Tool for Measurement of ACT (TMACT)
TMACT Definition & Usage
The Tool for Measurement of ACT (TMACT) is a contemporary evaluation tool used to assess how well a program is implementing critical elements of Assertive Community Treatment (ACT). The TMACT guides higher-quality ACT implementation efforts through rigorous fidelity assessment. It was developed by Maria Monroe-DeVita, Ph.D., Lorna Moser, Ph.D., and Greg Teague, Ph.D. and is used in many U.S. states and several countries. The view of ACT offered through the TMACT is a contemporary update that comprises the following:
- Flexible and individualized application of resources, where the team delivers highly responsive, individualized, biopsychosocial and rehabilitative services in people’s natural environments that address their goals and needs, and are provided with appropriate timing and intensity;
- A team approach to treatment delivery, where an interdisciplinary group of providers with individual areas of expertise share responsibility for meeting people’s complex service needs, integrating care, and providing an array of service interventions; and
- Recovery-oriented services as the focus of care, where the team promotes self-determination and respects consumers as experts in their own right.
The TMACT is a comprehensive rating protocol and guide, consisting of Part I: Introduction, Part II: Itemized Data Collection Forms, and an Appendix. After eight years of pilot-testing and updating the TMACT, we offer the full tool for download here. This version is referred to as TMACT 1.0, Revision 3. TMACT revisions consist of minor clarifying updates, which should minimally impact previous scoring using earlier versions.
More about the TMACT
Although there is a large amount of research showing that Assertive Community Treatment (ACT) can produce better individual outcomes and improved cost savings, the effectiveness of ACT will depend on the quality of the particular program delivering it, specifically the degree of program fidelity, or how faithfully its core elements are implemented.
The Tool for Measurement of ACT (TMACT) was developed from the Dartmouth Assertive Community Treatment Scale (DACTS), which was developed to measure the adequacy of ACT team implementation. Compared to the DACTS, the TMACT is more sensitive to change, as it is a more nuanced measure of ACT program fidelity setting a higher bar for ACT program performance. Recent research further suggests that higher fidelity scores on the TMACT were associated with reductions in state hospital and acute crisis unit stays, and improvements in retention of service recipients and competitive employment rates.
The TMACT has 47 program-specific items. Each item is rated on a 5-point scale ranging from 1 (“not implemented”) to 5 (“fully implemented”). Standards used for establishing the anchors for the “fully implemented” ratings were determined by a combination of expert opinion and the empirical literature. The average rating across the 47 items reflects the final TMACT Rating, which serves as an index of overall performance.
After eight years of pilot-testing, updating, and using the TMACT, Version 1.0 Revision 3 (2018) is posted for download. Training is strongly encouraged for reliable and valid use of the TMACT; however, it is not required. TMACT authors do not currently certify individuals as TMACT trainers. Please contact TMACT authors for training inquiries.
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TMACT Summary Scale (1.0rev3) provides an overview of TMACT items and rating anchors. This should be used for reference only, not for conducting a review. TMACT Protocol Part I (1.0rev3): Introduction provides an overview of the TMACT and, most importantly, guidance on how to prepare, conduct, and follow up after a TMACT review. TMACT Protocol Part II (1.0rev3): Itemized Data Collection Forms is used to gather needed data and rate a team across all 47 items. Treat Part II as a workbook to document information and make ratings for a given team. Be sure to review an important update to the Rating Guidelines for the Specialist Team here. To qualify for the “no rate” option with vacant or newly filled positions, teams must demonstrate an annual staff turnover rate of 39% or less. |
TMACT Protocol – Appendix (1.0rev3) includes example forms, letters, and a final report sample to support your use of the TMACT. Note: the 1.0rev3 Appendix will be posted shortly. Team Survey and Excel Spreadsheet are data collection tools used in a TMACT evaluation and are sent to the team ahead of the review (refer to Protocol Part I for further instructions). |
These items are included in Part II but may be easier to download here. Please refer to TMACT Part I for instructions on how to use the Chart Review Logs (Log I and Log II) and Chart Review Tally Sheets (Tally Sheet Log I and Tally Sheet Log 2).
Hard to keep up with exactly what has changed? We understand. We created a Q&A to explain changes made since TMACT 1.0 Revision 1. We also recorded a webinar: Part I is nearly two hours long and covers through EP6. Part II is about 45 minutes and includes a preview into eTMACT. Presentation handout available here.
eTMACT is here!
The electronic TMACT (eTMACT) is a secure, web-based software platform (SaaS). It streamlines the fidelity review process through data collection, management, analysis, and report development, improving both efficiency and accuracy. Administrative entities invested in having ACT teams undergo fidelity reviews may subscribe to eTMACT and arrange to contract with or appoint trained reviewers to conduct reviews of area ACT teams. Training in the use of the TMACT is offered independently of the license agreement to access and use eTMACT.
Watch an overview of eTMACT here.
For more information regarding the TMACT, including training and consultation options for administering this fidelity tool, please complete this form or email the TMACT authors directly.