, S. (2006). Defining intervention strategies on ACT teams and exploring correlates of their use. Paper presented at the annual meeting of the MacArthur research network on the law and mental health, Cambridge, MA.Google Scholar
  16. McGrew, G. H., Wilson, R., & Bond, G. R. (2002). An exploratory study of what clients like least about assertive community treatment. Psychiatric Services, 53, 761–763.CrossRefPubMedGoogle Scholar
  17. Moser, L. L., & Bond, G. R. (2009). Scope of agency control: Assertive community treatment teams’ supervision of consumers. Psychiatric Services, vol. 60, pp. 922–928. Unpublished dissertation, Indiana University-Purdue University, Indianapolis.Google Scholar
  18. Mueser, K. T., Corrigan, P. W., Hilton, D. W., Tanzman, B., Chaub, A., Gingerich, S., et al. (2002). Illness management and recovery: A review of the research. Psychiatric Services, 53, 1272–1284.CrossRefPubMedGoogle Scholar
  19. Neale, M. S., & Rosenheck, R. A. (2000). Therapeutic limit setting in an assertive community treatment program. Psychiatric Services, 51, 499–505.CrossRefPubMedGoogle Scholar
  20. O’Connell, M., Tondora, J., Croog, G., Evans, A., & Davidson, L. (2005). From rhetoric to routine: Assessing perceptions of recovery-oriented practices in a state mental health and addiction system. Psychiatric Rehabilitation Journal, 28, 378–386.CrossRefPubMedGoogle Scholar
  21. Onken, S. J., Craig, C. M., Ridgway, P., Ralph, R. O., & Cook, J. (2007). An analysis of the definitions and elements of recovery: A review of the literature. Psychiatric Rehabilitation Journal, 31, 9–22.CrossRefPubMedGoogle Scholar
  22. Salyers, M. P., & Tsemberis, S. (2007). ACT and recovery: Integrating evidence-based practice and recovery orientation on assertive community treatment teams. Community Mental Health Journal, 43, 619–641.CrossRefPubMedGoogle Scholar
  23. Salyers, M., Bond, G., Teague, G., Cox, J., Smith, M., Hicks, M., et al. (2003). Is it ACT yet? Real world examples of evaluating the degree of implementation for assertive community treatment. The Journal of Behavioural Health Services & Research, 30(3), 304–320.CrossRefGoogle Scholar
  24. Salyers, M., Tsai, J., & Stultz, T. (2007). Measuring recovery orientation in a hospital setting. Psychiatric Rehabilitation Journal, 31, 131–137.CrossRefPubMedGoogle Scholar
  25. Silverstein, S. M., & Bellack, A. S. (2008). A scientific agenda for the concept of recovery as it applies to schizophrenia. Clinical Psychology Review, 28, 1108–1124.CrossRefPubMedGoogle Scholar
  26. Solomon, P., & Stanhope, V. (2004). Recovery: Expanding the vision of evidence-based practice. Brief Treatment and Crisis Intervention, 4, 311–321.CrossRefGoogle Scholar
  27. SPSS Inc. (1998). SPSS base 8.0 for windows user’s guide. Chicago, IL: SPSS Inc.Google Scholar
  28. Stanhope, V. (2007). The role of process: Examining consumer-provider service interactions. Unpublished dissertation, University of Pennsylvania.Google Scholar
  29. Stein, L. I., & Test, M. A. (1980). An alternative to mental health treatment. I: Conceptual model, treatment program, and clinical evaluation. Archives of General Psychiatry, 37, 392–397.PubMedGoogle Scholar
  30. Sylvestre, J., Nelson, G., Sabloff, A., & Peddle, S. (2007). Housing for people with serious mental illness: A comparison of values and research. American Journal of Community Psychology, 40, 125–137.CrossRefPubMedGoogle Scholar
  31. Teague, G., Bond, G., & Drake, R. (1998). Program fidelity in assertive community treatment: Development and use of a measure. American Journal of Orthopsychiatry, 68, 216–232.CrossRefPubMedGoogle Scholar
  32. Watts, J., & Priebe, S. (2002). A phenomenological account of users’ experiences of assertive community treatment. Bioethics, 16, 339–454.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Sean A. Kidd
    • 1
    • 2
    Email author
  • Lindsey George
    • 1
  • Maria O’Connell
    • 3
  • John Sylvestre
    • 4
  • Helen Kirkpatrick
    • 5
  • Gina Browne
    • 5
  • Lehana Thabane
    • 6
  1. 1.McMaster Department of Psychiatry and Behavioural NeurosciencesSt. Joseph’s Healthcare, Centre for Mountain Health Services, J WingHamiltonCanada
  2. 2.Independent Clinician Scientist & Head, Psychology ServiceCentre for Addiction and Mental Health, Schizophrenia ProgramTorontoCanada
  3. 3.Yale Program on Recovery and Community HealthNew HavenUSA
  4. 4.University of Ottawa Department of PsychologyOttawaCanada
  5. 5.McMaster University School of NursingHamiltonCanada
  6. 6.McMaster University Department of Clinical Epidemiology and BiostatisticsHamiltonCanada

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