Implementation, Fidelity and Sustainability of Forensic Assertive Community Treatment

Joseph P. Morrissey, Ph.D., Principal Investigator

Gary Cuddeback, Ph.D., Co-Investigator

Karen Cusack, Ph.D., Co-Investigator

Funding Source: The John D. and Catherine T. MacArthur Foundation’s Mental Health Policy Network

Forensic Assertive Community Treatment (FACT) is a specialized version of Assertive Community Treatment focused on persons with severe mental illness who are involved with the criminal justice system. FACT holds great promise as a treatment intervention that can improve public health and public safety outcomes, but there is little evidence that FACT can achieve these outcomes. To this end, part I of this two part study was designed to examine: (1) the barriers and obstacles faced in implementing FACT, (2) the adaptations in the basic Assertive Community Treatment model needed for optimal use with forensic populations, and (3) the factors that influence the sustainability of FACT programs over time. Part II of the study addresses the criminal justice and mental health outcomes of FACT.

In the first part, 28 forensic mental health programs were screened to identify 12 FACT teams for site visits about their consumers, their interface with the criminal justice system, and implementation and sustainability challenges. Site visit findings were reviewed by an expert panel knowledgeable about the interface between assertive community treatment and the criminal justice system. The findings indicate that little consensus exists about a program model for FACT and that several issues require more research to guide its further dissemination. FACT represents an opportunistic adaptation to growing numbers of mentally ill persons who are involved with the criminal justice system but practice has outpaced the evidence base.

Part II of the study entails the re-analysis of administrative data from the State of California’s Mentally Ill Offender Crime Reduction Grant (MIOCRG) program. MIOCRG funded the development of FACT and Forensic Intensive Case Management (FICM) teams and employed a randomized controlled design to compare criminal justice outcomes between FACT or FICM and usual community care. The re-analysis of these data seeks to examine further the benefits of FACT versus FICM in achieving desirable public health and public safety outcomes. Preliminary findings indicate that both types of enhanced programs (FACT and FICM) resulted in decreases in jail time for participants. Neither FACT nor FICM resulted in change on self-report measures of symptoms or quality of life. Additional analyses are on-going.