6.10 karen batia
TRANSCRIPT
National Alliance to End Homelessness ~ Targeting for
Success: Serving Families with the Highest Needs
Karen Batia, [email protected]
July 2011
Heartland Alliance for Human Needs & Human Rights
What is Assertive Community Treatment (ACT)?
Developed in the 1970s Mendota Mental Health Institute in Wisconsin Arnold Marx, M.D., Leonard Stein, M.D.,
and Mary Ann Test, Ph.D. Goal – treatment model for individuals with
severe mental illness - remain in the community and minimize impact of mental illness, improve quality of life
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Why was ACT needed?
Mental health system was complex and services were fragmented
Difficult to access needed services, if they existed Services were time-limited People cycled in and out of the hospital with no
continuity of care Skills learned in the hospital were not transferred to the
community
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Who typically receives ACT services?
According to SAMHSA – individuals with the most serious and intractable symptoms of mental illness and experience the greatest impairment in functioning
People who are homeless, co-occurring substance use disorders, involvement with criminal justice system
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Philosophy of ACT
Individualized, comprehensive and flexible treatment, support and rehabilitation services
Multidisciplinary team Majority of contacts with participants are in
community settings Team leader provides direct services
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Philosophy of ACT
Team is the fixed point of responsibility for services
Service provided as long as needed rather than on a pre-determined timeframe
Shared and small caseload Assertive outreach and approach
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Heartland “ACT” Teams
ACCESS (ACT → Community Support Treatment Teams)
Street Outreach FACT Harm Reduction Housing/Residential International FACES (Refugee Mental Health)
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Family Assertive Community Treatment
•Strengthening At-Risk Homeless Families•Conrad N. Hilton Foundation; Polk Brothers; McCormick Foundation; Prince Charitable Trust; City of Chicago
ACT Fidelity Scale Criteria
(Dartmouth Fidelity Scale 2003)
Traditional Assertive Community Treatment
(ACT)
Family Assertive Community Treatment (FACT)
Small Caseload Participant provider ratio of 10 - 12 to 1 Participant = single adult
Participant provider ratio of 10 - 12 to 1 Participant = a family (see admission criteria for definition), or Participant = a child in the family who has a serious emotional disorder and individual treatment plan separate from the family plan requiring intensive services Participant = a child with DCFS involvement
Team Approach Provider group functions as a team rather than an individualized approach; each staff member contributes expertise as appropriate
Provider group functions as a team rather than an individualized approach; cross-training ensures core competencies are shared by the team and not just one clinician
ACT Fidelity ACT FACT
Program Meeting Team meets frequently to plan and review services for each participant (daily)
Team meets frequently to plan and review services for each participant (three to four times per week)
Practicing Team Leader
Supervisor of front line clinicians provides direct services
Continuity of Staffing
Program maintains same staffing over time
Staff Capacity Program operates at full capacity
Psychiatrist on Staff
1 FTE per 100 - 120 participants 0.20 FTE Psychiatrist; access to Child Psychiatrist
Nurse on Staff 1 FTE per 50 - 72 participants Brokered medical services based on insurance provider coverage (IL All Kids)
ACT Fidelity ACT FACT
Substance Abuse Specialist on Staff
1 FTE per 50 – 72 participants 1 FTE per 50 – 72 participants
Vocational Specialist on Staff
1 FTE per 50 - 72 participants Brokered employment, vocational and financial literacy services through partners; vocational expertise of team used to develop soft skills with participants
Program Size Program is sufficient absolute size to provide consistently the necessary staffing diversity and coverage
(5 - 6 direct service FTE)
ACT Fidelity ACT FACT
Explicit Admission Criteria
Clearly identified mission to serve a particular population and has and uses measurable and operationally defined criteria to screen out inappropriate referrals
Single adults with serious mental illness and extensive psychiatric hospitalization history
Homeless families, defined as women between the ages of 18 and 25 with at least one child below the age of five who are currently living in shelters or exiting the child welfare system into homelessness
Priority criteria— mothers who have a mental health or substance use disorder (or both), who may be experiencing domestic violence, and a history of chronic, often multigenerational homelessness, whose children may display or be at risk of developmental delays and attachment disorders
ACT Fidelity ACT FACT
Intake Rate Program takes participants in at a low rate to maintain a stable service environment
Full Responsibility for Treatment Services
In addition to case management, program directly provides psychiatric services, counseling/psychotherapy, housing support, substance abuse treatment, employment/rehabilitative services
In addition to case management, program directly provides counseling/psychotherapy, housing support, substance use counseling, and child development assessment and intervention. FACT will connect families to brokered services including: employment/rehabilitative services, financial literacy, medical and oral health care, supportive permanent housing, Beacon’s LIOP/TOTS and Thresholds Mother’s Project.
