A Call for Better Data to Guide ACT Policy and Programs

April 1st, 2019

Taking Issue

Lorna Moser, Ph.D., and Maria Monroe-DeVita, Ph.D.

Four decades after its development, assertive community treatment (ACT) continues to be a critical service program within U.S. mental health systems of care. Understanding its availability is essential for adequate coverage of people with serious mental illness who need this comprehensive, high-intensity service. We commend Spivak and colleagues for casting a spotlight on the need for more—and better—ACT across the U.S. Their findings resonate with what we know to be true in our own work…. [read more]


Photo by Michał Parzuchowski

ACT in a Rural Setting

The TMACT Breakdown

There’s always been some uncertainty about the extent ACT can be implemented in less urban (more rural) settings. The published literature is rather scant, and often not really evaluating “ACT,” but some lighter version of the model. In preparation for a training, we took a look at our own NC ACT fidelity data of 73 teams, and more closely examined the teams with a less than 100 population per square mile of catchment area (11 teams).

TMACT Ratings:
Mean: All teams (3.9) vs. Most Rural (4.0)
Median: All teams (3.8) vs. Most Rural (4.0)
Highest/Lowest ratings: All Teams (4.2 / 3.2) vs. Most Rural (4.3 / 3.6)

Our most rural team is the most western part of the state, serving 3 counties totaling 1,020 sq miles (mountainous area) with total general population of 46,559. Population per sq mile = 46. This team is serving 69 individuals, operating a “medium sized ACT team.” Most recent TMACT rating is 4.3 (High Fidelity).

Photo by Wes Hicks

Choice in Housing: Coco’s Story

“You never forget that feeling when you are somebody,” shared an audience member, who also shared some background, while discussing supportive housing and watching Coco’s story.

Amidst a discussion of supportive housing, we showed this video:

Sixty team members, spanning positions (COD, employment and peer specialists, QPs, nurses, psychiatrists, therapists, and team leaders) and the state (Asheville to Wilmington), attended our recent High-Fidelity ACT 101 training in Raleigh, NC.

UNC program helps clients push through mental illness to success

“What we’re doing with them comes from what they tell us they want,” VanderZwaag said. “The idea is that initially we try to help them identify what are the things they value, what are their goals for the next year and then longer term, and then we try to help them figure out what’s getting in the way of achieving those goals.”

Read about our Chatham-based ACT team and their Step-Down ACT program in this 2016 News and Observer Article here.


Lorna Moser – Presenting at Evidence-Based Practices Conference 2016

Come see the Institute Director share her knowledge at the conference.


Keynote Presenter:  Lorna Moser, PhD, HSPP, is director of the Institute for Best Practices within the University of North Carolina (UNC) Center for Excellence in Community Mental Health and is a licensed psychologist with specialized training in psychiatric rehabilitation and mental health services research. She is the co-developer of the Tool for Measurement of ACT (TMACT), a nationally recognized contemporary measure of ACT fidelity.