Communities across the U.S. are increasingly looking for ways to improve mental health services, especially for individuals with serious and severe diagnoses and disabilities. This group not only requires the most intensive clinical treatment and support, but also case management in order to avoid the risks of homelessness, substance abuse, and unemployment.
But, case management is not a single system or model and there are countless ways to structure a system to provide treatment and support. When it comes to providing holistic mental health and social services for individuals with severe conditions and limitations, one evidence-based model is increasingly being considered: Assertive Community Treatment (ACT).
Let’s take a look at this model and see when it works best and where the mental health and social service industry is headed.
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Mental health and social services are increasingly shifting away from traditional case management models. Instead, the ACT model builds on the strengths of other models but takes it to a whole new, client-centered level. The ACT model involves an intensive and comprehensive approach to case management defined by smaller case loads, a multi-disciplinary team approach, shared caseloads, services delivered by the team in a person’s natural environment, unlimited timeframe, and 24-hour coverage.
ACT is a direct service model that goes beyond coordination and referrals and may even replace some residential or intensive outpatient programs in some circumstances. This means that ACT clinical team members provide the most needed services to clients directly, usually in the client’s home or wherever they can be found, instead of in a clinical setting. Because clients are assigned a team and not just a single case manager, treatment and services are highly integrated. The ACT team can integrate everything from mental health treatment to housing assistance, and work together seamlessly to tailor treatment and services to the individual needs, goals, and circumstances of each client.
Providing services in the client’s home brings added benefits as well. Clinicians can assess and address needs much more effectively when they interact with the client in a natural environment. They can observe the client’s surrounding and interactions with families and other significant relationships. And, they can help clients immediately implement treatment and behavior changes in their real, day-to-day environment. Additionally, most ACT programs provide 24-hour coverage and do not preemptively limit the duration of services. This ensures that clients get what they need, when they need it, in a personal, natural setting.
The theory behind ACT is that having consistent, caring, person-centered relationships between clients and service providers leads to better outcomes. Those outcomes include significant improvements in the client’s quality of life, more independent living and higher rates of treatment retention.
While the even lower client-to-practitioner ratio requires more personnel than traditional case management models, recipients of ACT actually use fewer high-cost services. ACT has been shown to reduce emergency room visits, use of psychiatric crisis services, and psychiatric hospitalization. Finally, ACT service models eliminate the need for large offices and service facilities throughout a community, which ends up dramatically reducing the cost of services while actually increasing their quality and effectiveness.
While both traditional case management and assertive community treatment have their strengths and advantages, There is an increasing movement towards ACT, especially for individuals with severe diagnoses and disabilities. While traditional case management can be an effective option for less severe clients in areas with adequate resources and service providers, ACT can provide far more individualized and integrated treatment and support. At the end of the day, understanding the strengths and limits of each model is the first step in creating or redesigning a service model that not only meets client’s needs but ensures the best outcomes.