Assertive Community Treatment

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The content is sourced from: https://handwiki.org/wiki/Medicine:Assertive_community_treatment

Assertive community treatment (ACT) is an intensive and highly integrated approach for community mental health service delivery. ACT teams serve individuals with the most serious forms of mental illness, predominantly but not exclusively the schizophrenia spectrum disorders. ACT service recipients may also have diagnostic profiles that include features typically found in other DSM-5 categories (for example, bipolar, depressive, anxiety, and personality disorders, among others). Many have histories of frequent psychiatric hospitalization, substance abuse, victimization and trauma, arrests and incarceration, homelessness, and additional significant challenges. The symptoms and complications of their mental illnesses have led to serious functioning difficulties in several areas of life, often including work, social relationships, residential independence, money management, and physical health and wellness. By the time they start receiving ACT services, they are likely to have experienced failure, discrimination, and stigmatization, and their hope for the future is likely to be quite low.

community mental health physical health mental illnesses

References

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For a definitive analysis of the essential components of the ACT approach, see: Linkins, K., Tunkelrott, T., Dybdal, K., & Robinson, G. (2000, April 28). Assertive community treatment literature review. Report prepared for Health Care Financing Administration & Substance Abuse and Mental Health Services Administration. Falls Church, VA: The Lewin Group. [1].
Allness, D. J., & Knoedler, W. H. (2003). A manual for ACT start-up: Based on the PACT model of community treatment for persons with severe and persistent mental illnesses. Arlington, VA: National Alliance on Mental Illness.
Witheridge, T. F. (1991). The "active ingredients" of assertive outreach. In N. L. Cohen (Ed.), Psychiatric outreach to the mentally ill (pp. 47-64). San Francisco: Jossey-Bass. (New Directions for Mental Health Services, no. 52.)
McGrew, J. H., & Bond, G. R. (1995). Critical ingredients of assertive community treatment: Judgments of the experts. Journal of Mental Health Administration, 22, 113-125.
Bond, G. R., Drake, R. E., Mueser, K. T., & Latimer, E. (2001). Assertive community treatment for people with severe mental illness: Critical ingredients and impact on patients. Disease Management & Health Outcomes, 9, 141-159.
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V.A. Mental Health Intensive Case Management training in Tucson, Arizona (2002); Mary Ann Test describes the history of the ACT model. https://www.youtube.com/watch?v=Y_S0GeO3Iws
New York State ACT Institute at Pathways to Housing (2005); Sam Tsemberis Interviews Len Stein about Assertive Community Treatment. https://www.youtube.com/watch?reload=9&v=683yoITWZxc#action=share
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The program subsequently developed into a larger agency, Mental Health Resources; http://www.mhresources.org
ACT innovations at Thresholds (http://www.thresholds.org) were led by Jerry Dincin, Thomas F. Witheridge, Daniel J. Wasmer, Debra Pavick, John Mayes, Karen Kozlowski Graham, and others.
Witheridge, T. F., Dincin, J., & Appleby, L. (1982). Working with the most frequent recidivists: A total team approach to assertive resource management. Psychosocial Rehabilitation Journal, 5, 9-11.
Witheridge, T. F., & Dincin, J. (1985). The Bridge: An assertive outreach program in an urban setting. In L. I. Stein & M. A. Test (Eds.), The Training in Community Living model: A decade of experience (pp. 65-76). San Francisco: Jossey-Bass. (New Directions for Mental Health Services, no. 26.)
Witheridge, T. F. (1989). The assertive community treatment worker: An emerging role and its implications for professional training. Hospital and Community Psychiatry, 40, 620-624.
McGrew, J. H., & Bond, G. R. (1997). The association between program characteristics and service delivery in assertive community treatment. Administration and Policy in Mental Health, 25, 175-189.
For information about Thresholds and its Bridge assertive outreach programs, go to: http://www.thresholds.org/.
Stein, L. I., & Test, M. A. (1985), Editors' notes. In L. I. Stein, L. I., & Test, M. A. (Eds.), The Training in Community Living model: A decade of experience (pp. 1-5). San Francisco: Jossey-Bass. (New Directions for Mental Health Services, no. 26.)
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Slagg, N. B., Lyons, J., Cook, J. A., Wasmer, D. J., Witheridge, T. F., & Dincin, J. (1994). A profile of clients served by a mobile outreach program for homeless mentally ill persons. Hospital and Community Psychiatry, 45, 1139-1141.
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Gold Award: Helping mentally ill people break the cycle of jail and homelessness. The Thresholds State, County Collaborative Jail Linkage Project, Chicago (2001). Psychiatric Services, 52, 1380-1382.
