ASSERTIVE COMMUNITY TREATMENT: ACT 101. Rebecca K. Sartor, LICSW

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1 ASSERTIVE COMMUNITY TREATMENT: ACT 101 Rebecca K. Sartor, LICSW

2 A LITTLE BIT ABOUT ME HOW I ENDED UP HERE

3 LEARNING OBJECTIVES To develop an understanding of: How ACT Evolved Practice Principles Services Delivered Who is Eligible for ACT Services? The Shift towards Evidence Based Practices Challenges that Exist in the ACT Model

4 WHAT IS ACT?

5 ASSERTIVE COMMUNITY TREATMENT Also known as: PACT: (Program of Assertive Community Treatment) Assertive Outreach Mobile Treatment Teams Continuous Treatment Teams Other State Specific Names

6 ACT AS A MODEL AND A PHILOSOPHY OF CARE Assertive Community Treatment is a specific modality of community based mental health care Also, it helps to think of it as a PHILOSOPHY of care: relationship with providers at the core

7 HISTORY OF ACT Towards a new outpatient model of care.

8 A GAP IN OUR CARE Almost 30 years ago, mental health professionals in Wisconsin (Drs Marx, Stein, and Test) took note of the revolving door that existed in inpatient care Teaching skills on an inpatient unit wasn t translating to improved lives at discharge In particular, those clients with the most severe impairment in functioning due to mental health symptoms were stuck in this revolving door pattern Let s do something different! Shifting the multidisciplinary team outside of the hospital walls

9 A SHIFT FROM TRADITIONAL OUTPATIENT CARE Case Management Model Client needs are assessed and referrals are made to appropriate providers Not always integrated This model works for many clients, but others fall through the cracks ACT One core team of providers with varying skill sets Higher intensity and ability to outreach The team provides all care: services are not referred externally Community & home based

10 PRACTICE PRINCIPLES ON ACT TEAMS A TEAM approach: varying skill sets Care provided where it is needed (home, community, etc.) Smaller caseloads (staff to client ratio 1:10) Services are not timelimited & individualized A shared caseload: working together towards improved lives Core providers: all care is provided in context of team (as much as possible) 24/7 crisis availability and 24/7 access to care

11 SERVICES & CARE AVAILABLE ON ACT Crisis Services as needed Thorough Clinical Evaluation/Assessment Psychiatric Care Case Management Medication Administration and Management Illness, Management and Recovery Skills Substance Abuse Treatment Employment Services Assistance with Activities of Daily Living Intervention with Family & Natural Supports Coordination of Care: medical, housing, benefits, etc.

12 RECOMMENDED STAFFING ON ACT TEAMS ACT Leader Psychiatrist Psychiatric nurses Employment specialists Substance abuse specialists Peer specialists Program Assistant (BA level clinician to assist ACT Leader) Other specialized mental health professionals

13 WHO BENEFITS FROM ACT? The Typical ACT client

14 ELIGIBILITY CRITERIA FOR ACT ACT is designed and effective for clients who: Are diagnosed with some of the most severe mental health issues and symptoms (most frequently those with psychotic disorders and severe mood disorders with psychotic components) Have consistent difficulty living in the community independently Have not benefited from more traditional treatment approaches

15 ELIGIBILITY, CONT. Frequently utilize the emergency room, emergency services, and inpatient care (medical and psychiatric Have housing instability (homelessness, substandard living conditions) Have legal issues (involvement in the criminal justice system/frequent legal contact) Have substance abuse issues

16 In short, ACT is appropriate for clients who are often the highest utilizers of services and resources (often expensive resources) & have the most serious impairment from their mental health symptoms.

17 THE EVIDENCE: How do we know it works?

18 OUTCOMES & EVIDENCE BASED CARE ACT programs have been implemented over the past 30 years in about 35 states as well as at least 5 different countries Research shows: When ACT programs are implemented correctly, we see a reduction in psychiatric hospitalizations as well as more housing stability Improved quality of life Reduction in symptoms and improved social functioning Improved client & family satisfaction

19 ADDITIONAL PROOF Extensive research (Phillips, et al) shows that ACT: Reduces hospitalizations/inpatient care Increases housing stability If the program has a substance abuse component, improvement in substance use outcomes occur Higher rates of competitive employment (in those programs that have a supported employment component) Higher level of satisfaction from clients, families, and natural supports Cost savings in the big picture

20 ACT AS ONE OF MANY EVIDENCED BASED TREATMENTS: ONE SIZE DOES NOT FIT ALL AND THE ACT MODEL IS DESIGNED FOR A PARTICULAR SET OF CLIENTS WITH SPECIFIC CLINICAL NEEDS

21 IF IT WORKS Why is NH not providing more ACT?

22 CHALLENGES TO IMPLEMENTATION The belief that ACT is too costly: Examining the reality in the larger context (savings are on the BIG PICTURE level) Need for state support to grow this model of practice In our current system of care, a true ACT model is not financially sustainable for the individual mental health center (1 Psychiatrist for 100 clients, staff ratio of 1:10, fee for service billing, peer specialists model does not formally exist)

23 CHALLENGES, CONT Staffing Perspective of a former ACT clinician Developing a specialized work force: it takes a certain person to be an ACT clinician Training and ongoing supervision needs for evidence based care

24 QUESTIONS?