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Assertive Community Treatment - PowerPoint


									     Assertive Community

An Evidence Based Practice –
Recovery in the Community
What is Assertive Community

   Assertive Community Treatment
    is a team treatment approach
    designed to provide comprehensive,
    community-based psychiatric
    treatment, rehabilitation, and
    support to persons with serious and
    persistent mental illness.
Assertive Community Treatment by
Different Names

     ACT
     PACT
     Assertive Outreach
     Mobile Treatment Teams
     Continuous Treatment Team

     (not NAZI Case Management!)
How did ACT start?
   The ACT model of care evolved
    out of the work of Arnold Marx,
    M.D., Leonard Stein, and Mary
    Ann Test, Ph.D., in the late 1960s
    and early 1970’s.
   Mendota State Hospital - Madison,
   Patients stabilized in the hospital
    but always returned after discharge.
How did ACT start?

     Barb Lontz, Social Worker
     ―the community and not the hospital is
      where patients need the most help‖.
     1972 – Hospital ward staff moved to
      the community to provide intensive
      24/7 outreach care.
First Results
   ―If clients are stabilized in community,
    the majority of hospitalizations can be
    avoided. Over time, consumers will
    achieve greater satisfaction and ability to
    function in the community.‖
   Massively reduced periods of
   Even when crisis occurred and re-
    admittance was necessary, discharge was
Who does ACT serve?
   Consumers served by ACT are individuals
    with serious and persistent mental illness or
    personality disorders, with severe functional
    impairments, who have not been effectively
    engaged by traditional outpatient mental
    health care and psychiatric rehabilitation

   Persons served by ACT often have co-existing
    problems such as homelessness, substance
    abuse problems, or involvement with the
    judicial system.
ACT is characterized by;
   Team approach-             Substance abuse
    Primary provider            services
   Services provided in       Psycho education
    community                  Family support
   Highly individualized      Community
   Assertive approach          integration
   Long term services         Health Care needs
   Emphasis on                 addressed
ACT Team Staffing…

   A program serving 100 consumers
    has at least:
       1   or more full-time psychiatrists
       2   full-time nurses
       2   full-time substance-abuse specialists
       2   full-time employment specialists
       1 or more peer specialists
ACT Team Staffing…
   Team approach:
       90% or more of consumers have contact with
        more than 1 team member per week.
   Practicing team leader:
       A full-time program supervisor (also called the
        team leader) provides direct services at least
        50% of the time.

   Peer Specialists:
       Consumers hold team positions (peer
        specialists) or other positions for which
        they are qualified with full professional status.
Help is Provided in the Community
     Rather than seeing consumers only a
      few times a month, ACT team members
      with different types of expertise contact
      consumers as often as necessary.

     Help and support are available 24
      hours a day, 7 days a week, 365 days
      a year, if needed.
Shared Caseload
    ACT team members do not have
     individual caseloads. Instead, the team
     shares responsibility for consumers in
     the program.

    Each consumer gets to know multiple
     members of the team. If a team
     member goes on vacation, gets sick, or
     leaves the program, consumers know
     the other team members.
Time not Limited
     ACT has no preset limit on how long
      consumers receive services. Over time,
      team members may have less contact
      with consumers, but still remain
      available for support if it’s needed.

     Consumers are never discharged
      from ACT programs because they are
Close Attention to Needs
     ACT team members work closely with
      consumers to develop plans to help
      them reach their goals.

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

   Careful attention is possible
    because the team works with only a
    small number of consumers —
    about 10 consumers for each team
ACT Provides Assistance With…
    Activities of daily      Health care
                              Medications
    Housing
                              Co-Occurring
    Family life               disorders integrated
    Employment                (substance use)
    Benefits                 Counseling
    Managing finances
Organizational Boundaries…
     Explicit admission criteria
     No more than 6 new admissions per
     24-hour coverage
     Responsibility for coordinating hospital
      admissions and discharge
     Full responsibility for treatment
     Time-unlimited services
   Assertive Community Treatment has been the
    subject of more than 25 randomized controlled
   Research shows that ACT is effective in reducing
    hospitalization and increasing housing stability,
   Is no more expensive than traditional care, and
   Is more satisfactory to consumers and family than
    standard care.
   Multiple studies show ACT programs reduce
    hospital days by about 58% compared to case
    management services—and by about 78%
    compared to outpatient clinic care.

   Results from several forensic ACT programs
    indicated lower arrests, jail days and

   Notable results for one forensic ACT program:
      • 85 percent fewer hospital days—saving $917,000
      in one year
      • 83 percent reduction in jail days—saving jail costs

   Compared to traditional case
    management programs, high fidelity
    ACT programs result in;

       fewer hospitalizations
       increased housing stability
       improved quality of life
How ACT is funded
   Almost all ACT programs are initially
    funded publically through state and
    county funds.
   Since 1990’s, state mental health
    authorities have used federal Medicaid
    funding to support an increasing share of
    ACT programs.
   People not eligible for Medicaid are
    funded almost exclusively by state and
    local funds.
How ACT is funded
   Under Medicaid, ACT services usually are
    financed under the Rehabilitation and
    Targeted Case Management Service
   In many states, mental health authorities
    do not control mental health care reform.
   This is why it is important to educate
    state Medicaid offices about ACT.
   ACT has evolved from direct provision of
    services to contracts for specific services
    by private providers.
How ACT is funded
   For more information contact:

The National Alliance for the Mentally
 Ill’s PACT Technical Assistance
    200 N. Glebe Rd., Suite 1015
    Arlington, VA 22203
What States Fund ACT?
   Despite the documented treatment success
    of ACT, only six states (DE, ID, MI, RI, TX,
    WI) currently have statewide ACT programs.

