Resiliency and Disease Management
Assertive Community Treatment (ACT)

Background

Programs of Assertive Community Treatment have been around since the early 1970s. The original model developed by Arnold Marx, M.D., Leonard Stein, M.D., and Mary Ann Test, Ph.D., in Madison, Wisconsin, was intended to demonstrate the effectiveness of providing comprehensive services delivered by a multi disciplinary team to persons who had not responded to traditional mental health service approaches. Assertive Community Treatment (ACT) teams in Texas represent a system wide replication of the National Alliance for the Mentally Ill endorsed Program for Assertive Community Treatment (PACT) model.

The philosophy and fundamental principles of the PACT model have been firmly engrained into our states Mental Health Community Services Standards. TDMHMR began implementing ACT in 1995 by providing limited federal mental health block grant funding for community mental health service activities that were focused on reduction in state hospital usage. In FY'96, TDMHMR began requiring ACT as a "best practice" for persons with the most severe problems related to their mental illness. Today there are approximately 50 teams in operation throughout the state in both rural and urban areas.

Program Components

ACT is a self-contained program that serves as the fixed point of responsibility for providing treatment, rehabilitation and support services to identified consumers with severe and persistent mental illnesses. Using an integrated services approach, the ACT team merges clinical and rehabilitation staff expertise, e.g., psychiatric, substance abuse, employment, and housing within one mobile service delivery system. Accordingly, there are be minimal referrals of consumers to other program entities for treatment, rehabilitation, and support services.

The ACT team maintains a small consumer-to-clinician ratio (10:1). Program design is inclusive of service coordination, rehabilitative services, psychiatric services, nursing services, medication management, housing support, substance abuse treatment, and vocational services. The ACT team also works with families to provide education and support. Services are need-based vs. time-limited and provided in the consumer's natural environment 80% of the time.

The ACT team maintains 24-hour responsibility and availability for covering and managing psychiatric crisis for ACT consumers. Team staffing includes 4 hours of dedicated psychiatrist time per week per 20 consumers served and there is at least one registered nurse providing direct services. For FY 2008 DSHS revised the ACT Fidelity Manual, which is now two separate instruments: Urban ACT and Rural ACT.

Target Population

A typical ACT team consumer has schizophrenia or another serious mental illness such as Bipolar disorder and has experienced multiple psychiatric hospital admissions either at the state or community level. Due to the symptoms of serious mental illness, a typical ACT client may have difficulty remembering to take medications, has experienced homelessness, has lived in a board and care facility or another specialized residential facility, is on Supplemental Security Income (SSI), and has been unsuccessful in maintaining regular employment and housing.

System Outcomes

ACT is the most well researched service model for persons with severe and persistent mental illness and is currently being promoted by the National Alliance for the Mentally III as a "best practice.". Longitudinal studies consistently produce positive outcomes for the system, consumers and families. Consumers and family members of consumers receiving ACT services continue to relate the positive impact of ACT upon their satisfaction with overall mental health services. The most recognized benefit since program implementation has been the reduction in hospitalization of high system utilizers.

This page was last modified August 09, 2007