Assertive Community Treatment (ACT) NAMI Maryland Annual Conference The Conference Center at Sheppard Pratt Friday, October 17, 2014 Saturday, October.

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