Oregon Center of Excellence for Assertive Community Treatment

ACT programs in Oregon ACT Program Most recent fidelity review Most recent ACT Fidelity Score Number of ACT clients served Size of Program (micro, midsized, large) Linn County Mental HealthJuly Micro South Lane Mental HealthJanuary Micro Community Health AllianceSeptember Micro Laurel Hill CenterOctober Midsized Columbia Community Mental HealthMay Micro Benton County Behavioral HealthDecember Micro Wallowa Valley Center for WellnessJanuary Micro Deschutes County Mental HealthJanuary Midsized Telecare CorporationMay Large Center for Human DevelopmentJuly Micro Central City ConcernMay Large Yamhill County Mental HealthSeptember Micro Options for Southern OregonSeptember Midsized Community Counseling SolutionsOctober Micro Mid-Columbia Center for LivingJune Micro

Summary of Fidelity Data  15 ACT programs meeting fidelity: 10 Micro ACT teams; 3 Midsized ACT teams; 2 Large ACT teams  Large teams are defined as serving 80 and above; Midsized serves between 40-79; Micro teams serve 39 or less.  Benchmark Fidelity Score is 114. Almost 50% of programs scored between 114 and 116. Very little margin of error is built into the system to maintain fidelity (meet the benchmark of 114) for the next review.

Item Analysis: What is going well  Small caseloads  Team approach  Explicit admission criteria  Intake rate  Full responsibility of services  Hospital discharge

TIP 1: Allocate Sufficient FTE for ACT Specialists  Psychiatrist time: 5 of 15 programs (33%) scored 3 or below  Nurse time: 5 of 15 programs (33%) scored 3 or below with only one program without a nurse  Vocational Specialist: 7 programs (47%) scored 3 or below with three programs not having a vocational specialist  Peer Specialist: 12 programs (80%) scored 3 or below with 3 programs not having a peer specialist

Tip 1: Sufficient FTE  Substance abuse specialists across ACT programs well staffed- 12 of 15 (80%) scored a 5 on this item; the remaining 3 programs scored 3 or below  Additional points can be scored if the FTE levels of specialist staff was boosted: Six programs could pick up 2-5 additional points by boosting staff FTE Five programs could pick up 6-7 additional points Four programs could score additional 8-11 points by increasing staff FTE

Tip 2: Increase Substance Abuse Services  Most ACT teams have a substance abuse specialist dedicated to the ACT team and have allocated sufficient FTE H9: Substance abuse specialist on staff –12 of 15 (80%) scored a 5 on this item; the remaining 3 programs scored 3 or below  However, the amount of individual substance abuse services provided and group SA treatment is low

Tip 2: Increase Substance Abuse Services  Fidelity methodology to measure SA services is to review charts of the SA service provider  Is it an issue of not enough focus on specific provision of substance abuse services or documentation?

SA items on the DACT  Three fidelity items measure provision of substance abuse services:  S7: Individualized substance abuse treatment  S8: Co-occurring treatment groups  S9: Dual disorder model

S7: Individualized SA treatment  Six programs scored 3 which indicates that the number of minutes of individualized treatment was less than 24 minutes per week Fidelity Score on S7: Number of ACT programs

S8: Co-occurring disorder treatment groups  7 teams scored 3 or below on this item Fidelity Score on S8: Number of ACT programs

Increasing SA Group attendance  Peer providers co-facilitating IMR or E- IMR groups  Location of group services more central location in the community  Offer participation incentives (contingency management) or snacks  Explore barriers to treatment (socio- cultural, stigma, interpersonal, transportation, childcare)

S9: Dual Disorder Model  Many programs doing well here Fidelity Score on S9: Number of ACT programs

Tip 3: OS9: Transition to less intensive services  Nine programs (60%) scored 3 on this item  1) regular assessment of need for ACT services- what we are looking for is more regular than the annual assessment-  Ideally establishing regular meetings at least quarterly assessments/review of need for service

Transition to Less Intensive Service  2) Explicit criteria or markers for transition Checklists ACT Transition Readiness Scale Systematic review of specific domains with the flexibility to add areas that may be individualized to each individual ACT participant served

Transition to Less Intensive Service  3) Transition is gradual and individualized with assured continuity of care

Transition to Less Intensive Service  4) Status is monitored following transition, per individual need documentation of face to face contacts with individual even after date of closure accompanying to new service provider

Transition to Less Intensive Service  5) Option to return to the ACT team if needed Almost all teams score well here

Crisis services  Overall ACT programs in Oregon scoring the lowest on this item and the peer provider item.  ACT programs are typically scoring a 2 or 3 on this item because they typically are contracting out after hours crisis response to a third party and not always available for consultation.

Crisis Coverage: Fidelity Item  To score a 5 – The program provides 24-hour crisis coverage directly with an ACT team member on call at all times. ACT team is the first responder: the ACT clients have direct access to ACT team number after hours AND the ACT team member will go out in- person after hours if need be to respond to crises.  4 – An ACT team member is on call at all times. Calls may go first to an emergency program or third party provider (e.g. Protocall, Multnomah Crisis Line, etc.), however, the ACT team is ALWAYS contacted for consult for all crisis calls for all ACT participants and makes the decision about need for ACT team involvement and willing to respond in person after hours if needed.

Crisis Coverage: Fidelity Item  3 – An ACT team member is on call at all times. Calls may go first to an emergency program (e.g. Protocall, Multnomah Crisis Line, etc.). The emergency program may handle the call directly without contacting an ACT team member (To score a 4, the ACT team is always consulted for ACT clients, whereas at a 3, the decision is made by the emergency program whether or not to involve the ACT team.)  2 – There is no organizational policy in which an ACT team member is always on call AND ACT team members are NOT contacted even by phone consultation for crisis planning. However, the difference between a 1 and 2, there is crisis coordination between the crisis team and the ACT team. The ACT program has crisis plans in place for ACT participants (in writing) and has established routine communication with the emergency program providing after hours crisis services.  1 – The ACT program is not involved in providing after hours crisis services or involvement is not formalized. Crisis planning may be communicated verbally between ACT team members and a crisis team, however if no written plan is in place, the score is a 1.

Well Done!!!  15 ACT programs in Oregon achieving ACT fidelity and providing a full array of services to promote recovery and self sufficiency  Many new ACT programs coming on line this year (NARA, Cascadia, Polk County, Marion County, Outside In, Sequoia)

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