Can you make modifications to the Assertive Community Treatment (ACT) model and still be effective? Dr. Terry Krupa and Dr. Shirley Eastabrook of Queen’s University are working with the staff of four community mental health programs in the Kingston and Brockville area to answer that question. Several critical features of ACT varied among the four programs, and the researchers want to understand those differences and how they affected clients. Their findings will help in the development of best practices for providing mental health care in Ontario.

Why bother with another study of ACT?

Much has been written about ACT since the concept was first developed in Wisconsin in 1980. But this study is different. Variations on Assertive Community Treatment: A Study of Approaches and Client Outcomes of Four Teams in South Eastern Ontario looks at how ACT is working in this province and explores the tension between appropriate roles for ACT and the challenges faced by ACT as an integrated service delivery model.

Do current ACT standards meet client needs in Ontario?

The Variations study gathered information about the local client population that reveals some important differences between these ACT clients and those studied elsewhere.

American studies, for example, have generally reported substance abuse rates of 80%, which explains why ACT standards require a substance abuse expert for the team. Substance abuse rates for these Ontario clients, however, were much lower, even though the usual criteria for screening admissions to ACT were applied. This suggests that teams need to consider client profiles at a program level and allocate resources to meet identified needs, such as helping clients with employment.

The study results are also shedding light on areas of need that are rarely addressed directly in the ACT literature, such as parenting. Almost 40% of the clients of these ACT teams have children (20% have school-age children).

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