Identifying Competencies of the ACT Program Nurse Using the DACUM Method.

The nurse role on an Assertive Community Treatment (ACT) team requires a specialized set of skills in psychiatric community-based care. While the ACT model has existed for fifty years, no nationally recognized standard curriculum to train ACT nurses has been developed. The ACT Nursing Project described in this paper aimed to create a competency-based on-board training program using the Developing a Curriculum (DACUM) method. Eight ACT nurses from three states served as the expert panel to create a DACUM chart detailing the full set of nine duties and 127 tasks required of ACT nurses. To verify the DACUM results, 57 ACT nurses from four states completed a survey and confirmed that 80% of the tasks identified by the expert panel were also performed by the validation sample of ACT nurses. This paper describes how the DACUM duties and tasks provided the framework to develop onboard training curriculum for ACT program nurses. The next step is to pilot the onboard training curriculum to newly hired ACT nurses to ensure they are equipped to meet the complex needs of people living with serious mental illness, and to increase their competency, job satisfaction and decrease the high annual turnover rate among ACT nurses.

Statewide implementation of high-fidelity recovery-oriented ACT: A case study.

Background: Assertive Community Treatment (ACT) is a recognized evidence-based practice, but the use of Translation Science to ensure the broad implementation of high quality ACT services has not yet been fully explored. This single intrinsic case study explores how Oregon uses strategies identified through Translation Science to achieve statewide implementation of high-fidelity recovery-oriented ACT. Method: Multiple data sources were used to evaluate this implementation process, including ACT fidelity review reports, programmatic outcome data, a national ACT taskforce survey, and focus groups with program participants. Findings: In 2013, the Oregon Health Authority funded the creation of the Oregon Center of Excellence for Assertive Community Treatment to support the implementation of ACT. It also implemented administrative rules requiring an annual re-certification process with a minimum level of fidelity to the evidence-based model. Other implementation strategies included establishing an ACT Advisory Committee, quarterly reviews of implementation and outcome data, and trainings promoting the role of peer providers and related evidence-based practices. Conclusion: High-fidelity recovery-oriented ACT services in Oregon are maintained through multiple strategies, including codifying the minimum level of ACT implementation into state administrative rule, linking fidelity benchmarks scores to Medicaid reimbursements, and funding ongoing oversight, training and technical assistance through a statewide technical assistance center. Strict adherence to the ACT model has been a key to ensuring a uniform level of high-quality care across Oregon while incorporating additional evidence-based practices without compromising the integrity of the original model. Plain language abstract: Assertive Community Treatment (ACT) is a mental health program serving individuals with the most severe mental illness in the community. While ACT is an evidence-based practice, there is more research needed to explore how ACT is implemented and maintained in different settings. In 2013, Oregon implemented ACT statewide. The Oregon Center of Excellence for ACT was created to provide training and technical assistance to ACT teams and conduct yearly fidelity reviews. Oregon is among the few states who have attached funding to yearly ACT certification, uses community sizes to determine the size of the ACT teams, and the technical assistance center not only provides training but also conducts yearly review of fidelity to the ACT model. This case study will review the steps Oregon took to implement ACT, how it continues to monitor fidelity to the model and provide training and support, and focus on recovery orientation and integrating evidence-based practices. Continued support, training, and the linking of fidelity benchmark scores to program funding are the ways that Oregon makes sure that ACT teams are successfully implementing the ACT model to fidelity with recovery-oriented care.

A measure to evaluate classroom teaching practices in nursing.

AIM: The Oregon Consortium for Nursing Education (OCNE) Classroom Teaching Fidelity Scale was created to measure the implementation of the OCNE curriculum and its related pedagogy. BACKGROUND: OCNE is a partnership of eight community colleges and the five-campus state-supported university. OCNE developed a shared competency-based curriculum and pedagogical practices. An essential part of the OCNE evaluation was to measure the extent the curriculum and pedagogical model were implemented on each partner campus. METHOD: The scale was developed using a multistep methodology, including review of the literature and OCNE guidelines and materials, frequent consultation with local and national advisory boards, and multiple observations of OCNE classrooms over a two-year period. RESULTS: Fidelity scores are reported for 10 OCNE colleges observed in 2009. CONCLUSlON: The creation and use of this fidelity scale and similar measures may contribute to the emerging science of nursing education by more clearly documenting educational reform efforts..

Factors affecting the academic progression of associate degree graduates.

The Oregon Consortium for Nursing Education (OCNE) is a coalition of community colleges and the campuses of the Oregon Health & Sciences University (OHSU), created to share a competency-based curriculum by which associate degree graduates from an OCNE campus are eligible to complete requirements for the bachelor's degree after 1 year of additional full-time study. Since 2006, three graduating classes from consortium community college programs have graduated 760 students eligible for direct transfer to OHSU; however, only 228 (30%) have actually transferred. This study aimed to explore the factors that influenced the 208 graduates in the class of 2010 not to transfer. The primary reasons for discontinuing their nursing education, in ranked order, were financial concerns, conflict with time and energy for work, and conflict with time and energy for family. This study has implications for achieving the academic progression goals recommended in the Institute of Medicine's The Future of Nursing report.

Rearrest and linkage to mental health services among clients of the Clark County mental health court program.

OBJECTIVE: This study examined rearrest and linkage to mental health services among 368 misdemeanants with severe and persistent mental illness who were served by the Clark County Mental Health Court (MHC). This court, established in April 2000, is based on the concepts of therapeutic jurisprudence. This study addressed the following questions about the effectiveness of the Clark County MHC: Did MHC clients receive more comprehensive mental health services? Did the MHC successfully reduce recidivism? Were there any client or program characteristics associated with recidivism? METHODS: A secondary analysis of use of mental health services and jail data for the MHC clients enrolled from April 2000 through April 2003 was conducted. The authors used a 12-month pre-post comparison design to determine whether MHC participants experienced reduced rearrest rates for new offenses, reduced probation violations, and increased mental health services 12 months postenrollment in the MHC compared with 12 months preenrollment. RESULTS: The overall crime rate for MHC participants was reduced 4.0 times one year postenrollment in the MHC compared with one year preenrollment. One year postenrollment, 54 percent of participants had no arrests, and probation violations were reduced by 62 percent. The most significant factor in determining the success of MHC participants was graduation status from the MHC, with graduates 3.7 times less likely to reoffend compared with nongraduates. CONCLUSIONS: The Clark County MHC successfully reduced rearrest rates for new criminal offenses and probation violations and provided the mental health support services to stabilize mental health consumers in the community.

Beyond components: using fidelity scales to measure and assure choice in program implementation and quality assurance.

Fidelity scales have become an accepted part of intervention research. Initially, fidelity scales focused on critical components of an intervention. In this paper we argue that the next generation of fidelity scales should include key process variables such as choice. Since choice is an essential element in all empowerment and recovery driven intervention models, a fidelity scale for an enhanced version of the Individual Placement and Support (IPS) supported employment model that incorporates choice as a fundamental component was developed as part of a SAMHSA community action grant. The process for developing the choice component and the dimensions measured are also described.