TMACT Returning

A Note from our Director:

In North Carolina, ACT policy specifies minimal expectations of fidelity and therefore ratings can have a larger consequence than merely informing quality improvement feedback. As many of you have heard in this forum or elsewhere, Maria Monroe-DeVita and I (TMACT co-authors) have held strong on the importance of not altering the TMACT fidelity review protocol itself — i.e., not giving credit for phone/virtual contacts in items that explicitly say to measure only face-to-face (in-person) contacts; not crediting for virtual daily team meetings as an equal substitute for in-person daily team meetings).

Hence, we have been cautious about when we restart in-person reviews here in NC. As many of you have heard from us, we (and a couple of other states) developed and used a virtual EBP Quality Review process in lieu of in-person fidelity reviews during the pandemic. These were developed from the TMACT, included some COVID-specific enhancements, and did not entail item-level ratings. This helped us understand practice as it was being provided during the pandemic, and where we offered some guidance and support the best we could during such unusual times.

These EBP Reviews served their interim purpose. There is something missed without a systematic measure that rates the team across 120 + facets of a complex program.

We are preparing to return to in-person TMACT reviews in earlier part of 2022. In NC, we have a plan in place where we intend to review a NC ACT team in January and closely review their data to understand where and to what extent we believe lingering effects of the pandemic had an impact on practice, and thereby also ratings. We are also developing a booster training of sorts, which will include reinforcing where the TMACT protocol allows for inclusion of virtual/telephone modes of service delivery – and where it does not, how we might still track virtual/phone modes of service delivery for the sake of reporting out practice. In North Carolina, we utilize TMACT review teams staffed with a Lead Reviewer (someone who work with us at the Institute for Best Practices, or someone who work with our NC DHHS team) and then an ACT provider trained to assist with reviews. With the time that has gone by, there is a great need for refresher trainings.

Fortunately, all of this toggles well with the eventual launch of eTMACT in 2022 – a secure, web-based platform for the TMACT, which will significantly reduce the time involved in carrying out the review (from the reviewer perspective), further enhance the accuracy of ratings, and result in more timely feedback to ACT teams. More to come on that at a latter point for those out there already using the TMACT.


In the News

The New York Times – February 25th, 2020

Mental-Health Researchers Ask: What Is ‘Recovery’?

There are many ways to measure mental distress. But it’s far harder to predict, or even describe, the improvement that often follows.

A thoughtful piece in NY Times last week speaks to the challenges in capturing – measuring — someone’s recovery.  There are two primary features of a good measure — reliability (you can capture the same findings consistently (time/rater/items) and validity (you are measuring what you think you are measuring)  A nicely crafted *standardized* measure often succeeds with the reliability feature.  However, it may miss the boat entirely or partly on the validity aspect of a good measure. The NYT author touches on that challenge when it comes to capturing recovery.  It is so personal that standardized assessments may struggle with validity — “you wouldn’t pick it up unless you knew how to ask” — in this case, with regard to people’s relationships with auditory hallucinations.


Read the Article

Upcoming Webinar

March 6th, 2020 | 12pm – 3pm

Enhancing Skills to Succeed with Independent Living

This webinar training meets the Community Support Team (CST) service definition requirement for the Basics of Psychiatric Rehabilitation and Functional Assessments.  A Certificate of Attendance will be sent to only those who have registered for this webinar (i.e., if multiple team members intend to attend together on a single computer, please be sure to register each individual separately).

This webinar will be led by UNC Institute for Best Practices staff and will cover the following topics:

  • Housing First model
  • Community living and participation skills – Taking Inventory!
  • Assessment – gathering the right level of data to inform services and supports
  • Person-centered planning – what matters most, and how to help them get there by building on strengths, and overcoming barriers
  • Enhancing community living and participation skills by delivering planned interventions

Presenter: Lorna L. Moser

Event Registration

UNC Center for Excellence in Community Mental Health receives nearly $500,000

UNC Health Care Newsroom – January 23, 2020

UNC Center for Excellence in Community Mental Health
receives nearly $500,000 to study mental health program

Lorna Moser, PhD, associate professor of psychiatry and director of the Center’s Institute for Best Practices, is principal investigator for a three-year, nearly $500,000 grant from the Laura and John Arnold Foundation for a national study to look at Assertive Community Treatment (ACT) for individuals with serious mental illness.

…. “We hope to generate valuable descriptive data on the state of ACT implementation across the U.S. to guide current and future efforts to make smarter use of (sadly) limited resources in community mental health,” Moser continued. “We believe study results will be useful to policy-makers and funders, but also providers and mental health services researchers.

“ACT, when optimally implemented, can play an important role in our system of care to divert individuals with serious mental illness away from institutional settings such as hospitals, jails, and restrictive residential settings to more integrated community settings,” continued Moser….

Read the Article

In the News

The Washington Post Magazine – January 13th, 2020

What Schizophrenia Does to Families

A mother, a son, an unraveling mind — and a mental health system that can’t keep up

This is an overwhelmingly familiar, sad, discouraging read.

It evoked many reactions, including — a continued fragmented, underfunded, antiquated system of care (day treatment; unregulated group homes). I’m thankful that, despite the many hurdles and barriers out there, I also get to see success stories — often a result of the work of compassionate and committed providers. If I didn’t see such success stories, it would be hard to remain in this field of work and advocacy.

I wish WaPo would have made this a multi-part series to flesh this out more, include more stakeholder perspectives and broaden their research sources.


Read the Article

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

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.