Higenbottam, J. A., Etches, B., Shewfelt, Y., & Alberti, M. (1992). Riverview/Fraser Valley assertive outreach program. In R. B. Deber & G. G. Thompson (Eds.), Restructuring Canada's health services system: How do we get there from here? Proceedings of the Fourth Canadian Conference on Health Economics, August 27–29, 1990, University of Toronto. Toronto: University of Toronto Press, 185-190.
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Hoult, J. (1987). Replicating the Mendota model in Australia. Hospital and Community Psychiatry, 38, 565.
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Diamond, R. J., & Van Dyke, D. (1985). Rural community support programs: The experience in three Wisconsin counties. In L. I. Stein & M. A. Test (Eds.), The Training in Community Living Model: A decade of experience (pp. 49 – 63). (New Directions for Mental Health Services, no. 26.)
Rosenheck, R. A., & Neale, M. S. (1998). Cost-effectiveness of intensive psychiatric community care for high users of inpatient services. Archives of General Psychiatry, 55, 459-466.
Bond, G. R., Miller, L. D., Krumwied, R. D., & Ward, R. S. (1988). Assertive case management in three CMHCs: A controlled study. Hospital and Community Psychiatry, 39, 411 – 418.
McDonel, E. C., Bond, G. R., Salyers, M., Fekete, D., Chen, A., McGrew, J. H., & Miller, L. (1997). Implementing assertive community treatment programs in rural settings. Journal of Administration and Policy in Mental Health and Mental Health Services Research, 25, 153-173.
For information about the Indiana ACT Center, go to: https://labs.science.iupui.edu/act.
According to the state's Department of Community Health, Michigan ACT teams served 6,487 people in fiscal 2004; for more information, go to: http://www.michigan.gov/mdch/0,1607,7-132-2941_4868_38495_38496_38504-130083--,00.html.
For a description of Michigan's statewide ACT program development initiative, see: Plum, T. B., & Lawther, S. (1992). How Michigan established a highly effective statewide community-based program for persons with serious and persistent mental illness. Outlook, a publication of the National Association of State Mental Health Program Directors Research Institute, 2, July–August–September issue, 2-5.
In Minnesota, ACT became a Medicaid-funded service in 2005; now there are more than two dozen teams, serving both urban and rural parts of the state. For information go to: http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=ID_058151
Morse, G. A., Calsyn, R. J., Klinkenberg, W. D., Trusty, M. L., Gerber, F., Smith, R., Tempelhoff, B., & Ahmad, L.(1997). An experimental comparison of three types of case management for homeless mentally ill persons. Psychiatric Services, 48, 497-503.
Morse, G. A., Calsyn, R. J., Miller, J., Rosenberg, P., West, L., & Gilliland, J. (1996). Outreach to homeless mentally ill people: Conceptual and clinical considerations. Community Mental Health Journal, 32, 261-274.
Morse, G., Calsyn, R. J., Allen, G., Tempelhoff, B., & Smith, R. (1992). Experimental comparison of the effects of three treatment programs for homeless mentally ill people. Hospital and Community Psychiatry, 43, 1005-1010.
For information about ACT programs in New York go to: https://my.omh.ny.gov/analytics/saw.dll?PortalPages
Gold, P. B., Meisler, N., Santos, A. B., Carnemolla, M. A, Williams, O. H., & Keleher, J. (2005). Randomized trial of supported employment integrated with assertive community treatment for rural adults with severe mental illness. Schizophrenia Bulletin, 32, 378-395.
Gold, P. B., Meisler, N., Santos, A. B., Keleher, J., Becker, D. R., Knoedler, W. H., Carnemolla, M. A., Williams, O. H., Toscvano, R., & Stormer, G. (2003). The Program of Assertive Community Treatment: Implementation and dissemination of an evidence-based model of community-based care for persons with severe and persistent mental illness. Cognitive and Behavioral Practice, 10, 290-303.
Wasylenki, D. A., Goering, P. N., Lemire, D., Lindsey, S., & Lancee, W. (1993). The Hostel Outreach Program: Assertive case management for homeless mentally ill persons. Hospital and Community Psychiatry, 44, 848-853.
Lafave, H. G., de Souza, H. R., & Gerber, G. J. (1996). Assertive community treatment of severe mental illness: A Canadian experience. Psychiatric Services, 47, 757-759.
Tibbo, P., Joffe, K., Chue, P., Metelitsa, A., & Wright, E. (2001). Global Assessment of Functioning following assertive community treatment in Edmonton, Alberta: A longitudinal study. Canadian Journal of Psychiatry, 46, 131-137.
Marshall, M., & Creed, F. (2000). Assertive community treatment - is it the future of community care in the UK? International Review of Psychiatry, 12, 191-196.
Burns, T., & Firn, M. (2002). Assertive outreach in mental health: A manual for practitioners. New York: Oxford University Press.
