The implementation of a program for assertive community treatment - Learning from past experience

Objective: To examine various issues concerning the implementation of a pro gram for assertive community treatment (ACT). Method: In-depth interviews were conducted with participants of an ACT proj ect implemented in the 1970s. A quality analysis was undertaken, assessing the issues that prevented the expansion of such an approach as well as issu es to be considered in future implementation of ACT. Results: Social, cultural, organizational, professional, and economic facto rs were identified that will continue to play decisive roles in the integra tion of such a program. The A CT implementation in question occurred at the same time as the shift to community psychiatry, without having been linked to that approach. Currently, social factors such as self-help groups and p arents foster the implementation of such programs. The organizational facto rs include the importance of linking ACT to existing health care services, as well as adapting ACT to these services. The association of this type of project with a research team did not ensure a successful implementation. A third factor is the psychiatrist's training and motivation with respect to the practice of this approach. Finally, economic issues are playing a large r role in the implementation of this approach. Conclusion: This study relates different issues regarding the implementatio n of an A CT. The results represent assumptions that need to be confirmed b y assessing ACT implementation in Quebec as well as in the rest of Canada.