System-Wide Implementation of ACT in Ontario: An Ongoing Improvement Effort

Abstract

In the late 1990s, the government of Ontario undertook a province-wide implementation of Assertive Community Treatment (ACT). Capacity grew to 59 teams within 6 years. This paper describes the implementation process, focusing on three phases--start-up, or the enabling phase; feedback, or the reinforcement phase; and response, or the corrective action phase. Key implementation supports include an active oversight committee with representation from both the ministry and the field and the availability of the planning data on ACT performance. Three areas of underperformance were identified: lower than expected team caseloads, drift from the target client group, and significant under-staffing in the teams. Likely causes were suggested, and corrective actions developed, which centered on clarifying the ACT standards, especially related to intake criteria, rate of intake and staffing, increasing team funding, and establishing expectations for reporting and accountability. While these corrective responses are promising, implementation of infrastructure and mechanisms for providing systematic practice feedback is still underdeveloped.

Assertive Community Treatment in the Netherlands: Outcome and Model Fidelity

“…Effective leadership and an innovative culture are also crucial factors. 22,37 The results of our study showed that it may be worthwhile investing all of these efforts to achieve successful implementation.…”

“…Compared with other countries, the bed rate in the Netherlands remains among the highest in the world. 33 Unlike other countries, 22,[34][35][36] deinstitutionalization has not been a topic of high priority for the Dutch government. The Netherlands can be characterized as a caring society, where marginalization is not accepted.…”

“…Adherence to ACT fidelity criteria was not always the aim. In contrast with other countries, such as the United States and Canada, [21][22][23] the implementation of the ACT model in the Netherlands was not part of a mental health reform and shift in locus of care from hospital to community. There was no government funding and support.…”

Complex Interventions and Interorganisational Relationships: Examining Core Implementation Components of Assertive Community Treatment

“…In addition, implementation of the model has been seen as challenging [24]. Stein and Test reported that financing and coordination of the treatment programme as major implementation barriers [13].…”

Need and use of services by persons with co-occurring substance use and mental disorders within a community mental health system

“…intensive case management or assertive community treatment or ACT). Previous research suggests that there were general challenges associated with the implementation of ACT services in the province of Ontario -the jurisdiction from which study data were drawn (George, Durbin, & Koegl, 2009). This study adds a new layer to these findings suggesting that participation in ACT-type services was less frequent when persons had co-occurring substance use problems.…”