Innovation and Its Discontents: Pathways and Barriers in the Diffusion of Assertive Community Treatment.
Policy PointsWidespread diffusion of policy innovation is the exception rather than the rule, depending as it does on the convergence of a variety of intellectual, political, economic, and organizational forces. The history of Assertive Community Treatment (ACT) provides a compelling case study of t...
| Publicado en: | Milbank Quarterly Vol. 97; no. 4; pp. 1151 - 1200 |
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| Formato: | Artículo |
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Wiley-Blackwell
Dec2019
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=140269915&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 140269915 longDbName: Social Sciences Full Text (H.W. Wilson) uiTag: AN controlInfo: bkinfo: jinfo: jid: 0887378X MIQ jtl: Milbank Quarterly issn: 0887378X maglogo: Y pubinfo: dt: Dec2019 vid: 97 iid: 4 pid: 480 pub: Wiley-Blackwell artinfo: ui: 140269915 10.1111/1468-0009.12429 ppf: 1151 ppct: 49 formats: tig: atl: Innovation and Its Discontents: Pathways and Barriers in the Diffusion of Assertive Community Treatment. aug: au: ROCHEFORT, DAVID A. affil: Northeastern University su: United States Assertiveness training Diffusion of innovations Health services accessibility Health policy Social support Community-based social services Integrated health care delivery Medical protocols Evidence-based medicine sug: subj: Assertiveness training Diffusion of innovations Health services accessibility Health policy Social support Community-based social services United States Administration of Public Health Programs Other Individual and Family Services Integrated health care delivery Medical protocols Evidence-based medicine keyword: Assertive Community Treatment community mental health care community support systems deinstitutionalization evidence‐based practice policy diffusion recovery model Assertive Community Treatment community mental health care community support systems deinstitutionalization evidence‐based practice policy diffusion recovery model ab: Policy PointsWidespread diffusion of policy innovation is the exception rather than the rule, depending as it does on the convergence of a variety of intellectual, political, economic, and organizational forces. The history of Assertive Community Treatment (ACT) provides a compelling case study of this process while also showing how conditions may shift over time, altering the scenarios for continued program expansion.Diffusion of a program like ACT challenges government to play a nuanced role in which public endorsement and resources are used to strengthen a worthwhile service, but without suppressing flexibility and ongoing experimentation as core program values.Acceptance as a proven form of "evidence‐based practice" is a critical element in the validation of ACT and other community mental health interventions that combine clinical and social features in novel ways. However, the use of conventional evidence‐based research as a singular gold standard of program value narrows the range of stakeholder input, as well as the evaluation methodologies and forms of data deemed worthy of attention. Context: Originating at the county level in Wisconsin in the early 1970s, Assertive Community Treatment is one of the most influential mental health programs ever developed. The subject of hundreds of research studies and recipient of enthusiastic backing from private advocacy organizations and government agencies, the program has spread widely across the United States and internationally as a package of resources and management techniques for supporting individuals with severe and chronic mental illness in the community. Today, however, ACT is associated with a rising tide of criticism challenging the program's practices and philosophy while alternative service models are advancing. Methods: To trace the history of the Assertive Community Treatment movement, a diffusion‐of‐innovation framework was applied based on relevant concepts from public policy analysis, organizational behavior, implementation science, and other fields. In‐depth review of the literature on ACT design, management, and performance also provided insight into the program's creation and subsequent evolution across different settings. Findings: A number of factors have functioned to fuel and to constrain ACT diffusion. The former category includes policy learning through research; the role of policy entrepreneurs; ACT's acceptance as a normative standard; and a thriving international epistemic community. The latter category includes cost concerns, fidelity demands, shifting norms, research contradictions and gaps, and a multifactorial context affecting program adoption. Currently, the program stands at a crossroads, strained by the principle of adherence to a long‐standing operational framework, on the one hand, and calls to adjust to an environment of changing demands and opportunities, on the other. Conclusions: For nearly 50 years, Assertive Community Treatment has been a mainstay of community mental health programming in the United States and other parts of the world. This presence will continue, but not in any static sense. A growing number of hybrid and competing versions of the program are likely to develop to serve specialized clientele groups and to respond to consumer demands and the recovery paradigm in behavioral health care. pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
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