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Assertive community treatment across the Atlantic: comparison of model fidelity in the UK and USA

  • Matthew Fiander (a1), Tom Burns (a1), Gregory J. Mchugo (a2) and Robert E. Drake (a2)
Abstract
Background

The significant reductions in hospital admission demonstrated in US assertive community treatment (ACT) studies have not been replicated in the UK. Explanations cite poor UK ‘model fidelity’ and/or better UK standard care. No international model-fidelity comparisons exist.

Aims

To compare high-fidelity US ACT teams with a UK team.

Method

The UK700's ACT team (n=97) was compared with high-fidelity US ACT teams (n=73) by using two measures: a forerunner of the Dartmouth Assertive Community Treatment schedule (to assess adherence to ACT principles) and 2-year prospective activity data.

Results

The UK and US teams had similar high-fidelity scores. Although significant differences were found in the amount and type of activity, practice differences in areas central to ACT were not great.

Conclusions

The failure of UK ACT studies to demonstrate the outcome differences of early US studies cannot be attributed entirely to the lack of ACT fidelity.

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Copyright
Corresponding author
Dr Matthew Fiander, Department of Psychiatry, St George's Hospital Medical School, Jenner Wing, CranmerTerrace, London SW17 ORE, UK. Tel: 020 8725 0683; fax 020 8725 3538; e-mail: mfiander@sghms.ac.uk
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Declaration of interest

None.

Footnotes
References
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Assertive community treatment across the Atlantic: comparison of model fidelity in the UK and USA

  • Matthew Fiander (a1), Tom Burns (a1), Gregory J. Mchugo (a2) and Robert E. Drake (a2)
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