«DRAFT VERSION Implementation Resource Kit User’s Guide Table of Contents Acknowledgments Foreword Introduction Background Project Philosophy and ...»
Assertive Community Treatment
Implementation Resource Kit
Implementation Resource Kit User’s
Table of Contents
Project Philosophy and Values
Components of the Assertive Community Treatment Implementation Resource Kit
How to Use the Resource Kit Materials—An Implementation Plan
A Word About Terminology
Implementing Evidence-Based Practices Project
Annotated Bibliography for Assertive Community Treatment
Special Populations Appendix
DRAFT 2003 IMPLEMENTATION RESOURCE KIT USER’S GUIDE 1 Acknowledgments We wish to acknowledge the many people who contributed to the development of the materials
on assertive community treatment for the Implementing Evidence-Based Practices Project:
Development team for the Assertive Community Treatment implementation resource kit Charlene Allred Elizabeth Edgar Melody Olsen Marsha Antista Bridget Harron Dawn Petersen Charity Appell Barbara Julius Tom Patittuci Steve Baron Karin Linkins Joe Phillipps Gary Bond Gary Morse Robert Rosenheck Mimi Chapman Kim Mueser John Santa Judy Cox Michael Neale Mary Woods Co-leaders of the development team for the Assertive Community Treatment implementation resource kit Susan D. Phillips Barbara J. Burns Special thanks to Deborah Allness & Bill Knoedler whose book, The PACT Model of Community-Based Treatment for Persons with Severe and Persistent Mental Illnesses: A Manual for PACT Start-Up, was adapted in developing these materials and is used with permission of the publisher, National Alliance for the Mentally Ill, Assertive Community Treatment Technical Assistance Center; and Karen Linkins and the Lewin Group for their work developing a budget simulation model for assertive community treatment.
Steering committee, Implementing Evidence-Based Practices Project, Phase I
Project manager, Implementing Evidence-Based Practices Project, Phase I Patricia W. Singer DRAFT 2003
IMPLEMENTATION RESOURCE KIT USER’S GUIDE 2Foreword The Substance Abuse and Mental Health Services Administration's (SAMHSA) Center for Mental Health Services (CMHS) is a proud sponsor of this implementation resource kit for Assertive Community Treatment. As the federal agency responsible for promoting the quality, availability, and accessibility of services for people with mental illness, CMHS is responsible for identifying treatments for mental illness that work. The materials in this resource kit document the evidence for the effectiveness of Assertive Community Treatment and provide detailed information to help communities to implement the practice in real world settings. During development of the implementation resource kit, we placed special emphasis on 1) strengthening the consensusbuilding process, 2) expanding the involvement of consumers and families, 3) including practical orientation to issues involving service organization and financing, and 4) insisting on paying careful attention to issues of ethnic and cultural sensitivity and overall cultural competence. We are well pleased with the result.
Many other organizations contributed to developing this implementation resource kit. This broad coalition of researchers, providers, administrators, policy makers, consumers and family members, gives the resource kit its strength and vitality. We are especially appreciative of the support provided by The Robert Wood Johnson Foundation that sponsored the early stages of the Project, when evidence-based Assertive Community Treatment was identified as a practice ready for widespread implementation. We agreed. Assertive Community Treatment is critical for many persons with serious mental illness because it provides for comprehensive, structured services and supports in a community setting. It is supported by over 25 years of research, yielding a strong evidence base with generalizability to a variety of settings. With the Olmstead decision by the Supreme Court in 1999, community integration has been put into the forefront of mental health systems planning. The Assertive Community Treatment model is synonymous with moving persons with severe and persistent mental illness from institutionalized or more restricted settings of care toward more independent and community-based systems of care.
This implementation resource kit reflects the current state-of-the-art concerning evidence-based Assertive Community Treatment. It addresses both the “key ingredients” of the clinical model and many practical considerations essential for successful implementation. It also describes the need for each community to adapt the model to its particular needs and characteristics. Careful attention to unique community needs, coupled with fidelity to the key ingredients of the practice, equals successful implementation. The closer the kit user comes to following the implementation resource kit guidance, the more likely the practice will yield good results for consumers.
DRAFT 2003 IMPLEMENTATION RESOURCE KIT USER’S GUIDE 3 As mental health services research and evaluation progress, CMHS hopes to support the development of implementation resource kits for additional evidence-based practices, and to refine this and other previously-developed resource kits to take new evidence into account.
Indeed, evaluation of planned pilot projects for implementing this resource kit and associated implementation strategies will tell us much about how to make improvements in future versions.
We hope that this and other evidence-based practice implementation resource kits will be helpful to communities across the nation as they strive to provide the most effective services possible for persons suffering from mental illness.
This document is part of an evidence-based practice implementation resource kit developed through a contract (no. 280-00-8049) from the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Center for Mental Health Services (CMHS) and a grant from The Robert Wood Johnson Foundation (RWJF). These materials are in draft form for use in a pilot study.
No one may reproduce, reprint, or distribute this publication for a fee without specific authorization from SAMHSA.
IMPLEMENTATION RESOURCE KIT USER’S GUIDE 4Introduction Welcome to the Assertive Community Treatment implementation resource kit. It has been produced by the Implementing Evidence-Based Practices Project as part of an effort to promote treatment practices in community mental health service settings that are known to be effective in supporting the recovery of adults with severe mental illnesses. The goal: to improve the lives of consumers by increasing the availability of effective mental health services.
