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The CCAF: Certification Centre for ACT and Flexible ACT


The CCAF (Certification Centre for ACT and Flexible ACT) is a non-profit foundation set up by Dutch mental health care professionals and researchers. The CCAF certifies ACT and Flexible ACT teams which maintain model fidelity. CCAF-certified teams deliver recognizable, similar and guaranteed quality of care and treatment. The certificates assure organizations, family representatives and mental health care purchasers of the quality provided by these teams. In this way the CCAF promotes model fidelity in the rollout of these two models for SMI patients.

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Model fidelity and certification

The Certification Centre for ACT and Flexible ACT (CCAF) conducts audits of ACT and Flexible ACT teams to assess the teams’ model fidelity. Teams found to satisfy the requirements are certified and included in the CCAF register. The Centre conducts about 30 audits a year. The assessment of ACT teams Until now, the CCAF has used a slightly adapted version of DACTS (Dartmouth ACT Scale) to assess ACT teams. When the TMACT – an enhanced ACT assessment tool being developed in the United States of America – is ready, it may be translated in Dutch. The assessment of Flexible ACT teams To assess Flexible ACT teams the CCAF uses the Flexible ACTs (Flexible ACT scale), which is partly based on DACTS, but includes more items relating to the process of care delivery, quality assurance and routine outcome monitoring. You can download the english version of the Flexible ACTs below and also the manual. Download: Flexible ACTs: fidelity scale Flexible ACT – english version, december 2010 Download: Manual Flexible Assertive Community Treatment, 2013


Our manuals are translated into different languages.

ACT and Flexible ACT in the Netherlands

Both ACT and Flexible ACT teams operate in the Netherlands. The two models are outlined below. ACT for the most severely ill patients ACT provides multi-disciplinary care with shared caseloads for the 20% group of most severely ill patients with SMI. When a patient under the care of an ACT team stabilizes, he or she proceeds to a lighter form of care such as case management, provided by ‘step-down’ teams. There are now 35 ACT teams in the Netherlands. Flexible ACT for all SMI patients Flexible ACT provides multi-disciplinary care for the whole group (100%) of SMI patients in a particular region (50,000 inhabitants). Continuity of care is provided for these patients. If necessary (in the event of an imminent crisis recurring psychosis, threat of readmission) a Flexible ACT team can provide full ACT care by switching to shared caseload and intensive outreach. After the crisis a step-down procedure takes place within the same team, which ensures more continuity. Because the area covered is smaller, the team is better able to support social inclusion for these patients. The teams collaborate extensively with social partners for that purpose. There are now about 300 Flexible ACT teams in the Netherlands.

European ACT and Flexible ACT conference: every two years

The ACT method is used in several countries in Europe. As well as over a hundred ACT and Flexible ACT teams in the Netherlands, there are 250 ACT teams in the UK and 20 in Spain. Croatia has also started to introduce ACT. The Council of Europe is in favour of intensive care outside psychiatric hospitals and optimal social inclusion for people with SMI. In conjunction with European partners, the CCAF aims to stimulate further use of the ACT and Flexible ACT models by providing information for policy makers, professionals and national client organizations. Members of the board of the CCAF participate in the European Assertive Outreach Foundation (EAOF). The aim of this foundation is to stimulate an European-wide dialogue about the development of evidence-based models of Assertive Outreach (EAOF). Following the example of the annual ACT conference in the USA, the CCAF is stimulating the organization of a biennial European ACT and Flexible ACT conference. The first was held in the Netherlands, 6 and 7 October 2011,  the second in Spain, 26-28 Juni 2015 in Avilés, Spain and the third was held in Oslo, Norway 24-27 June 2015. You can find more information about the upcoming conference, and also the presentations and programme of the 2011, 2013 and 2015 conference on: EAOF-klein.gif