ABSTRACT
In both New York and Oklahoma, a window of opportunity was required for pro-change policy entrepreneurs to promote assertive community treatment (ACT). In Oklahoma, with the closing of Eastern State Hospital, National Association of Mental Illness (NAMI)-Oklahoma found the opportunity to convince the state that ACT saves money in the long term and reduces hospitalization and prison rates. The demand for the adoption of evidence-based practices in mental health and substance abuse treatment is motivated by a perceived gap between research and practice, and this gap continues to motivate efforts to transform services by implementing evidence-based practices. Considering the numerous political, economic, environmental, cultural, and geographic challenges, it is important to examine those practitioners in the field actually involved in the implementation of ACT. As long as knowledge input from the street-level entrepreneurs providing the actual treatment remains scarce, flawed implementation, rather than flawed policy, will be blamed, much to the detriment of society's most vulnerable population—the severely mentally ill.
