CLINICAL HANDBOOK OF SCHIZOPHRENIA

33. Assertive Community Treatment 335mechanisms, identifying leadership within an organization, and developing a plan forimplementation that includes training, supervision, and program monitoring. Numerousresources are emerging to help in the implementation of ACT. In recent years, detailedpractice manuals have become available. In addition, the National Implementing EBPProject developed materials that aid implementation, including materials translated intoSpanish. The National Alliance on Mental Illness (NAMI) has a technical assistance centerto promote ACT dissemination and has given special attention to the methods forbuilding consensus in a community among family members and clients. In the remainderof this section we present brief recommendations for the roles of different stakeholders inACT implementation.State mental health authorities have an important role in the success of ACT programimplementation. States that have established standards to define requirements foraccrediting ACT programs have done so with the intent of increasing program fidelity.Another role for state mental health authorities is to ensure stable and adequate funding.In some states this has necessitated the arduous process of revising the state Medicaidplan. A state-level technical assistance center can provide new teams with support in resourceacquisition, along with ongoing consultation and training. In some cases, technicalassistance centers may also help to monitor implementation progress and work withteams to develop performance improvement plans.At the agency administrator level, careful decisions about staff hiring, especially forsupervisory positions, are an important element in the success of an ACT team. ACT servicesare aimed at clients with high service needs and an array of complicating life circumstances.The level of clinical skill among team members should be sufficiently high tomeet the challenge of providing intensive, recovery-oriented ACT services. Ongoing trainingspecifically geared toward clinical skills development among practitioners should be apriority at all levels of any organization that offers ACT services. ACT teams work bestwhen they admit clients at a controlled rate. Commitment from all levels of the organization,including the patience to endure the inevitable challenges and ambiguities of thestart-up phase, is also necessary. Ongoing monitoring of program implementation is anothercritical step in successful implementation.Support from mental health authorities at the state and local levels, along with commitmentand support from agency administration, is necessary to provide a foundationfor sustaining ACT services; however, equally important efforts must be made at thepractitioner and team levels to ensure that high-quality ACT is implemented. A knowledgeable,empowered team leader is the linchpin of successful ACT.A team leader should manage both clinical and administrative aspects of the team’sfunctioning. On the administrative side, team leaders should have considerable authoritywith respect to both hiring decisions and taking disciplinary action when appropriate.Team leaders should be informed of relevant program model expectations and maintainservice data records that document compliance with these expectations. It is helpful towork in tandem with agency billing and/or information management departments to provideregular reports of frequency and intensity of services, location of service, and otherdata deemed relevant to managing ACT team practice. These data are also useful in monitoringprogram implementation over time.Team leaders should ensure their team’s participation in monitoring efforts; externalreview is an excellent way to gauge program fidelity, the team’s development over time,and to help establish team plans and goals for strategic improvements in service. If externalreview is not available, team leaders can use published resources to monitor theteam’s progress. Team leaders should also ensure that client outcome data are trackedand used to guide team goal setting.