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Assertive Community Treatment (ACT)
NAMI Maryland Annual Conference
The Conference Center at Sheppard Pratt
Friday, October 17, 2014
Saturday, October 18, 2014
Bette Stewart
Goals for Today
● Describe who is appropriate for ACT services● Describe basic principles of ACT services● Describe how ACT services differ from Case
Management Services● Describe history of ACT and how ACT has
evolved over 40 years● Describe how to access ACT services in your
community
The Who, What, Where, Why & How
● Who does ACT serve?● What do ACT services look like ?● Where did ACT begin and where is it now?● Why is Maryland a supporter of ACT?● How do we know it’s ACT?
WHO is appropriate for ACT?
● Individuals with:– Severe and persistent mental health conditions
(schizophrenia, bipolar and schizoaffective disorders)
– High users of institutions● Inpatient psychiatric beds● Jail/prison● Crisis stabilization
WHO is appropriate for ACT?
● Individuals for whom traditional mental health services have not adequately engaged the person in treatment
● Homelessness● Significant difficulty doing the everyday things
needed to live independently in the community
WHO determines eligibility?
● Eligibility is based on the previous criteria● Referrals come from inpatient units, emergency
rooms, outpatient clinics, community at large, detention centers, mental health courts, and yes, from families
● A licensed mental health clinician meets with the individual to complete an evaluation to determine if that person meets eligibility criteria
WHAT are ACT Team Staffing Requirements
● A full-time licensed clinical mental health worker (social worker, licensed professional clinical provider, masters level nurse, psychologist, etc.)
● A prescriber (psychiatrist or psychiatric nurse nurse practitioner)
● Nurses● Employment Specialists
WHAT are ACT Team Staffing Requirements
● Substance use specialists● Peer counselors● Case managers● Counselors / Therapists
WHAT are the ACT Core Principles?
● Small caseloads, with a ratio of 1:10● Team approach● 24/7 access to a team member● Assertive engagement skills and approaches● Working with families● Service provision in the community● Recovery focused
WHAT do ACT services look like?
● ACT is different than Case Management● ACT operates as a Transdisciplinary Team
– Interdisciplinary team– Multidisciplinary team
● WHAT guides ACT services?
Case Management v ACT
● Case Management is time limited● Case Management refers individuals to existing
community resources● Case Managers have their own case load of
clients the are responsible to serve
Case Management v ACT
● ACT services are time unlimited● ACT provides all services without brokering to
other providers (except for services they are not equipped to handle, such as somatic care, physical therapy, etc.)
● ACT functions as a team with every staff member familiar with every client
●Multidisciplinary
●Interdisciplinary
●Transdisciplinary
WHO does WHAT?
● Specialists● Generalists● Working as a Team
– Different discipline perspective– Continuity of care– Meeting clinical and rehabilitative needs– Sharing responsibility– Decreasing staff-burnout
WHAT ACT services include:
● Person-centered approach to service delivery● Access to multiple levels of care● A strong focus on wellness and recovery● Help finding and keeping employment● Assistance with substance use● Finding and maintaining (keeping) housing● Finances (accessing benefits, budgeting,
explaining how work will affect benefits, etc.)
WHAT ACT services include:
● Self-management skill development● Medication management● Attention to and coordination of care for other
medical needs● Building a community network of support for the
individual
HOW do we know ACT is effective?
● Evidence-based Practice● Research outcomes
– Decreased hospitalizations and incarcerations– Improved housing stability, quality of life, client
satisfaction, and vocational outcomes
● FOLLOW THE MODEL TO GET THE ROBUST OUTCOMES SEEN IN THE RESEARCH!
WHAT guides ACT services?
● Code of Maryland Regulations (COMAR) 10.21.19.01
● Fidelity Assessments by the Behavioral Health Administration Monitors– DACTS– TMACT
● Model adherence tied to reimbursement rate
HOW did ACT start and WHY continue with ACT?
● Mendota State Hospital; Madison, WI● From “Training in Community Living”, to
“Hospital without Walls”, to a Recovery Model of Care
● Hospitals are charged with getting the person back to the community
● People may need hands on support and side-by-side supports to be successful
Maryland ACT Teams
● Anne Arundel● Baltimore City● Baltimore County● Frederick County● Harford County● Howard County
● Lower-Shore● Mid-Shore● Montgomery County● Prince George's
County● Washington County
●THANK YOU FOR CHOOSING MY WORKSHOP TODAY!
● FOR QUESTIONS OR WANT ADDITIONAL INFORMATION PLEASE CONTACT ME, BETTE STEWART AT
● [email protected]● 410-646-5181
