Date on Paper


Document Type

Doctoral Paper

Degree Name




Committee Chair

Mary-Beth Coty

Committee Member

Ruth Staten

Author's Keywords

Assertive Community Treatment, Severe Mental Illness, Hospitalization, and Intensive Case Management.


Background: Severe mental illness is a devastating and undertreated problem in our society. Assertive Community Treatment (ACT) services could help fill the void left from the deinstitutionalization movement providing the severely mentally ill the needed support while allowing them to remain in their communities.

Aim: This evidence-based scholarly (EBP) project addressed the following question; How does length of time in ACT affect the number or length of hospitalizations, and incarcerations in patients with severe mental illness.

Methods: This project is a program evaluation of an Assertive Community Treatment Team Program in a metropolitan city. The impact evaluation consists of data collected by medical record review of the ACT patients, covering their first year of participation in ACT services, assessing number of hospitalizations, number of hospital days, number of 30-day readmissions, and number of incarcerations. The process evaluation was done using the Dartmouth ACT fidelity score.

Results: No significant differences were found for any of the study measures with the exception of the mean hospitalization number from the first three-month period (0.1290 ± 0.42755) to the second three-month period (0.3226 ± 0.59928), (t(30) = -2.257, p=0.031). Mean increased of 0.19355 with a 95% CI between -0.36868 and -0.0184. The magnitude of effect was large (eta squared =0.145).

Implication for Practice: Although no significant findings related to ACT reduction in resource utilization were found, a significant increase in hospitalization was found within the three-month time frame which was contrary to initial expectations of the project. Additional studies are needed to reconcile this finding. Recommendations were made for collection of additional data during admission to ACT to enhance better understanding of the impact of ACT on severely mental ill community dwellers.

Included in

Nursing Commons