ASSERTIVE COMMUNITY TREATMENT 1 Assertive Community Treatment ACT

ASSERTIVE COMMUNITY TREATMENT 1

Assertive Community Treatment (ACT) is a self-contained mental health program made up of a multidisciplinary mental health staff, including a peer specialist, who works as a team to provide majority of the treatment, rehabilitation, and support services consumers need to achieve their goals 2

Target Population Persons with: n Severe mental illness/psychotic disorders n Significant functional impairments n High-users of psychiatric hospitals n SMI and High risk or history of criminal justice involvement n Inability to participate in traditional services or those who do not engage in any mental health services n Coexisting substance abuse disorder n Individuals with SMI who are homeless 3

Assertive Community Treatment -Highlightsn n n Recognized as an Evidence-Based Practice by SAMHSA Treatment, Rehabilitation, and support Services 24/7. Small Staff to Consumer Ratio (1: 10) Majority of services delivered in community locations/consumers’ residences Individualized, comprehensive and flexible treatment, support, and rehabilitation services Team members are direct providers of services 4

Required Services Service Coordination by an assigned service coordinator/case manager n 24 Hour Crisis Assessment and Intervention n Symptom Assessment and Management n Medication Prescription, Administration, Monitoring, and Documentation n Dual Diagnosis Substance Abuse Services n 5

Required Services – cont’d Employment Services n Activities of Daily Living n Social/Interpersonal Relationship and Leisure-Time Skill Training n Peer Support Services n Education, Support, and Consultation to Families n 6

ACT Staff Requirements n Position Urban Rural Team Leader 1 FTE 1 FTE Psychiatrist 16 hrs for 50 consumers 16 hours for 50 consumers RN 3 FTE 2 FTE Peer Splst 1 FTE Masters level 4 FTE 2 FTE Other level 1 -3 FTE 1. 5 – 2. 5 FTE Pgm/Adm Asst 1 – 1. 5 FTE 1 FTE 7

ACT Outcomes n Individuals in ACT…… • • • Less Symptomatic Spend significantly more time in independent living Earn more income from competitive work Better social relationships Greater satisfaction with life 8

Comparison ACT versus TCM ACT TCM Multidisciplinary Team Individual CM Primary provider of treatment, rehabilitation, and support Provides linkage to many services 24 -Hour coverage with ACT on- After hours on-call/crisis call services Low staff-to-consumer ratio(1: 10) High staff –to-consumer ratio(1: 30) 9

Pennsylvania ACT History n n n Community Treatment Team (CTT) was designed in 1995 as PA’s model of ACT CTT was included in the Medicaid state plan before it was eliminated due to lack of statewide implementation Programs emerged in Philadelphia and the Lehigh Valley in response to SMH discharges. 10

PA ACT Background – cont’d n n n Draft Bulletin (’ 95) describes CTT as modeled after ACT and PACT Draft regulations (’ 95) on CTT Program Standards distributed to MCO’s as guide 34 Teams in 14 Counties in PA as of 9/06 - 10 identify as ACT Serves about 2200 consumers 11

Assertive Community Treatment WHY NOW? n “A Call for Change: Toward a Recovery - Oriented Mental Health Service System for Adults” provided the philosophical framework for the transformation of the Commonwealth’s mental health service delivery system 12

ACT – Why Now? – cont’d n The subsequent follow-up white paper titled “Strategies for Promoting Recovery and Resilience and Implementing Evidence Based Practices" issued in October 2006 reinforced the state’s commitment to actively support the development of Evidence Based Practices (EBP) 13

ACT Forum – Feb 23, 2007 n n n A meeting of about 150 individuals including provider agencies, County MH/MR offices, Managed Care Organizations, NAMI affiliates, Consumers/Family Members. The keynote presenter was a nationally recognized ACT consultant from Oklahoma The goal of this forum was to provide information about developing, implementing, and monitoring ACT programs that would conform to the fidelity standards 14

ACT Forum Outcomes n Outcomes included better understanding of the following ACT-related items: n n n How to plan for the start-up and implementation of ACT teams The need for fidelity to National ACT standards for improved outcomes The need for data collection and on-going evaluation of ACT teams 15

ACT Forum Outcomes –cont’d n n n How to monitor and sustain ACT teams While there are still some concerns for the providers who currently provide services similar to ACT, there was a clear willingness among most of the provider agencies to at least try to move in the direction of fidelity Most importantly, this forum served as the launching pad for the state’s initiative to promote Assertive Community Treatment. 16

Next Steps n n n Development and Issuance of Assertive Community Treatment Bulletin – May 31, 2007 OMHSAS Advisory Committee to identify representatives for future ACT workgroup/steering committee – June 30, 2007 Hire ACT consultant and identify TA deliverables for FY 2007/2008 – June 30, 2007 17

Next Steps – cont’d n Create RFP process for developing two new ACT teams and phase-out conversion of two CTTs in FY 2007/08 Draft RFP by July 15 Ø Issue RFP by August 15 Ø Projects Selection by November 15 Ø 18

Next Steps – cont’d n n n Create an OMHSAS ACT Workgroup/Steering Committee – August 2007 Identify full-time State ACT lead person – August 2007 Conduct a 1 -day follow-up meeting with all PA ACT/CTT providers, potential developers, counties, and MCOs – August 2007 (after RFP is issued) 19

Next Steps – cont’d n n Begin training and TA for the four teams selected thru the RFP process – November 2007 Consider developing a State Plan Amendment for ACT – FY 2008/2009 20