WHAT IS P/ACT?

Program for Assertive Community Treatment (P/ACT) fulfills the needs of a population resistant to traditional clinic-based treatment. They need continued medication, a broad range of clinical services, help acquiring their basic needs (food, housing, health care, shopping, budgeting, etc.), as well as support, as they recover enough to start working and integrating into the community. P/ACT is a community-based system consisting of a mobile team of professionals, whose responsibility it is to treat the patient in the community, wherever she or he are. Team services are available on a 24-hour basis, 7 days a week.

Consumers in P/ACT receive all services from the P/ACT team, not the multiple, loosely linked mental health, substance abuse, housing, and rehabilitation agencies. The P/ACT team meets a client's many individual and round the-clock needs by providing a full range of psychiatric and medical care, and social and rehabilitation and support services. P/ACT team is not a "linkage" case management program which connects patients to core services provided by agencies in the community.

The P/ACT model is one of active involvement in assisting a client to improve the level of functioning and to better manage the symptoms of the illness in the community.

a. Fundamental CharACTeristics: The primary provider of P/ACT services is the "core services team", a highly trained, multidisciplinary mental health staff organized as an accountable mobile agency, or a team of health workers who function interchangeably to provide treatment, rehabilitation, and support services required by each client to live in the community.

Whenever possible, the P/ACT team delivers the services itself. It takes responsibility for coping with crises, counseling client-members, educating them about mental illness, and managing and (if necessary) delivering medications. The team also works with families and others, helps with entitlements and finances, finds support for independent housing, and provides rehabilitation. The team also helps client-members to understand their medical condition and to make appointments with doctors and dentists.

The "core services team" consists of a number of staff based on the number of clients. The staff provides treatment, rehabilitation, and support activities seven days a week, as needed, as well as 24 hours crisis intervention. The staff ratio is usually one staff to every 10-12 clients.

P/ACT team members must possess a wide range of aptitudes and professional skills. The optimal team represents a coordinated combination of the various mental health professionals - psychiatrist, nurse, social worker, substance abuse treatment specialists, vocational rehabilitation counselors, and increasingly, peer counselors. Forensic specialists can be added when necessary.

Treatment, rehabilitation and support services are integrated. By integrating psychiatric and medical treatment with rehabilitation and support services, the complex interaction of symptoms and psychosocial functioning can be effectively addressed throughout the course of the illness.

An essential ingredient in the way that services are delivered in the P/ACT program is "Assertive Outreach." The team is mobile, and the majority of treatment and rehabilitation interventions take place "in vivo" (in the community), that is in the patient's own residence and neighborhood, at employment sites, in recreation and leisure sites like parks, movie houses, and restaurants. A monitoring study of P/ACT revealed that the team spent 76% of their time in the community, not in the office! The team reaches out to consumers wherever they are --- in their caretaker's home, in hospitals, in jails or in homeless shelters.

The treatment process begins with a thorough clinical and functional assessment, and development of an individualized treatment plan. Such an assessment could take place in the hospital if the entry point into the system is through hospitalization. Support services are provided in the areas of housing, health, financial, leisure time activities, legal assistance management, etc.

For real changes in psychosocial functioning to occur, it may be necessary to provide long-term treatment, rehabilitation, and support services within which clients have the opportunity to re-compensate, consolidate gains, sometimes slip back, and then take the next steps. Hence the current P/ACT model provides ongoing long-term, rather than time-limited treatment. Thus providing stable clinical relationships and continuity of care across time.

Employment plays a central role in P/ACT. It is the major means of providing daily structure to the clients. The team itself, through staff designated for the purpose, carries out the majority of the vocational rehabilitation. The team assists clients to obtain individually structured employment in the "real world". Clients are supported and taught active skills.

Individualization of treatment for all clients and through the years is central to P/ACT. The great diversity of persons with psychiatric disorders, and the fact that both the person and the disorder are constantly changing over time requires that services be highly individualized.

b. How Does the Team Work: Whenever possible, the P/ACT team delivers the services itself. It takes responsibility for coping with crises, counseling clients, educating them about mental illness, and managing and (if necessary) delivering medications. The team also works with families and others, helps with entitlements and finances, finds support for independent housing, and provides rehabilitation. The team also helps clients to understand their medical condition and to make appointments with doctors and dentists.

The P/ACT team might enable a client to ride a bus, shop for groceries, and prepare meals. Team members might accompany clients to job interviews, provide skills training, and counsel the clients about social interaction on the job. Other clients might be provided with mental health and drug abuse counseling.

The team provides social and daily living supports. The team meets regularly and shares responsibility for delivering and coordinating care for the group of clients. Sharing responsibility improves the moral of the group, assures continuity of care for the client, and reduces burnout and turnover of members of the team.

Goals of (P/ACT)

The program's primary objectives are to serve individuals whose needs are not served by the current system, improve their "quality of life" while living independently in the community, and to provide comprehensive, integratd care--both psychiatric and medical. Goals are achieved as a result of the application of assertive community-based support services.

a. The goals of P/ACT Teams are: To enable the client to self-manage his/her symptoms. Medication compliance improves with appropriate medication and with minimal side effects. Therefore, emphasis is placed on optimal psychopharmacology. By ensuring the right dosage and titration of medication, minimizing side effects, and educating the client on the relationships between symptoms, side effects, functionality, and medication, the team enables self management of medication and symptoms. Additional methods of coping must be shared by the team members and clients, such as behavior modification, cognitive techniques, and other methods to enable functioning in the community.

To enable the client to meet basic needs and improve his/her quality of life. Based on individual needs, the client is empowered through education and in vivo participation to live in the community, i.e.: a place to live in; doing laundry; shopping; cooking; eating in restaurants; grooming; budgeting; using transportation; finding a job; use of leisure time; recreational and social activities; and using social services.

To support maximum integration in the community. The team strives to enable the client to function wherever he/she wants in a continuum of opportunities, be it living arrangements, work, study, or social functioning. It should be noted that severe mental illness, unless stabilized, robs individuals of the insight needed to define what they want. Therefore, stabilization of symptoms is a prerequisite to defining personal goals and to achieving maximum integration in the community.

To ensure that treatment, rehabilitation and support services are integrated. Integrating services ensures continuity of care. Also, the complex interaction of symptoms and psychosocial functioning can be effectively addressed, as needed, throughout the course of the person's life while part of the team.

To prevent and avoid long hospitalization, to shorten necessary hospital stays, and to prevent relapses. The experience with P/ACT in other states has shown a greater incidence of short-term hospitalizations. Due to the scarcity of hospital beds; the reduction of hospital days; and the fact that stabilization is no longer the goal of the stay in the hospital, it is recommended that short-stay hospital beds be assigned specifically to the P/ACT teams. Crisis housing and assignment of supported apartments are essential to achieve this goal.

To enable the client to acquire a meaningful, productive role in the community. As much as feasible, meaningful and productive occupation is the major means of providing daily structure to the clients. While the team may designate staff (rehabilitation professional) who may carry out the majority of vocational or other type of rehabilitation, everyone on the team needs to work towards that purpose. The team assists and enables clients to obtain individually structured occupations in the "real world." Clients are supported and taught active skills.

To build the client's trust and comfort level, P/ACT team members have a cultural orientation. The client should feel comfortable with the team's ethnic composition. Since teams operate within a designated geographic/catchment area, team composition, sensitivity to cultural issues, and flexibility in assigning clients to appropriate teams are of utmost importance.

 

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