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Reminder: CARF ACT Standards Inadequate - Not Researched Evidence-Based

For Immediate Release, July 7, 2000
Contact: Chris Marshall

As the CARF (formerly the Council for the Accreditation of Rehabilitation Facilities) markets accreditation for assertive community treatment, NAMI reissues this E-News sent last fall. CARF standards lack fidelity to the well-researched assertive community treatment model developed in Madison, Wisconsin. CARF frankly admits that their standards are not based on outcome research, or on any research at all, but are "field driven" which can mean watered down to the lowest requirements that their paying customers are willing to meet.

NAMI seeks fidelity to The National PACT Standards developed under the auspices of the U.S. Substance Abuse and Mental Health Services Administration, in contract #97MO4766501D. The P/ACT standards are available on the NAMI Web site at The terms PACT (program of assertive community treatment) and ACT (assertive community treatment) program are used interchangeably in the research literature. For example, in Schizophrenia Bulletin Volume 21, the author states, "The ACT model was first developed and evaluated by Stein and Test in Madison, Wisconsin." As described in a major assertive community treatment review article in Schizophrenia Bulletin Vol. 24, the authors in describing PACT say, "...this approach, commonly referred to as the assertive community treatment (ACT) model...." In the June 2000 issue of Psychiatric Services an article on ACT states, "The efforts of Drs.Test and Stein (founders of PACT), Dr. William Knoedler, Deborah Allness, M.S.S.W, and many others have resulted in the publication of manuals, videos, and a range of materials that have brought assertive community treatment into the therapeutic mainstream."

In repeated research studies, and recently stated in an article by Dr. Lisa Dixon in the June 2000 issue of Psychiatric Services on page 762, " Higher fidelity has been consistently linked to better outcomes." Dr. Dixon continued, "If a program isn't assertive community treatment, it will not produce the outcomes of an assertive community treatment program."

The CARF standards lack fidelity in key areas: staffing, services, and organization. A checklist of ACT staffing, services, and operation characteristics is one tool measuring fidelity to ACT. NAMI seeks fidelity to the spirit of the model too. Staff attitudes and an atmosphere of trust and hope that fosters respectful collaboration with consumers must also be assessed when evaluating fidelity of assertive community treatment programs.

The bottom line: standards are either truly meaningful or they are not. NAMI will have to emphasize to its 220,000 members that CARF does not represent state-of-the-science approaches.

The November 1, 1999 e-news can be reached by clicking here.