TMACT Definition & Usage

The Tool for Measurement of ACT (TMACT) is a contemporary evaluation tool used to assess how well a program is implementing critical elements of Assertive Community Treatment (ACT).

The TMACT is used to assess ACT program fidelity and guide higher quality ACT implementation efforts. It was developed by Maria Monroe-DeVita, Ph.D., Lorna Moser, Ph.D., and Greg Teague, Ph.D. and is used in many U.S. states and several countries.

The view of ACT offered through the TMACT is a contemporary update that comprises the following:

  • Flexible and individualized application of resources, where the team delivers highly responsive, individualized, biopsychosocial and rehabilitative services in people’s natural environments that address their goals and needs, and are provided with appropriate timing and intensity;
  • A team approach to treatment delivery, where a multidisciplinary group of providers with individual areas of expertise share responsibility for meeting people’s complex service needs, integrating care, and providing an armory of service interventions; and
  • Recovery-oriented services as the focus of care, where the team promotes self-determination and respects consumers as experts in their own right.

The TMACT is a comprehensive rating protocol and guide, consisting of Part I: Introduction, Part II: Itemized Data Collection Forms, and an Appendix. After 8 years of pilot-testing and updating the TMACT, we offer the full tool for download here. This version is referred to TMACT 1.0, revision 3.  TMACT revisions consist of more minor, clarifying updates, which should minimally impact previous scoring using earlier versions.

More about the TMACT

Although there is a large amount of research showing that Assertive Community Treatment (ACT) can produce better individual outcomes and improved cost-savings, the effectiveness of ACT will depend on the quality of the particular program delivering this service – how faithfully best practice elements are implemented, known as “program fidelity.”

The Tool for Measurement of ACT (TMACT) originated from the Dartmouth Assertive Community Treatment Scale (DACTS), which was developed to measure the adequacy of ACT team implementation. Compared to the DACTS, the TMACT is more sensitive to change, as it is a more nuanced measure of ACT program fidelity setting a higher bar for ACT program performance. Recent research further suggests that higher fidelity scores on the TMACT were associated with reductions in state hospital and acute crisis unit stays, and improvements in retention of service recipients and competitive employment rates.

The TMACT has 47 program-specific items. Each item is rated on a 5-point scale ranging from 1 (“not implemented”) to 5 (“fully implemented”). Standards used for establishing the anchors for the “fully-implemented” ratings were determined by a combination of expert opinion and the empirical literature. The average rating across the 47 items reflect the final TMACT Rating, which serves as an index of overall performance.

After eight years of pilot-testing, updating, and using the TMACT, Version1.0 Revision 3 (2018) is posted for download. Training is strongly encouraged for reliable and valid use of the TMACT, however it is not required. TMACT authors do not currently certify individuals as TMACT trainers. Please contact TMACT authors for training inquiries.

  • TMACT Summary Scale (1.0rev3) provides an overview of TMACT items and rating anchors. This should be used for reference only, not in conducting a review.
  • TMACT Protocol Part I (1.0rev3): Introduction provides an overview of the TMACT, but most importantly, guidance in how to prepare, conduct, and follow-up after a TMACT review.
  • TMACT Protocol Part II (1.0rev3): Itemized Data Collection Forms is what is used to gather needed data and rate a team across all 47 items. Treat Part II as a workbook used to document information and make ratings for a given team. Be sure to check out a very important update to the Rating Guidelines for the Specialist Team here. To qualify for “no rate” option with vacant or newly filled positions, teams must demonstrate an annual staff turnover rate of 39% or less.
  • TMACT Protocol – Appendix (1.0rev3) includes example forms, letters, and final report sample to support your use of the TMACT.  *Note the 1.0rev3 Appendix will be posted shortly.
  • Team Survey and Excel Spreadsheet are data collection tools used in a TMACT evaluation, sent to the team ahead of the review (refer to Protocol Part I for further instructions).

These items are included in Part II, but may be easier to download here. Please refer to TMACT Part I for instructions in how to use these Chart Review Logs (Log I and Log II) and Chart Review Tally Sheet Log I and Tally Sheet Log 2.

Hard to keep up with exactly what has changed?  We understand. We created this Q&A to explain changes made since TMACT 1.0 Revision 1. We also recorded a webinar for you!  Part I is nearly 2 hours long and takes you up until about EP6.  Part II is about 45 minutes, finishes up with the review AND gives you a sneak peak into eTMACT.  PowerPoint Handout here.

eTMACT is here!

The electronic TMACT (eTMACT) is a secure, web-based subscription software as a service(SaaS). The process for carrying out a fidelity review is streamlined by the use of software that makes data collection, management, analysis, and report development easier and with improved accuracy. Administrative areas who are invested in having area ACT teams undergo fidelity reviews would subscribe to eTMACT software and arrange to contract with and/or appoint trained reviewers to utilize the software to conduct reviews of area ACT Teams. Training in the use of the TMACT is a service offered independent of this license agreement to access and use eTMACT.

Check out this Overview of eTMACT here:

For more information regarding the TMACT, including training and consultation options for administering this fidelity tool, please complete this form, or email the TMACT authors directly.

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