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Department of Psychiatry, St George's Hospital Medical School, London
Psychiatric Research Center, Lebanon, NH, USA
Correspondence: Dr Matthew Fiander, Department of Psychiatry, St George's Hospital Medical School, Jenner Wing, Cranmer Terrace, London SW17 ORE, UK. Tel: 020 8725 0683; fax 020 8725 3538; e-mail: mfiander{at}sghms.ac.uk
Background The significant reductions in hospital admission demonstrated in US assertive community treatment (ACT) studies have not been replicated in the UK. Explanations cite poor UK ‘model fidelity’ and/or better UK standard care. No international model-fidelity comparisons exist.
Aims To compare high-fidelity US ACT teams with a UK team.
Method The UK 700's ACT team (n=97) was compared with high-fidelity US ACT teams (n=73) by using two measures: a forerunner of the Dartmouth Assertive Community Treatment schedule (to assess adherence to ACT principles) and 2-year prospective activity data.
Results The UK and US teams had similar high-fidelity scores. Although significant differences were found in the amount and type of activity, practice differences in areas central to ACT were not great.
Conclusions The failure of UK ACT studies to demonstrate the outcome differences of early US studies cannot be attributed entirely to the lack of ACT fidelity.
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