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ASSERTIVE COMMUNITY TREATMENT

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Assertive Community Treatment (ACT)

Assertive Community Treatment (ACT) is a self-contained mental health program made up of a multidisciplinary mental health staff, including a peer specialist, who works as a team to provide majority of the treatment, rehabilitation, and support services consumers need to achieve their goals

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Target PopulationPersons with: Severe mental illness/psychotic disorders Significant functional impairments High-users of psychiatric hospitals SMI and High risk or history of criminal

justice involvement Inability to participate in traditional services

or those who do not engage in any mental health services

Coexisting substance abuse disorder Individuals with SMI who are homeless

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Assertive Community Treatment -Highlights-

Recognized as an Evidence-Based Practice by SAMHSA

Treatment, Rehabilitation, and support Services 24/7.

Small Staff to Consumer Ratio (1:10) Majority of services delivered in community

locations/consumers’ residences Individualized, comprehensive and flexible

treatment, support, and rehabilitation services

Team members are direct providers of services

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Required Services Service Coordination by an assigned

service coordinator/case manager 24 Hour Crisis Assessment and

Intervention Symptom Assessment and

Management Medication Prescription,

Administration, Monitoring, and Documentation

Dual Diagnosis Substance Abuse Services

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Required Services – cont’d Employment Services Activities of Daily Living Social/Interpersonal Relationship

and Leisure-Time Skill Training Peer Support Services Support Services Education, Support, and

Consultation to Families

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ACT Staff Requirements

Position Urban Rural

Team Leader 1 FTE 1FTE

Psychiatrist 16 hrs for 50 consumers

16 hours for 50 consumers

RN 3 FTE 2 FTE

Peer Splst 1 FTE 1 FTE

Masters level 4 FTE 2 FTE

Other level 1-3 FTE 1.5 – 2.5 FTE

Pgm/Adm Asst

1 – 1.5 FTE 1 FTE

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ACT Outcomes

Individuals in ACT……• Less Symptomatic• Spend significantly more time in

independent living• Earn more income from competitive

work• Better social relationships• Greater satisfaction with life

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Comparison ACT versus TCM

ACT TCM

Multidisciplinary Team Individual CM

Primary provider of treatment, rehabilitation, and support

Provides linkage to many services

24-Hour coverage with ACT on-call

After hours on-call/crisis services

Low staff-to-consumer ratio(1:10)

High staff –to-consumer ratio(1:30)

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Pennsylvania ACT History Community Treatment Team (CTT) was

designed in 1995 as PA’s model of ACT CTT was included in the Medicaid state

plan before it was eliminated due to lack of statewide implementation

Programs emerged in Philadelphia and the Lehigh Valley in response to SMH discharges.

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PA ACT Background – cont’d Draft Bulletin (’95) describes CTT as

modeled after ACT and PACT Draft regulations (’95) on CTT CTT Program Standards distributed to

MCO’s as guide 34 Teams in 14 Counties in PA as of

9/06- 10 identify as ACT Serves about 2200 consumers

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Assertive Community Treatment WHY NOW?

“A Call for Change: Toward a Recovery - Oriented Mental Health Service System for Adults” provided the philosophical framework for the transformation of the Commonwealth’s mental health service delivery system

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ACT – Why Now? – cont’d The subsequent follow-up white paper

titled “Strategies for Promoting Recovery and Resilience and Implementing Evidence Based Practices" issued in October 2006 reinforced the state’s commitment to actively support the development of Evidence Based Practices (EBP)

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ACT Forum – Feb 23, 2007 A meeting of about 150 individuals

including provider agencies, County MH/MR offices, Managed Care Organizations, NAMI affiliates, Consumers/Family Members.

The keynote presenter was a nationally recognized ACT consultant from Oklahoma

The goal of this forum was to provide information about developing, implementing, and monitoring ACT programs that would conform to the fidelity standards

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ACT Forum Outcomes Outcomes included better

understanding of the following ACT-related items:

How to plan for the start-up and implementation of ACT teams

The need for fidelity to National ACT standards for improved outcomes

The need for data collection and on-going evaluation of ACT teams

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ACT Forum Outcomes –cont’d

How to monitor and sustain ACT teams

While there are still some concerns for the providers who currently provide services similar to ACT, there was a clear willingness among most of the provider agencies to at least try to move in the direction of fidelity

Most importantly, this forum served as the launching pad for the state’s initiative to promote Assertive Community Treatment.

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Next Steps Development and Issuance of Assertive

Community Treatment Bulletin – May 31,2007

OMHSAS Advisory Committee to identify representatives for future ACT workgroup/steering committee – June 30, 2007

Hire ACT consultant and identify TA deliverables for FY 2007/2008 – June 30, 2007

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Next Steps – cont’d Create RFP process for developing two

new ACT teams and phase-out conversion of two CTTs in FY 2007/08

Draft RFP by July 15 Issue RFP by August 15 Projects Selection by November

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Next Steps – cont’d Create an OMHSAS ACT

Workgroup/Steering Committee – August 2007

Identify full-time State ACT lead person – August 2007

Conduct a 1-day follow-up meeting with all PA ACT/CTT providers, potential developers, counties, and MCOs – August 2007 (after RFP is issued)

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Next Steps – cont’d Begin training and TA for the four teams

selected thru the RFP process – November 2007

Consider developing a State Plan Amendment for ACT – FY 2008/2009