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
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Describe who is appropriate for ACT services
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Describe basic principles of ACT services
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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
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Who does ACT serve?
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What do ACT services look like ?
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Where did ACT begin and where is it now?
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Why is Maryland a supporter of ACT?
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How do we know it’s ACT?
WHO is appropriate for ACT?
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Individuals with:
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Severe and persistent mental health conditions
(schizophrenia, bipolar and schizoaffective disorders)
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High users of institutions
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Inpatient psychiatric beds
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Jail/prison
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Crisis stabilization
WHO is appropriate for ACT?
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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?
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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
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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
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Substance use specialists
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Peer counselors
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Case managers
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Counselors / Therapists
WHAT are the ACT Core Principles?
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Small caseloads, with a ratio of 1:10
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Team approach
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24/7 access to a team member
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Assertive engagement skills and approaches
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Working with families
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Service provision in the community
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Recovery focused
WHAT do ACT services look like?
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ACT is different than Case Management
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ACT operates as a Transdisciplinary Team
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Interdisciplinary team
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Multidisciplinary team
WHAT guides ACT services?
Case Management v ACT
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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
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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
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Multidisciplinary
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Interdisciplinary
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Transdisciplinary
WHO does WHAT?
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Specialists
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Generalists
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Working as a Team
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Different discipline perspective
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Continuity of care
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Meeting clinical and rehabilitative needs
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Sharing responsibility
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Decreasing staff-burnout
WHAT ACT services include:
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Person-centered approach to service delivery
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Access to multiple levels of care
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A strong focus on wellness and recovery
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Help finding and keeping employment
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Assistance with substance use
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Finding and maintaining (keeping) housing
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Finances (accessing benefits, budgeting, explaining
how work will affect benefits, etc.)
WHAT ACT services include:
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Self-management skill development
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Medication management
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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?
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Evidence-based Practice
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Research outcomes
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Decreased hospitalizations and incarcerations
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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?
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Code of Maryland Regulations (COMAR)
10.21.19.01
Fidelity Assessments by the Behavioral Health
Administration Monitors
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DACTS
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TMACT
Model adherence tied to reimbursement rate
HOW did ACT start and WHY
continue with ACT?
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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
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Anne Arundel
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Lower-Shore
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Baltimore City
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Mid-Shore
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Baltimore County
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Montgomery County
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Frederick County
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Prince George's County
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Harford County
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Washington County
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Howard County
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THANK YOU FOR CHOOSING MY
WORKSHOP TODAY!
FOR QUESTIONS OR WANT ADDITIONAL
INFORMATION PLEASE CONTACT ME, BETTE
STEWART AT
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bstewart@psych.umaryland.edu
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410-646-5181