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Community -based services for persons with severe and persistent mental illness: An analysis of Assertive Community Treatment (ACT) in Nebraska

Maria B Monroe-DeVita, University of Nebraska - Lincoln


Assertive Community Treatment (ACT) is an intensive, community-based program for persons with severe and persistent mental illness and has been developed in many states as a hospital alternative. In January 1999, the Nebraska Health and Human Services System (HHSS) implemented ACT teams in two communities originally targeted for state hospital downsizing efforts. This study is a comprehensive evaluation of the two Nebraska ACT teams, which collectively served 140 clients at the time of examination. Specific hypotheses were developed across six different program and policy-related issues: (1) eligibility criteria and pre-admission procedures, (2) financing strategies, (3) service array and service delivery, (4) program fidelity, (5) clinical assessment measures and procedures, and (6) clinical outcomes. The extent to which the two ACT teams differed from each other, from policy intent, and from national trends was examined across all six issues. ACT team members collected outcome and service delivery measures, while the Principal Investigator (PI) of this study collected all program and policy-related data via direct examination of policy documents, intensive interviews with key informants, and naturalistic observation. Results suggest that overall, both ACT teams adhered to similar eligibility criteria, provided similar service arrays, and demonstrated fidelity to the intended program, reflecting both Nebraska policy intent and national trends. However, both teams, particularly Hastings ACT, did not consistently adhere to program evaluation requirements, making it difficult to fully evaluate clinical outcomes over time. Those outcome variables that were available suggest that Omaha ACT clients tended to demonstrate improvement in independent living status outcomes, but showed no significant change or improvement with respect to other outcome domains. Findings point to the importance of providing services that are more psychosocial in nature, tying program compliance with funding, and emphasizing the role of clinical data in program management and services. Factors that facilitated and hindered program and program evaluation implementation were further explored in order to guide recommendations for future efforts in this area. ^

Subject Area

Health Sciences, Mental Health|Psychology, Clinical

Recommended Citation

Monroe-DeVita, Maria B, "Community -based services for persons with severe and persistent mental illness: An analysis of Assertive Community Treatment (ACT) in Nebraska" (2001). ETD collection for University of Nebraska - Lincoln. AAI3022652.