Assertive Community TreatmentAn Evidence-based Practice

2

Assertive Community Assertive Community Treatment Treatment has different nameshas different names

ACTACT

PACTPACT

Assertive OutreachAssertive Outreach

Mobile Treatment TeamsMobile Treatment Teams

Continuous Treatment TeamsContinuous Treatment Teams

3

ACT practice principlesACT practice principles

ACT is a service delivery model, ACT is a service delivery model,

not a case management programnot a case management program

ACT’s primary goal is recovery ACT’s primary goal is recovery through community treatment and through community treatment and habilitationhabilitation

4

A team approachA team approach

In vivo servicesIn vivo services

A small caseloadA small caseload

Time-unlimited Time-unlimited servicesservices

A shared caseload A shared caseload

Flexible service Flexible service deliverydelivery

Fixed point of Fixed point of responsibilityresponsibility

Crisis management Crisis management available 24 hours a available 24 hours a day, day, 7 days a week 7 days a week

ACT practice principlesACT practice principles

ACT is characterized by:ACT is characterized by:

5

ACT practice principlesACT practice principles

ACT is for consumers with the ACT is for consumers with the most challenging and persistent most challenging and persistent problemsproblems

Programs that adhere most Programs that adhere most closely to closely to the ACT model are more likely to the ACT model are more likely to get get the best outcomesthe best outcomes

6

Primary responsibilityPrimary responsibilityfor all servicesfor all services

ACT team members are experienced in ACT team members are experienced in psychiatry, psychology, nursing, social psychiatry, psychology, nursing, social work, rehabilitation, substance-abuse work, rehabilitation, substance-abuse treatment, and employment treatment, and employment

Rather than referring consumers Rather than referring consumers to multiple programs and services, to multiple programs and services, the ACT teamthe ACT team provides the treatment and provides the treatment and services consumers needservices consumers need

7

Help is provided where it is Help is provided where it is neededneeded

Rather than working with consumers in Rather than working with consumers in an office or hospital, ACT team an office or hospital, ACT team members work with consumers in their members work with consumers in their homes, neighborhoods, and other places homes, neighborhoods, and other places where their problems and stresses where their problems and stresses arise and where they need support and arise and where they need support and skillsskills

8

Help is provided wheHelp is provided where it is neededre it is needed

Rather than seeing consumers only a Rather than seeing consumers only a few times a month, ACT team members few times a month, ACT team members with different types of expertise with different types of expertise contact consumers as often as contact consumers as often as necessarynecessary

Help and support are available 24 Help and support are available 24 hours a day, 7 days a week, 365 hours a day, 7 days a week, 365 days a year, days a year, if neededif needed

9

Shared caseloadShared caseload

ACT team members do not have ACT team members do not have individual caseloads. Instead, individual caseloads. Instead, the team shares responsibility the team shares responsibility for consumers in the programfor consumers in the program

Each consumer gets to know Each consumer gets to know multiple members of the team. If multiple members of the team. If a team member goes on vacation, a team member goes on vacation, gets sick, or leaves the gets sick, or leaves the program, consumers know the program, consumers know the other team membersother team members

10

No preset time limits on No preset time limits on servicesservices

ACT has no preset limit on how ACT has no preset limit on how long consumers receive services. long consumers receive services. Over time, team members may have Over time, team members may have less contact with consumers, but less contact with consumers, but still remain available for still remain available for support if it’s neededsupport if it’s needed

Consumers are never discharged Consumers are never discharged from ACT programs because they from ACT programs because they are “noncompliant”are “noncompliant”

11

Close attention to Close attention to consumers’ needsconsumers’ needs

ACT team members work closely ACT team members work closely with consumers to develop plans with consumers to develop plans to help them reach their goalsto help them reach their goals

Every day, ACT teams review each Every day, ACT teams review each consumer’s progress in reaching consumer’s progress in reaching those goals. If consumers’ needs those goals. If consumers’ needs change or a plan isn’t working, change or a plan isn’t working, the team responds immediatelythe team responds immediately

12

Close attention to Close attention to consumers’ needsconsumers’ needs

Careful attention is possible Careful attention is possible because the team works with because the team works with only a small number of only a small number of consumers — about 10 consumers consumers — about 10 consumers for each team member for each team member

13

ACT provides assistance ACT provides assistance with…with…

Activities of daily Activities of daily livingliving

HousingHousing

Family lifeFamily life

EmploymentEmployment

BenefitsBenefits

Managing financesManaging finances

Health careHealth care

MedicationsMedications

Co-Occurring Co-Occurring disorders integrated disorders integrated treatment (substance treatment (substance use) use)

CounselingCounseling

14

ACT targets consumers with:ACT targets consumers with:

Severe and persistent mental Severe and persistent mental illnessillness

Significant difficulty doing the Significant difficulty doing the everyday things needed to live everyday things needed to live independently in the community, independently in the community, oror

Continuously high-service needContinuously high-service need

15

ACT team staffingACT team staffing

Team approach: Team approach: 90% or more of consumers have 90% or more of consumers have contact with more than 1 team contact with more than 1 team member per weekmember per week

Practicing team leader: Practicing team leader: A full-time program supervisor A full-time program supervisor (also called the team leader) (also called the team leader) provides direct services at provides direct services at least 50% of the timeleast 50% of the time

16

ACT team staffingACT team staffing

A program serving 100 consumers has at A program serving 100 consumers has at least:least:

1 or more full-time psychiatrists 1 or more full-time psychiatrists

2 full-time nurses2 full-time nurses

2 full-time substance-abuse specialists2 full-time substance-abuse specialists

2 full-time employment specialists2 full-time employment specialists

Peer specialists:Peer specialists: Consumers hold team positions (sometimes Consumers hold team positions (sometimes

called peer specialists) or other positions called peer specialists) or other positions for which they are qualified with full for which they are qualified with full professional statusprofessional status

17

Organizational boundariesOrganizational boundaries

Explicit admission criteriaExplicit admission criteria

No more than 6 new admissions per No more than 6 new admissions per monthmonth

24-hour coverage24-hour coverage

Responsibility for coordinating Responsibility for coordinating hospital admissions and dischargehospital admissions and discharge

Full responsibility for treatment Full responsibility for treatment servicesservices

Time-unlimited servicesTime-unlimited services