UNC Center for Excellence in Community Mental Health receives nearly $500,000 to study mental health program

Lorna Moser, PhD, associate professor of psychiatry and director of the Center’s Institute for Best Practices, is principal investigator for a three-year, nearly $500,000 grant from the Laura and John Arnold Foundation for a national study to look at Assertive Community Treatment (ACT) for individuals with serious mental illness.

UNC Center for Excellence in Community Mental Health receives nearly $500,000 to study mental health program click to enlarge Lorna Moser, PhD

The UNC Center for Excellence in Community Mental Health (Center) has been awarded nearly $500,000 from the Laura and John Arnold Foundation (LJAF) for a national study to look at Assertive Community Treatment (ACT) for individuals with serious mental illness. Lorna Moser, PhD, associate professor in the UNC Department of Psychiatry and director of the Center’s Institute for Best Practices, (Institute), is the principal investigator (PI) for the three-year grant.

The project, “Establishing the current state of Assertive Community Treatment (ACT) implementation in the U.S.” will be the first comprehensive national ACT study. An ACT team provides 24/7 treatment for individuals with serious mental illness in a community or home setting.

Researchers expect this study to fill a large knowledge gap in not only the availability of ACT nationally, but the extent it is offered with higher fidelity (e.g., quality, adherence to the model’s ingredients). ACT and similar models (forensic assertive community treatment, FACT) are an important part of the crisis response system, helping divert people away from more institutional settings.

An ACT team is comprised of a multidisciplinary of staff, including social work, psychiatry, nursing, and a range of specialists in peer services, substance abuse, employment, housing, and psychiatric rehabilitation, providing intensive, wrap-around treatment and supports. The primary focus of ACT is to help individuals with serious mental illness live and succeed in more integrated community settings, avoiding more costly and restrictive settings.

“There’s been greater attention nationally to implementing ACT, which is exciting,” noted Moser. “Similarly, there are so many questions we need to answer to be smart about implementation efforts. It’s not just a question of access, it’s also about quality. Availability of a supportive policy, adequate funding, access to alternative services likely impact good faith efforts to implement ACT.”

The research team will conduct this project in two phases. The first involves a systematic surveying and interviewing of key stakeholders in each U.S. state to understand the availability of ACT or ACT-like programs, and relevant contextual factors. The second phase involves compiling ACT fidelity data across states using the Tool for Measurement of ACT (TMACT), of which Moser is a co-author, to better understand practice benchmarks, and begin exploring potential relationships between ACT fidelity and outcomes.  

Along with Moser, the research team includes Co-investigators Gary Cuddeback, PhD, MSW, MPH, professor, UNC School of Social Work and director of the Center’s Community Outcomes Research and Evaluation, Maria Monroe-DeVita, PhD, associate professor at the University of Washington-Seattle, co-director of the Northwest Mental Health Technology Transfer Center (MHTTC), and co-developer of TMACT, Lynette Studer, PhD, MSW, assistant professor, University of Wisconsin-Madison, and Victoria Jeffries, MPH, a research associate at the Center.

“We hope to generate valuable descriptive data on the state of ACT implementation across the U.S. to guide current and future efforts to make smarter use of (sadly) limited resources in community mental health,” Moser continued. “We believe study results will be useful to policy-makers and funders, but also providers and mental health services researchers.

“ACT, when optimally implemented, can play an important role in our system of care to divert individuals with serious mental illness away from institutional settings such as hospitals, jails, and restrictive residential settings to more integrated community settings," continued Moser.

“We are excited that the funding from the Arnold Foundation will allow Dr. Moser and her group to take their important work to the next level,” said John Gilmore MD, Eure Distinguished Professor of Psychiatry and director of the UNC Center for Excellence in Community Mental Health. The information they will gather will be critical for improving care and outcomes for patients with serious mental illness, not only in North Carolina, but across the country.

The Center’s Institute for Best Practices is staffed with 10 consultants and trainers who provide a range of technical assistance to support higher fidelity implementation of ACT and Individual Placement and Support (IPS) model of supported employment. Much of their work is funded by North Carolina Department of Health and Human Services, and includes 74 ACT teams and 33 IPS teams across North Carolina. The Institute provides technical assistance nationally, and in the past five years has worked with 12 other states. 

The UNC Center for Excellence in Community Mental Health offers a continuum of care for individuals with serious mental illness, including two high-fidelity ACT teams. The Center provides more than more than 36,000 visits annually to individuals from 44 North Carolina counties at locations in Orange, Wake, and Chatham counties.