Assertive Community Treatment: Evidence-based Practice or Managed Recovery

by Sandra Johnson

Overview

The twenty-first century has witnessed an explosion in studies on comparative health studies, but mental health remains virtually ignored. Unlike the well researched topic of health policy, there is a gap in the marketplace covering mental health policy and health care policymaking. This book fills that gap; it is a comparative analysis of the implementation of Assertive Community Treatment (ACT), an evidence-based practice employed in two states that promises to empower the well-being of individuals suffering from mental illness.

Assertive Community Treatment specifically examines the tension separating the notion of client recovery and evidence-based programs. Johnson challenges the assumption that practitioners should rely on evidence-based practices to close the gap between scientific knowledge and practice. She argues that in an era of managed care, this encourages state mental health administrators to adopt policies that are overly focused on outcomes. Programs that can measure the outcomes of care provided, and evidence-based practices, have become central aspects of the quality care agenda.

This study traces the role of policy entrepreneurs throughout the Assertive Community Treatment policymaking process. By differentiating mental health in general, qualitative research increases the chances of observing similarities and differences in outcomes. Johnson explains why the ACT model was adopted and implemented. She concludes that there is a clear monopoly by medical researchers and scientists within Assertive Community Treatment research, and as a result, too much emphasis is placed on the roles of policy entrepreneurs as the main innovators in the agenda and policy formulation stages. Johnson presents a strong argument for more innovation in the implementation stage.

Product Details

ISBN-13:	9781412814942
Publisher:	Transaction Publishers
Publication date:	10/15/2010
Pages:	188
Product dimensions:	6.10(w) x 9.20(h) x 0.70(d)

About the Author

Sandra J. Johnson received her Ph.D. in political science from The Graduate Center, The City University of New York (CUNY). Her specialties include the politics of healthcare, policy making, US presidency, Congress, and electoral politics. She is also the author of two articles currently under review concerning Assertive Community Treatment and the efficacy of evidence-based practices.

Table of Contents

List of Tables vii

Acknowledgments ix

I Assertive Community Treatment: Evidence-Based Practice or Managed Recovery? 1

II Medical Elites and Evidence-Based Practices: Yesterday and Today 15

III Process of Innovation: Theoretical Perspectives 39

IV The Role of the State Office of Mental Health in the Adoption and Implementation of Assertive Community Treatment in New York 55

V NAMI-Oklahoma's Role in the Adoption and Expansion of Assertive Community Treatment in Oklahoma 81

VI How Model Fidelity, Medicaid, and Legislative Ambiguity Influence Inconsistent Policy Outcomes in New York and Oklahoma 103

VII Street-Level Entrepreneurs: Promoting Recovery despite Political and Economic Challenges 127

Appendix: Methods 151

Bibliography 155

Index 177

Editorial Reviews

Can innovation be institutionalized? How can such objectives as quality and consumer empowerment and recovery, on the one hand, be reconciled with the drive for cost-savings, on the other? Is it possible to balance standardization with ground-level creativity and flexibility in the dissemination of model programs? Does an evidence-based service approach divert attention from crucial dimensions of effective program performance? These and other pivotal questions are examined by Sandra Johnson in this important new work concerning the spread of Assertive Community Treatment programs for individuals with severe mental health problems. Johnson makes a key contribution to our understanding of the politics of mental health policy, particularly the process of implementation, by calling attention to the political and economic factors impinging on the operation of ACT in two states based on her close familiarity with the policy studies literature combined with in-depth empirical research. Her findings deserve broad consideration.” — David A. Rochefort, Arts & Sciences Distinguished Professor, Political Science Department, Northeastern University "[Raises] thought-provoking comments and questions. . . . Assertive Community Treatment raises important issues for psychologists and the mental health field in general." —Gary Morse, PsycCRITIQUES

From the Publisher