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BACKGROUND: The significant reductions in hospital admission demonstrated in US assertive community treatment (ACT) studies have not been replicated in the UK. Explanations cite poor UK 'model fidelity' and/or better UK standard care. No international model-fidelity comparisons exist. AIMS: To compare high-fidelity US ACT teams with a UK team. METHOD: The UK 700's ACT team (n=97) was compared with high-fidelity US ACT teams (n=73) by using two measures: a forerunner of the Dartmouth Assertive Community Treatment schedule (to assess adherence to ACT principles) and 2-year prospective activity data. RESULTS: The UK and US teams had similar high-fidelity scores. Although significant differences were found in the amount and type of activity, practice differences in areas central to ACT were not great. CONCLUSIONS: The failure of UK ACT studies to demonstrate the outcome differences of early US studies cannot be attributed entirely to the lack of ACT fidelity.


Journal article


Br J Psychiatry

Publication Date





248 - 254


Community Mental Health Services, Diagnosis, Dual (Psychiatry), Hospitalization, Humans, Mental Disorders, Outcome and Process Assessment (Health Care), Program Evaluation, Prospective Studies, Therapeutic Community, Time Factors, United Kingdom, United States