Responsibility for Crisis Services
Program has 24-hour responsibility for covering psychiatric services
ACT Fidelity ACT FACT
Responsibility for Hospital Admissions and Discharge Planning
Program is involved in admissions and discharge planning
Program works to coordinate entry and discharge from any needed service
Time Unlimited Services (Graduation Rate)
Program rarely closes cases and remains point of contact for all participants as needed
Program works with families to secure stability and connection to needed community resources(18 to 24 months typically)
Community-Based Services
Program works to monitor status, develop community living skills in the community rather than the office
(60 – 80% contact in the community)
No Dropout Policy Program retains a high percentage of its participants through continued assertive engagement and re-engagement efforts
Program engages a high percentage of families identified as meeting entry criteria through continued assertive engagement and re-engagement efforts
ACT Fidelity ACT FACT
Intensity of Service High total amount of service time as needed (average of 2 hours of contact per week)
Frequency of Contact
High number of service contacts as needed
Work with Informal Support System
Program provides support and skills for participant support network
Individualized Substance Abuse Treatment
One or more members of the program provide direct treatment and substance abuse treatment for participants with
substance use disorders
Dual Disorder Treatment Groups
Program uses group modalities as a treatment strategy for people with substance use disorders
Program brokers group treatment services as needed
ACT Fidelity ACT FACT
Dual Disorders Model
Program uses a stage-wise treatment model that is non-confrontational and has gradual expectations
Program uses a wrap-around, stage-wise, strengths-based, trauma-informed and harm reduction oriented approach
Role of Consumers Consumers are involved as members of the team providing direct services
Consumers may be hired as members of the team; consumers provide program development input as participants of the Planning Coalition and through site visits and program evaluations
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Harm Reduction Housing & Residential
Supervisor(s) ~ Masters level licensed LSW/LCSW 0.50 FTE direct service/0.50 FTE supervision
Mental health clinician(s) - licensed Substance use specialist(s) - certified Housing specialist(s) Person(s) in recovery Employment specialist
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International FACES ~ Refugee ACT
Supervisors ~ Masters level licensed LCSW 0.50 FTE direct service/0.50 FTE supervision
Mental health clinicians - licensed Refugees from home country ~ cultural & language
broker Housing & resettlement specialists Employment, vocational & school specialists Trauma specialists
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Comprehensive & Targeted Services Are Not Enough
Systems Integration ~ Process by which dedicated systems integration staff organize systems to implement integrated services, reduce barriers, and decrease or eliminate gaps for a defined target population
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Why systems integration?
Populations with complex needs experience barriers to accessing services and resources
Many social issues cross service sectors
Collaborative efforts often fail because staff is not dedicated to managing the collaboration
Potential for larger-scale impact
Promotes efficient use of resources
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Systems integration process
Coalition formation
Identify systems and leaders
Work plan development
Identify focus
Outcomes
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Systems integration toolbox
Coalition building
Align and connect cross-system initiatives
Cross-training
Targeted training and technical assistance
Advocacy