   Nineteen states have at least one or more
    ACT pilot programs in their state.

   In the US, adults with severe and persistent
    mental illnesses constitute one-half to one
    percent of the adult population.

   It is estimated that 20 percent to 40 percent
    of this group could be helped by the ACT
    model if it were available.
Bluegrass Mobile Outreach Team
   The Mobile Outreach Team’s primary focus
    is to provide service and support to
    consumers with severe mental illness who
    have not been effectively engaged in
    conventional outpatient services.

   The Team aggressively works toward
    establishing collaborative relationships in
    the community with the anticipation that
    consumers will become more integrated,
    recover, and achieve meaningful life roles.
Bluegrass MOT – How Did it Start?
   HUD Grant Partnership with Lexington
    Salvation Army serving homeless women
    – 2004
   2006 – Salvation Army withdrew from the
   Executive Director, Joe Toy and CSP
    Director, Christy Bland developed a vision
    for an ACT Team to serve people with SMI
    with multiple hospitalizations and
    intensive needs.
   2008 – MOT Team initiated.
Bluegrass MOT

   Funding
       HUD Grant - $167,000
       $65,000 for salaries (only expenses
        associated with the services provided
        to individuals who are receiving
        housing subsidy under the grant)
       additional revenue generated from
        Medicaid reimbursable services.
Bluegrass MOT

   Eligibility Criteria;
       SMI
       Multiple psychiatric hospitalizations
       Homeless (to get on grant)
       Difficulty engaging in traditional mental
        health services
       In need of community resources but
        difficulty with access
Bluegrass MOT
   Staffing;
       Luanne Steele, Program Director (full time)
       Tiffany Penna, Case Manager (part time, 2
       Inge Petit, ARNP (part time, 1 day)
       Sandy Silver, LCSW (part time, 3 days)
       One vacant full time case management
       Two vacant part time Peer Specialist positions
Bluegrass MOT
   Staff tasks include;
       assisting consumers with creating and carrying
        out customized rehabilitation service plans
       psychiatric care
       referral to employment services
       housing assistance
       referral to substance abuse services
       referral to health care providers
       financial management
       education
       social support options
Bluegrass MOT and ACT Fidelity Scale
ACT                     MOT
 Small Caseload - 10    Small Caseload - 10
  to 1                    to 1 - yes
 Team Approach          Team Approach –
 Program Meeting         Team works with all
 Practicing Team
                          clients but Team is
  Leader                  too small.
                         Program Meeting –
                          shoot for once a week
                          but meet informally
                         Practicing Team
                          Leader - yes
Bluegrass MOT and ACT Fidelity Scale

ACT                        MOT
 Continuity of Staffing    Continuity of Staffing

 Staff Capacity             - yes
 Psychiatrist on staff     Staff Capacity - no

 Nurse on staff            Psychiatrist on staff -

 Substance Abuse
  Specialist on staff       Nurse on staff – yes
                             but not FT
                            Substance Abuse
                             Specialist on staff - no
Bluegrass MOT and ACT Fidelity Scale

ACT                         MOT
 Vocational Specialist      Vocational Specialist
  on staff                    on staff – yes and no
 Program Size               Program Size -no

 Explicit Admission         Explicit Admission
  Criteria                    Criteria - yes
 Intake rate                Intake rate - yes

 Full responsibility for    Full responsibility for
  Treatment Services          Treatment Services -
Bluegrass MOT and ACT Fidelity Scale

ACT                     MOT
 Responsibility for     Responsibility for
  crisis services         crisis services - no
 Responsibility for     Responsibility for
  hospital admissions     hospital admissions -
 Responsibility for      no
  hospital discharge     Responsibility for
  planning                hospital discharge
 Community based         planning - no
  services               Community based
                          services - yes
Bluegrass MOT and ACT Fidelity Scale

ACT                      MOT
 No drop-out policy      No drop-out policy -

 Assertive Engagement     yes
  mechanisms              Assertive Engagement

 Intensity of service     mechanisms - yes
 Frequency of contact    Intensity of service -

 Work with informal
  support system          Frequency of contact -
                          Work with informal
                           support system - yes
Bluegrass MOT and ACT Fidelity Scale

ACT                      MOT
 Individualized          Individualized
  substance abuse          substance abuse
  treatment                treatment - no
 Dual disorder           Dual disorder
  treatment groups         treatment groups - no
 Dual disorders DD       Dual disorders DD
  model                    model - no
 Role of Consumers on    Role of Consumers on
  Team                     Team – not yet
Bluegrass Mobile Outreach Team
   Results;
       Since May, 2008 MOT has served 43 clients.
       MOT currently serves 26 clients.
       72.53% of clients were homeless at entry to
        program – no one is currently homeless.
       There was an average of 6.79 admissions to
        ESH the year prior to program participation
       After admission to MOT the average of
        admissions to ESH dropped to .65
       4 clients are gainfully employed part time.
       5 clients have completed drug treatment
Bluegrass Mobile Outreach Team
   Luanne Steele, Program Director
   Inge Pettit, ARNP
   Tiffany Penna, Case Manager
   Sandy Silver, LCSW

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