Mowbray C T, Plum T B, Masterton T
School of Social Work, University of Michigan, Ann Arbor 48109-1106, USA.
Adm Policy Ment Health. 1997 Nov;25(2):125-39. doi: 10.1023/a:1022282820453.
Assertive Community Treatment (ACT) is now recognized as the model proven to be most successful in working with clients with long-term, severe mental illness. The first documented research replication study of ACT was Harbinger of Grand Rapids, in Kent County, Michigan. The Harbinger program influenced significant programmatic changes throughout the public mental health system in Michigan. This paper describes this evolution in community mental health locally and why these changes came about. The state-level strategy to implement replications of Harbinger is described, as well as funding and monitoring mechanisms that have now resulted in over 100 successful ACT programs in Michigan. For mental health administrators, the implications discussed include the future of ACT promotion and implementation, within the reality of a managed care framework.
积极社区治疗（ACT）现已被公认为是与长期患有严重精神疾病的患者合作最为成功的模式。ACT的首个有记录的研究复制项目是密歇根州肯特县大急流城的“先驱者项目”。该项目推动了密歇根州整个公共心理健康系统的重大项目变革。本文描述了当地社区心理健康的这一演变过程以及这些变革产生的原因。文中介绍了在州一级实施“先驱者项目”复制的策略，以及目前已在密歇根州促成100多个成功的ACT项目的资金和监测机制。对于心理健康管理人员而言，所讨论的影响包括在管理式医疗框架的现实情况下，ACT推广和实施的未来走向。
