community connections act and cm

8/13/2019 Community Connections ACT and CM

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Case Manager Perspectives on AssertiveCommunity Treatment: Critical Ingredients,

Clinical Ingredients, and Variations inImplementation

Results: Twenty-four of twenty-seven possible criticalingredients were rated very important by at least 50of teams. Full-time nurse on team was rated as themost important ingredient and medication manage-ment was rated as the most beneficial clinical activity.John H. McGrew, Ph.D., Bernice A. Pescosolido, Ph.D.,and Eric R. Wright, Ph.D.

IUPUI and Indiana University, BloomingtonObjective: The paper sought to identify casemanagers perspectives on the critical ingredients, andthe therapeutic mechanisms of action of AssertiveCommunity Treatment (ACT). ACT is an effectivemodel of community treatment for persons withsevere mental illness (SMI) (1-8). Although there isstrong evidence that ACT is successful (e.g.,decreased hospitalization use, increased overall levelof functioning), the essential structural and organi-zational program elements that underlie ACTeffectiveness have not been clearly establishedempirically. Few experimental (9) or quasi-experi-mental studies (10) have been conducted with theexpress purpose of establishing the importance ofparticular elements of ACT. The majority of publishedresearch that has attempted to identify the criticalelements empirically has relied on more indirectmethods. One method to help identify the coreingredients of an intervention is to ask informed stake-holders in the model (11 ). For example, McGrew andcolleagues(12) asked ACT experts to rate a list ofpossible critical ingredients of ACT, and also asked asample of ACT clients to nominate helpful elements ofACT (13). The current study asked ACT workers toprovide their perspective on the critical elements ofACT. ACT workers also were asked their opinionsabout the critical clinical elements or mechanisms ofaction thought to underlie ACT success.Method: ACT teams (n=73) attending the NationalAssertive Community Treatment Conference rated thedegree to which 16 clinical activities were beneficial toclients, and rated the importance to the ideal team,and the appropriateness for their team, of 27 possiblecritical ingredients.


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disciplinary evaluation and research study in order tomonitor and report on both the process and theoutcomes of this initiative.

Research TeamEric R. Wright, Ph.D., Associate Professor of

Sociology, IUPUI and Associate Director, IndianaConsortium for Mental Health Services Research,Principal Investigator.

David Mank, Ph.D., Professor Education, IU School ofEducation and Director, Indiana Institute on Dis-ability and Community, Co-Principal Investigator.

John McGrew, Ph.D., Associate Professor ofPsychology, IUPUI.

9. T.W. Hu, J.M. Jerrell: Estimating the cost of impactof three case management programmes fortreating people with severe mental illness.British Journal of Psychiatry 173 (Suppl36):26-32, 1998.

10. M.P. Salyers, T.W. Masterton, D. Fekete et al.:Transferring clients from intensive casemanagement: Impact on client functioning.American Journal of Orthopsychiatry 68:233-245, 199811. L. Sechrest, R.G. West, M.A. Phillips et al.: Someneglected problems in evaluation andresearch: Strength and integrity of treatments,Vol. 4. Edited by W. Yeaton. Beverly Hills, CA,Sage, 1979.

12. J.H. McGrew, G.R. Bond: Critical ingredients ofassertive community treatment: Judgments ofthe experts. Journal of Mental Health Admini-stration 22: 113-125, 199513. J.H. McGrew, R. Wilson, G.R. Bond: Client per-spectives on helpful ingredients of assertivecommunity treatment. Psychiatric Rehabili-tation Journal 19: 13-21, 1996.

Debra Mesch, Ph.D., Associate Professor, School ofPublic and Environmental Affairs, IUPUI.

Faith Thomas, M.A., Research Associate, IndianaInstitute on Disability and Community.

Terry F. White, M.B.A., Research OperationsManager, Indiana Consortium for Mental HealthServices Research, Project Director.

Project OverviewSoutheast Regional Center Evaluation(SERCE)

Study Desianhe Southeast Regional Center Evaluation projectbegan in Fall 2001 and is currently in the datacollection phase. This is a brief overview of theproject.

Because of the complexity and scope of this initiative,the evaluation protocol is multifaceted and com-prehensive. The specific protocols are being de-veloped by members of the evaluation team with inputfrom governmental policy makers and other com-munity members. While the research team is activelyseeking input from interested parties and stake-holders regarding the major components of theevaluation study, the specific research questionsguiding each component of the research project, howthe data will be collected, and the execution of theprotocol is the sole responsibility of the researchteam. All data will be collected and analyzed by theresearch team and their staff according to the highestscientific standards. The research team willsummarize key findings as data become available inaccordance with scientific standards governingevaluation research. Written and verbal reports willbe offered periodically to the State, otherstakeholders, and the public.

In April 2001, Governor Frank O Bannon announced anew initiative to improve health, mental health, andsocial services and support for persons with develop-ment disabilities and/or mental illness. Specifically, hedirected the Indiana Family and Social ServicesAdministration (FSSA) to begin restructuring existingservices in the southeast region of the state in orderto improve the quality of care and move more clientsinto the community while reducing the cost ofproviding care to these Hoosiers. The reconfigurationwould involve three major changes: the closing ofMuscatatuck State Development Center (MSDC), thedownsizing of Madison State Hospital (MSH), and thedevelopment of the new Southeast Regional CareCenter which will have a base of operation on thegrounds of Madison State Hospital. As part of thismajor policy initiative, FSSA has asked anindependent group of external researchers at IndianaUniversity to conduct a comprehensive, multi-


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ANNOUNCEMENTS. Ann Hohmann, Program Officer in the Services Research & Clinical Epidemiology Branch at NIMH,

and the project officer on the RISP that helped to create the Consortium is receiving an AchievementAward for Excellence in the Field of Mental Health from the Mental Health Section of the AmericanPublic Health Association. The 131 sI Annual Meeting of the APHA will be held in Philadelphia onNovember 9-13,2002.

. Bernice A. Pescosolido, Director of the Indiana Consortium for Mental Health Services Research,has been elected Vice President of the American Sociological Association. She will assume office inAugust 2003 following a year of service as Vice President-Elect.

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community connections act and cm

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