The teamwork in assertive community treatment (TACT) scale: development and validation.

Objective: Team design is meticulously specified for assertive community treatment (ACT) teams, yet performance can vary across ACT teams, even those with high fidelity. By developing and validating the Teamwork in Assertive Community Treatment (TACT) scale, investigators examined the role of team processes in ACT performance.

Methods: The TACT scale measuring ACT teamwork was developed from a conceptual model grounded in organizational research and adapted for the ACT and mental health context. TACT subscales were constructed after exploratory and confirmatory factor analyses. The reliability, discriminant validity, predictive validity, temporal stability, internal consistency, and within-team agreement were established with surveys from approximately 300 members of 26 Minnesota ACT teams who completed the questionnaire three times, at six-month intervals.

Results: Nine TACT subscales emerged from the analyses: exploration, exploitation of new and existing knowledge, psychological safety, goal agreement, conflict, constructive controversy, information accessibility, encounter preparedness, and consumer-centered care. These nine subscales demonstrated fit and temporal stability (confirmatory factor analysis), high internal consistency (Cronbach's alpha), and within-team agreement and between-team differences (rwg and intraclass correlations). Correlational analyses of the subscales revealed that they measure related yet distinctive aspects of ACT team processes, and regression analyses demonstrated predictive validity (encounter preparedness is related to staff outcomes).

Conclusions: The TACT scale demonstrated high reliability and validity and can be included in research and evaluation of teamwork in ACT and mental health teams.