Program fidelity is essentially a recipe to follow to get the desired final product and outcomes. The recipe specifies the not only the necessary ingredients, but also their doses or amounts. By definition, an evidence-based practice is to be clearly defined (i.e., the ingredients and doses specified) and produce positive outcomes
The intended use of the Tool for Measurement of ACT (TMACT) is to glean a snapshot of current Assertive Community Treatment (ACT) team structure, staffing, and practices to compare with a contemporarily defined ACT model (i.e., program fidelity). The ultimate purpose of this comparison is to guide quality improvement consultation while providing reliable quantitative indicators of performance for research and evaluation.
The TMACT’s detailed specification of practice, as well as accompanying tools, can help guide ACT implementation. Areas of relative strengths and limitations can be identified, both at the team-level and broader system-level (e.g., policies and funding), thereby assisting with targeted ongoing performance improvement efforts. The developmental progress of the team can be captured in a repetitive series of these fidelity assessments.
Some states and agencies tie fidelity scores to specific certification or licensing standards. While this approach may help to ensure consistency between the two types of standards, it should not be assumed that teams should receive the highest score (i.e., 5) on all items. That is, if the purpose of licensing and certification is to set a minimum standard of performance, then teams should not be held to the maximum score possible. Instead, teams should be held accountable to a threshold score or an acceptable range (e.g., scores of 4 or higher), with specific performance improvement expectations tied to lower scores, such as 3 or lower.