Fiander, M., Burns, T., McHugo, G. J., & Drake, R. E. (2003). Assertive community treatment across the Atlantic: Comparison of model fidelity in the UK and USA. British Journal of Psychiatry, 182, 248-254.
https://www.worldcat.org/title/manual-for-act-start-up-based-on-the-pact-model-of-community-treatment-for-persons-with-severe-and-persistent-mental-illnesses/oclc/241298325
"About NAMI | NAMI: National Alliance on Mental Illness". https://www.nami.org/About-NAMI.
For guidance on current United States ACT standards and practices, the SAMHSA website is a good place to begin: http://store.samhsa.gov/product/Assertive-Community-Treatment-ACT-Evidence-Based-Practices-EBP-KIT/SMA08-4345
Lachance, K. R., & Santos, A. B. (1995). Modifying the PACT model: Preserving critical elements. Psychiatric Services, 46, 601-604.
Cuddeback, G. S., Morrissey, J. P., & Meyer, P. S. (2006). How many assertive community treatment teams do we need? Psychiatric Services, 57, 1803-1806.
Mueser, K. T., Bond, G. R., Drake, R. E., & Resnick, S. G. (1998). Models of community care for severe mental illness: A review of research on case management. Schizophrenia Bulletin, 24, 37-74.
Stein, L. I., & Test, M. A. (Eds.). Alternatives to mental hospital treatment. New York: Plenum Press, 1978.
Stein, L. I., & Test, M. A. (1976). Retraining hospital staff for work in a community program in Wisconsin. Hospital and Community Psychiatry, 27, 266-268.
Test, M. A., & Stein, L. I. (1977). Special living arrangements: A model for decision-making. Hospital and Community Psychiatry, 28, 608-610.
Bond, G. R., Witheridge, T. F., Setze, P. J., & Dincin, J. (1985). Preventing rehospitalization of clients in a psychosocial rehabilitation program. Hospital and Community Psychiatry, 36, 993-995.
Bond, G. R., Witheridge, T. F., Dincin, J., Wasmer, D., Webb, J., & de Graaf-Kaser, R. (1990). Assertive community treatment for frequent users of psychiatric hospitals in a large city: A controlled study. American Journal of Community Psychology, 18, 865-891.
Bond, along with Mike McKasson, Michelle Salyers, and John McGrew, founded the ACT Center of Indiana, a technical assistance and training center for ACT and other evidence-based practices. For information on the ACT Center of Indiana, go to: https://labs.science.iupui.edu/act .
For a brief overview of ACT by Bond, go to: https://web.archive.org/web/20060925204549/http://www.bhrm.org/guidelines/ACTguide.pdf
Bond led the development of the most widely used fidelity instrument for ACT, the Dartmouth Assertive Community Treatment Scale (DACTS), also known as the Assertive Community Treatment Fidelity Scale. For the complete scale and the protocol for its administration, go to the evidence-based practices pages on the SAMHSA website: http://store.samhsa.gov/shin/content//SMA08-4345/EvaluatingYourProgram-ACT.pdf
McGrew, J. H., Bond, G. R. Dietzen, L., & Salyers, M. (1994). Measuring the fidelity of implementation of a mental health program model. Journal of Consulting and Clinical Psychology, 62, 670-678.
Teague, G. B., Bond, G. R., & Drake, R. E. (1998). Program fidelity in assertive community treatment: Development and use of a measure. American Journal of Orthopsychiatry, 68, 216-232.
Salyers, M. P., Bond, G. R., Teague, G. B., Cox, J. F., Smith, M. E., Hicks, M. L., & Koop, J. I. (2003). Is it ACT yet? Real-world examples of evaluating the degree of implementation for assertive community treatment. Journal of Behavioral Health Services & Research, 30, 304-320.
Bond, G. R., & Salyers, M. P. (2004). Prediction of outcome from the Dartmouth assertive community treatment fidelity scale. CNS Spectrums, 9, 937-942.
Bond, G. R., Evans, L., Salyers, M. P., Williams, J., & Kim, H. K. (2000). Measurement of fidelity in psychiatric rehabilitation. Mental Health Services Research, 2, 75-87.
Bond, G. R., Campbell, K., Evans, L. J., Gervey, R., Pascaris, A., Tice, S., Del Bene, D., & Revell, G. (2002). A scale to measure quality of supported employment for persons with severe mental illness. Journal of Vocational Rehabilitation, 17, 239-250.
Mueser, K. T., Fox, L., Bond, G. R., Salyers, M. P., Yamamoto, K., & Williams, J. (2003). Integrated Dual Disorders Treatment Fidelity Scale. In K. T. Mueser, D. L. Noordsy, R. E. Drake, & L. Fox (Eds.), Integrated treatment for dual disorders: A guide to effective practice (pp. 337-359). New York: Guilford Publications.
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Becker, D. R., & Drake, R. E. (2003). A working life for people with severe mental illness. New York: Oxford University Press.
