Model variance and model fidelity: The lessons from ACT

This chapter takes the assertive community treatment (ACT) model of community outreach as a starting point and examines what can and what cannot be varied and still achieve good results. ACT has a special place in community outreach as it was the first model of care confirmed by research, and controversy has raged about the need, or otherwise, for ‘model fidelity’. The chapter identifies the core ingredients—small caseloads, in vivo psychosocial treatments, mainstreaming, flexibility, 24/7 availability—and examines the evidence for and against them. It pays particular attention to the roles of support workers and the medical member of the team. Later developments such as flexible assertive outreach (FACT) are also described.