Author ORCID Identifier

Date Available


Year of Publication


Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation


Social Work


Social Work

First Advisor

Dr. Natalie Pope


Evidence-based practices for individuals with serious mental illness have not been widely implemented in United States public mental health systems. Mental health advocates have used the Supreme Court’s Olmstead decision to force states with underfunded community mental health services to develop more robust treatment systems. Using a case study, this article-based dissertation examines the process of mandated widespread implementation of Assertive Community Treatment (ACT) in Kentucky through the experiences of individuals involved in ACT creation and documents related to implementation and the state mental health system. Study 1 identifies precipitating factors to the Kentucky Olmstead settlement agreement that contributed to a lack of research-informed practices for individuals with serious mental illness. Study 2 examines how ACT knowledge was communicated by exploring the learning experiences of individuals involved in implementation. Study 3 investigates the impact of requiring program creation through a settlement agreement on individuals responsible for building these new practices. All 3 studies used qualitative methods determine findings. Study 1 used a content analysis of publicly available documents related to the Kentucky mental health system while Studies 2 and 3 relied on the thematic analysis of semi-structured interviews with individuals involved in ACT formation. Findings highlight the importance of governments prioritizing evidence-based practice for individuals with serious mental illness. The use of settlement agreements to force service provision may accomplish an important goal of providing needed services to a vulnerable population. However, rushed or poorly planned program creation strains systems of care and is detrimental to the wellbeing of individuals involved. By engaging in a thorough assessment of barriers prior to program creation, entities using settlement agreements can facilitate more effective implementation of evidence-based practice for individuals with serious mental illness.

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Social Work Commons