The User's Guide begins by providing general information about the Implementing EvidenceBased Practices Project, including the goals and values of the project. This is followed by descriptions of the materials contained in the resource kit and their proposed role in the implementation process. The basic structure of an implementation plan is outlined. Specific suggestions for implementing the practice of Assertive Community Treatment are presented in the Implementation Tips documents. This guide also contains a list of annotated references on Assertive Community Treatment and a special populations appendix which provides a review of the literature addressing the range of populations for which this practice has demonstrated efficacy or effectiveness.
If you have any questions or comments about these materials or the implementation process,
please contact Kristine Knoll at the NH-Dartmouth Psychiatric Research (e-mail address:
Kristine.M.Knoll@Dartmouth.EDU). We look forward to supporting your efforts to improve services to people with severe mental illness. Also, please share your experience in using these materials. Feedback from users will help refine and improve future versions of these implementation materials.
DRAFT 2003 IMPLEMENTATION RESOURCE KIT USER’S GUIDE 5 Background What are “evidence-based practices”?
Evidence-based practices are services for people with severe mental illness (consumers) that have demonstrated positive outcomes in multiple research studies.
Over the past 15 years, researchers in mental health service systems have gathered extensive data to support the effectiveness of several psychosocial and pharmacological treatments. In 1998, the Robert Wood Johnson Foundation convened a consensus panel of researchers, clinicians, administrators, consumers, and family advocates to discuss the research and to determine which practices currently demonstrated a strong evidence base. This project is an offshoot of these efforts.
The six evidence-based practices
Six practices were identified as currently demonstrating a strong evidence base:
standardized pharmacological treatment
integrated dual disorders treatment (substance use and mental illness) Other evidence-based practices for the treatment of persons with severe mental illnesses are being identified and will be promoted as the research evolves. This project is only a beginning attempt to establish models and procedures. This list of identified practices is not intended to be complete or exclusive. There should be many evidence-based practices in the future. Some promising practices being researched currently include peer support programming, supported housing, trauma services, and treatment for people with borderline personality disorder.
IMPLEMENTATION RESOURCE KIT USER’S GUIDE 6What is an implementation resource kit?
An implementation resource kit is a set of materials—written documents, videotapes,PowerPoint presentations, and a website—that support implementation of a particular treatment practice.
Specific materials in this resource kit have been developed for each of the key stakeholder groups
involved in the implementation effort:
consumers of mental health services family members and other supporters practitioners and clinical supervisors program leaders of mental health programs public mental health authorities Research has shown that providing practice guidelines to practitioners alone does not change practice. Change is most likely to occur and be sustained if all the major stakeholders in the mental health system are engaged and involved in the process of change. Therefore the materials and guidelines in this implementation resource kit are geared toward five different stakeholder groups. The materials for each specific stakeholder group were either written by representatives of that group or in close collaboration with them.
The resource kit materials are also designed to address three stages of change:
engaging and motivating for change (why do it) developing skills and supports to implement change (how to do it) sustaining the change (how to maintain and extend the gains) What is an implementation package?
An implementation package is a set of implementation materials (the resource kit) combined with complementary training and consultation that support implementation of the evidence-based practice. The resource kit materials are designed to be most effective when used with consultative and training services. As part of the Implementing Evidence-Based Practices Project, EBP implementation centers are being established in various states across the country to provide consultation and training (see www.mentalhealthpractices.org).
DRAFT 2003 IMPLEMENTATION RESOURCE KIT USER’S GUIDE 7 How was this implementation resource kit developed?
A team made up of multiple stakeholders developed each resource kit: researchers, clinicians, program managers and administrators, consumers, and family members. Documents oriented toward specific stakeholder groups were either written by the stakeholders or in close collaboration with them. A consensus panel, also comprised of multiple stakeholders, reviewed the materials developed for all of the six implementation resource kits to ensure consistency of presentation and attention to the various perspectives of the different constituencies.
For more information For a more detailed discussion of the project and the implementation strategies, refer to the
enclosed Psychiatric Services articles:
Drake RE, Goldman HH, Leff HS, et al: Implementing evidence-based practices in routine mental health service settings. Psychiatric Services 52:179–182, 2001.
Torrey WC, Drake RE, Dixon L, et al: Implementing evidence-based practices for persons with severe mental illnesses.
Psychiatric Services 52:45–50, 2001.
IMPLEMENTATION RESOURCE KIT USER’S GUIDE 8Project Philosophy and Values
The project rests on two philosophical tenets:
First, mental health services for people with severe mental illnesses should have the goal of helping people to develop high-quality, satisfying functional lives. That is, services should aim not just at helping consumers stay out of the hospital and reducing or stabilizing symptoms, but also at helping them to pursue their own personal recovery process. People want services that help them to manage their illnesses and to move ahead with their lives.
Second, consumers and their families have a right to information about effective treatments, and in areas where evidence-based practices exist, consumers and family members have a right to access effective services.
Evidence-based practices are not intended to be exclusive, mandatory, or rigid. Rather, they imply self-knowledge, self-determination, choice, individualization, and recovery.
Defining recovery There have been many efforts to define the recovery philosophy. The Consumer Advisory Panel for the Implementing Evidence-Based Practices Project drafted the following brief statement. The principles of recovery that informed the development of the implementation resource kit materials
hope personal responsibility education self-advocacy support The cessation of symptoms is not necessarily equal to recovery. Each person develops their own definition of recovery, which many view as a process rather than a destination.