Drake, R. E., Becker, D. R., & Bond, G. R. (2003). Recent research on vocational rehabilitation for persons with severe mental illness. Current Opinion in Psychiatry, 16, 451-455.
McHugo, G. J., Drake, R. E., Teague, G. B., Xie, H. Y. (1999). Fidelity to assertive community treatment and client outcomes in the New Hampshire dual disorders study. Psychiatric Services, 50, 818-824.
Drake, R. E., Mercer-McFadden, C., Mueser, K. T., McHugo, G. J., & Bond, G. R. (1998). Treatment of substance abuse in patients with severe mental illness: A review of recent research. Schizophrenia Bulletin, 24, 589-608.
Bond, G. R., Becker, D. R., Drake, R. E., Rapp, C. A., Meisler, N., Lehman, A. F., Bell, M. D., & Blyler, C. R. (2001). Implementing supported employment as an evidence-based practice. Psychiatric Services, 52, 313-322.
The SAMSHA toolkit for the evidence-based practice known as illness management and recovery can be found at: https://store.samhsa.gov/shin/content/SMA09-4463/PractitionerGuidesandHandouts.pdf .
Drake, R. E., Wilkness, S. M., Frounfelker, R. L., Whitley, R., Zipple, A. M., McHugo, G. J., & Bond, G. R. (2009). Public-academic partnerships: The Thresholds-Dartmouth partnership and research on shared decision making. Psychiatric Services, 60, 142-144.
http://www.academyhealth.org
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Mueser, K. T., Bond, G. R., Drake, R. E., & Resnick, S. G. (1998). Models of community care for severe mental illness: A review of research on case management. Schizophrenia Bulletin, 24, 37-74.
U.S. Department of Health and Human Services (1999). Mental health: A report of the Surgeon General — Chapter 4: Adults and mental health. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health.
For SAMHSA's "KIT" on the ACT approach, go to: http://store.samhsa.gov/product/Assertive-Community-Treatment-ACT-Evidence-Based-Practices-EBP-KIT/SMA08-4345
See: http://www.nami.org/Learn-More/Mental-Health-Conditions/Schizophrenia/Treatment
See: http://www.carf.org/Programs/BH/
See: http://store.samhsa.gov/list/series?name=Evidence-Based-Practices-KITs
Mueser, K. T., Torrey, W. C., Lynde, D., Singer, P., & Drake, R. E. (2003). Implementing evidence-based practices for people with severe mental illness. Behavior Modification, 27, 387-411.
Spindel, P., & Nugent, J. A. (2001). The trouble with PACT: Questioning the increasing use of assertive community treatment teams in community mental health. Toronto: Humber College of Applied Arts and Technology, http://akmhcweb.org/Articles/pact.htm.
http://www.dbdouble.freeuk.com/HistoryPACT.pdf
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Test, M. A., & Stein, L. I. (2001). Letters: A critique of the effectiveness of assertive community treatment. Psychiatric Services, 52, 1396-1397
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Parks, J., Pollack, D., Bartels, S., & Mauer, B. (2005). Integrating behavioral health and primary care services: Opportunities and challenges for state mental health authorities. Alexandria, VA: National Association of State Mental Health Program Directors.
Colton, C. W., & Manderscheid, R. W. (April 2006). Congruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states. Preventing Chronic Disease (serial online). Available from: URL: https://www.cdc.gov/pcd/issues/2006/apr/05_0180.htm.
Weinstein, L.C., Henwood, B.F., Cody, J. W., Jordan, M., & Lelar, R. (2011). Transforming assertive community treatment into an integrated care system: The role of nursing and primary care partnerships. Journal of the American Psychiatric Nurses Association, 17, 64-71.
McFarlane, W. R., Stastny, P., & Deakins, S. (1992). Family-aided assertive community treatment: A comprehensive rehabilitation and intensive case management approach for persons with schizophrenic disorders. New Directions for Mental Health Services, 53, 43-54.
Dixon, L., McFarlane, W. R., Lefley, H., Lucksted, A., Cohen, M., Falloon, I., Mueser, K., Miklowitz, D., Solomon, P., & Sondheimer, D. (2001). Evidence-based practices for services to families of people with psychiatric disabilities. Psychiatric Services, 52, 903-910.
Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford Press.
For information on DBT, go to: https://behavioraltech.org.
For an overview of issues associated with the treatment of personality disorders, see: Links, P. S. (1998). Developing effective services for patients with personality disorders. Canadian Journal of Psychiatry, 43, 251-259. Issues associated with the use of ACT for persons with the borderline personality disorder diagnosis are discussed in Horvitz-Lennon, M., Reynolds, S., Wolbert, R., & Witheridge, T. F. (2009), The role of assertive community treatment in the treatment of people with borderline personality disorder, American Journal of Psychiatric Rehabilitation, 12, 261-277.

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