Case Manager Perspectives on Assertive

Community Treatment: Critical Ingredients, Results: Twenty-four of twenty-seven possible critical

Clinical Ingredients, and Variations in ingredients were rated very important by at least 50%
of teams. Full-time nurse on team was rated as the
Implementation most important ingredient and medication manage-
ment was rated as the most beneficial clinical activity.
John H. McGrew, Ph.D., Bernice A. Pescosolido, Ph.D.,
and Eric R. Wright, Ph.D.
IUPUI and Indiana University, Bloomington

Objective: The paper sought to identify case

managers perspectives on the critical ingredients, and
the therapeutic mechanisms of action of Assertive
Community Treatment (ACT). ACT is an effective
model of community treatment for persons with
severe mental illness (SMI) (1-8). Although there is
strong evidence that ACT is successful (e.g.,
decreased hospitalization use, increased overall level
of functioning), the essential structural and organi-
zational program elements that underlie ACT
effectiveness have not been clearly established
empirically. Few experimental (9) or quasi-experi-
mental studies (10) have been conducted with the
express purpose of establishing the importance of
particular elements of ACT. The majority of published
research that has attempted to identify the critical
elements empirically has relied on more indirect
methods. One method to help identify the core
ingredients of an intervention is to ask informed stake-
holders in the model (11 ). For example, McGrew and
colleagues(12) asked ACT experts to rate a list of
possible critical ingredients of ACT, and also asked a
sample of ACT clients to nominate helpful elements of
ACT (13). The current study asked ACT workers to
provide their perspective on the critical elements of
ACT. ACT workers also were asked their opinions
about the critical clinical elements or mechanisms of
action thought to underlie ACT success.

Method: ACT teams (n=73) attending the National

Assertive Community Treatment Conference rated the
degree to which 16 clinical activities were beneficial to
clients, and rated the importance to the ideal team,
and the appropriateness for their team, of 27 possible
critical ingredients.
 .

~
9. T.W. Hu, J.M. Jerrell: Estimating the cost of impact disciplinary evaluation and research study in order to
of three case management programmes for monitor and report on both the process and the
treating people with severe mental illness. outcomes of this initiative.
British Journal of Psychiatry 173 (Suppl
36):26-32, 1998.
10. M.P. Salyers, T.W. Masterton, D. Fekete et al.: Research Team
Transferring clients from intensive case
management: Impact on client functioning. Eric R. Wright, Ph.D., Associate Professor of
American Journal of Orthopsychiatry 68:233- Sociology, IUPUI and Associate Director, Indiana
245, 1998 Consortium for Mental Health Services Research,
11. L. Sechrest, R.G. West, M.A. Phillips et al.: Some Principal Investigator.
neglected problems in evaluation and
research: Strength and integrity of treatments, David Mank, Ph.D., Professor Education, IU School of
Vol. 4. Edited by W. Yeaton. Beverly Hills, CA, Education and Director, Indiana Institute on Dis-
Sage, 1979. ability and Community, Co-Principal Investigator.
12. J.H. McGrew, G.R. Bond: Critical ingredients of
assertive community treatment: Judgments of John McGrew, Ph.D., Associate Professor of
the experts. Journal of Mental Health Admini- Psychology, IUPUI.
stration 22: 113-125, 1995
13. J.H. McGrew, R. Wilson, G.R. Bond: Client per- Debra Mesch, Ph.D., Associate Professor, School of
spectives on helpful ingredients of assertive Public and Environmental Affairs, IUPUI.
community treatment. Psychiatric Rehabili-
tation Journal 19: 13-21, 1996. Faith Thomas, M.A., Research Associate, Indiana
Institute on Disability and Community.

Project Overview Terry F. White, M.B.A., Research Operations

Southeast Regional Center Evaluation Manager, Indiana Consortium for Mental Health
Services Research, Project Director.
(SERCE)

The Southeast Regional Center Evaluation project Study Desian

began in Fall 2001 and is currently in the data
collection phase. This is a brief overview of the Because of the complexity and scope of this initiative,
the evaluation protocol is multifaceted and com-
project.
prehensive. The specific protocols are being de-
In April 2001, Governor Frank O'Bannon announced a veloped by members of the evaluation team with input
new initiative to improve health, mental health, and from governmental policy makers and other com-
social services and support for persons with develop- munity members. While the research team is actively
ment disabilities and/or mental illness. Specifically, he seeking input from interested parties and stake-
directed the Indiana Family and Social Services holders regarding the major components of the
Administration (FSSA) to begin restructuring existing evaluation study, the specific research questions
services in the southeast region of the state in order guiding each component of the research project, how
to improve the quality of care and move more clients the data will be collected, and the execution of the
into the community while reducing the cost of protocol is the sole responsibility of the research
providing care to these Hoosiers. The reconfiguration team. All data will be collected and analyzed by the
would involve three major changes: the closing of research team and their staff according to the highest
Muscatatuck State Development Center (MSDC), the scientific standards. The research team will
downsizing of Madison State Hospital (MSH), and the summarize key findings as data become available in
development of the new Southeast Regional Care accordance with scientific standards governing
Center which will have a base of operation on the evaluation research. Written and verbal reports will
grounds of Madison State Hospital. As part of this be offered periodically to the State, other
major policy initiative, FSSA has asked an stakeholders, and the public.
independent group of external researchers at Indiana
University to conduct a comprehensive, multi-
 ANNOUNCEMENTS

. Ann Hohmann, Program Officer in the Services Research & Clinical Epidemiology Branch at NIMH,
and the project officer on the RISP that helped to create the Consortium is receiving an Achievement
Award for Excellence in the Field of Mental Health from the Mental Health Section of the American
Public Health Association. The 131 sI Annual Meeting of the APHA will be held in Philadelphia on
November 9-13,2002.

. Bernice A. Pescosolido, Director of the Indiana Consortium for Mental Health Services Research,
has been elected Vice President of the American Sociological Association. She will assume office in
August 2003 following a year of service as Vice President-Elect.

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