The program of assertive community treatment: Implementation and dissemination of an evidence-based model of community-based care for persons with severe and persistent mental illness

The Program of Assertive Community Treatment (PACT), a multidisciplinary team approach, delivers integrated community-based treatment, rehabilitation, and support services to help persons with severe and persistent mental illness to avoid psychiatric hospitalization and to live independently in natural community settings. Twentyfive randomized clinical trials of PACT and its close adaptations, conducted over the past 30 years in several countries, demonstrate its effectiveness for this population in reducing use of inpatient psychiatric services and sustaining tenure in normalized housing. Programs based on the PACT model now operate in many countries and most states. Several states have disseminated these programs statewide using a mix of standards, financial incentives, monitoring of program performance, and expert training and consultation. However despite the strong evidence base for PACT, most states have neither committed the resources nor implemented fidelity assurance methods necessary to widely disseminate PACT and/or its close variants. For the PACT model, we offer our hypotheses about behavioral change processes underlying its approach, describe its major operational structure and process elements, briefly review the research evidence of its effectiveness, and summarize statewide dissemination efforts and factors facilitating effective dissemination. Lastly, as a case study of implementation and dissemination, we report our difficulties in implementing PACT in a rural South Carolina community mental health center (1995-2000), discuss how supervision and consultation by national PACT experts prevented a collapse of our project and turned it into a success, and outline our present plans, supported with a federal grant, to disseminate an integrated PACT and supported employment service in South Carolina's community mental health center system.