TMACT Returning
A Note from our Director:
In North Carolina, ACT policy specifies minimal expectations of fidelity and therefore ratings can have a larger consequence than merely informing quality improvement feedback. As many of you have heard in this forum or elsewhere, Maria Monroe-DeVita and I (TMACT co-authors) have held strong on the importance of not altering the TMACT fidelity review protocol itself — i.e., not giving credit for phone/virtual contacts in items that explicitly say to measure only face-to-face (in-person) contacts; not crediting for virtual daily team meetings as an equal substitute for in-person daily team meetings).
Hence, we have been cautious about when we restart in-person reviews here in NC. As many of you have heard from us, we (and a couple of other states) developed and used a virtual EBP Quality Review process in lieu of in-person fidelity reviews during the pandemic. These were developed from the TMACT, included some COVID-specific enhancements, and did not entail item-level ratings. This helped us understand practice as it was being provided during the pandemic, and where we offered some guidance and support the best we could during such unusual times.
These EBP Reviews served their interim purpose. There is something missed without a systematic measure that rates the team across 120 + facets of a complex program.
We are preparing to return to in-person TMACT reviews in earlier part of 2022. In NC, we have a plan in place where we intend to review a NC ACT team in January and closely review their data to understand where and to what extent we believe lingering effects of the pandemic had an impact on practice, and thereby also ratings. We are also developing a booster training of sorts, which will include reinforcing where the TMACT protocol allows for inclusion of virtual/telephone modes of service delivery – and where it does not, how we might still track virtual/phone modes of service delivery for the sake of reporting out practice. In North Carolina, we utilize TMACT review teams staffed with a Lead Reviewer (someone who work with us at the Institute for Best Practices, or someone who work with our NC DHHS team) and then an ACT provider trained to assist with reviews. With the time that has gone by, there is a great need for refresher trainings.
Fortunately, all of this toggles well with the eventual launch of eTMACT in 2022 – a secure, web-based platform for the TMACT, which will significantly reduce the time involved in carrying out the review (from the reviewer perspective), further enhance the accuracy of ratings, and result in more timely feedback to ACT teams. More to come on that at a latter point for those out there already using the TMACT.
~Lorna
A thoughtful piece in NY Times last week speaks to the challenges in capturing – measuring — someone’s recovery. There are two primary features of a good measure — reliability (you can capture the same findings consistently (time/rater/items) and validity (you are measuring what you think you are measuring) A nicely crafted *standardized* measure often succeeds with the reliability feature. However, it may miss the boat entirely or partly on the validity aspect of a good measure. The NYT author touches on that challenge when it comes to capturing recovery. It is so personal that standardized assessments may struggle with validity — “you wouldn’t pick it up unless you knew how to ask” — in this case, with regard to people’s relationships with auditory hallucinations.
