What is ACT?
ACT is a self-contained mental health program made up of multidisciplinary mental health staff, including a peer specialist, who work as a team to provide the majority of the treatment, rehabilitation, and support services that consumers need to achieve their goals. ACT is targeted towards individuals with severe and persistent mental illness, which are complex, have devastating effects on functioning, and, because of the limitations of traditional mental health services, may have gone without appropriate services.
ACT services are individually tailored for each consumer through relationship building, individualized assessment and planning, and active involvement with consumers to enable each to find and live in their own residence, to find and maintain work in community jobs, to better manage symptoms, to achieve individual goals, and to maintain optimism and recover. The services that an ACT team is required to provide include:
- Service Coordination by an assigned service coordinator/case manager
- 24 Hour Crisis Assessment and Intervention
- Symptom Assessment and Management
- Medication Prescription, Administration, Monitoring, and Documentation
- Dual Diagnosis Substance Abuse Services
- Employment Services
- Activities of Daily Living
- Social/Interpersonal Relationship and Leisure-Time Skill Training
- Peer Support Services
- Support Services
- Education, Support, and Consultation to Families
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ACT in Pennsylvania
ACT or ACT-like programs have been in existence in Pennsylvania since the mid 1990s. However, no state-wide standards existed for ACT until OMHSAS issued the ACT bulletin in September 2008 stipulating the standards and procedures for developing, administering, and monitoring Assertive Community Treatment programs in the Commonwealth. Currently PA has 43 ACT or ACT-like teams that serve about 3400 consumers.
Consistent with the concept of urban and rural teams in the National ACT Standards, the OMHSAS ACT bulletin defines two sizes of ACT teams:
- Full-size team (Urban): 10-12 Full Time Equivalent (FTE) multidisciplinary clinical staff plus a psychiatrist and program assistant. Staff to consumer ratio of 1:10 (not including the psychiatrist and the program assistant);
- Modified team (Rural): 6-8 Full Time Equivalent (FTE) multidisciplinary clinical staff plus a psychiatrist and program assistant. Staff to consumer ratio of 1:8 (not including the psychiatrist and the program assistant).
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Implementation/Expansion of High-Fidelity ACT
In the summer of 2008, OMHSAS contracted with Mercer Government Human Services Consulting (Mercer) to do the fidelity, cost, and outcome analyses of the ACT and Community Treatment Teams (CTT) teams in the state. CTT is a service model similar to ACT, though its implementation approaches vary. The findings from the fidelity, cost, and outcomes analyses were compelling, though not entirely unexpected. The findings were consistent with the research literature findings that those programs with lower fidelity cost much more when compared to those programs that were rated high on the fidelity study. Furthermore, teams that rated low on fidelity relied more heavily on additional services resulting in substantial increases in costs, which contravenes the basic principle of ACT as an all-inclusive team approach to service provision. The results of the outcome analysis, which focused on the areas of housing and employment, also showed a relationship between adherence to fidelity and positive outcomes.
In order to support the expansion of fidelity-based ACT programs in the state, OMHSAS has hired the services of a national consultant (Wisconsin PACT) as well as a state consultant to provide training and technical assistance (TA) to the ACT/CTT programs. OMHSAS has also sought the services of The Washington Institute for Mental Health Research & Training (University of Washington) for training on the fidelity measurement tool TMACT (Tools for Measurement of ACT).
In July 2009, OMHSAS convened a stakeholder meeting to discuss the findings from the Mercer study and to formulate plans to move towards full ACT fidelity for the existing ACT/CTT programs. One of the key recommendations that emerged from this meeting was to select some of the existing ACT or CTT teams as pilot programs to receive intensive technical assistance and training to transition to full ACT fidelity. OMHSAS may also provide one-time funding to the selected programs for start-up/organizational enhancement. The pilot teams to receive the TA have been identified and the consultants have already started working with some of the pilot teams. Additionally, training will also be available for other teams on areas like basic organizational structure and program operation as well as training in areas identified by outcome data and TMACT/DACTS (Tool for Measurement of ACT/Dartmouth Assertive Community Treatment Scale) scores.
In November 2009, as requested by OMHSAS, all counties that have ACT/CTT programs submitted Fidelity Action Plans outlining their strategy to transition to fidelity-based ACT teams. The plans have been reviewed by a workgroup, and OMHSAS is in the process of planning follow-up meetings to discuss specific details with each county.
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