The authors present a controlled evaluation of a rural adaptation of the assertive community treatment (ACT) model for clients with serious and persistent mental illness (SPMI). Four rural community mental health settings adopted an ACT model, while a fifth site blended ACT principles with those of the Rhinelander model, another approach to case management for persons with SPMI. A broad array of client and system outcomes were evaluated at six, 12, and 24 months into the intervention. Twelve-month findings alerted the authors to potential problems and weaknesses that were evaluated and addressed. Small positive findings at 24 months suggested the corrections may have had an impact.

The authors also provide descriptive data on the challenges of implementing complex services models, giving particular attention to barriers to mental health service provision that are uniquely rural.