1. Assertive Community Treatment (ACT) NAMI Maryland Annual Conference The Conference Center at Sheppard Pratt Friday, October 17, 2014 Saturday, October 18, 2014 Bette Stewart

2. Goals for Today ● Describe who is appropriate for ACT services ● Describe basic principles of ACT services ● Describe how ACT services differ from Case Management Services ● Describe history of ACT and how ACT has evolved over 40 years ● Describe how to access ACT services in your community

3. The Who, What, Where, Why & How ● Who does ACT serve? ● What do ACT services look like ? ● Where did ACT begin and where is it now? ● Why is Maryland a supporter of ACT? ● How do we know it’s ACT?

4. WHO is appropriate for ACT? ● Individuals with: – Severe and persistent mental health conditions (schizophrenia, bipolar and schizoaffective disorders) – High users of institutions ● Inpatient psychiatric beds ● Jail/prison ● Crisis stabilization

5. WHO is appropriate for ACT? ● Individuals for whom traditional mental health services have not adequately engaged the person in treatment ● Homelessness ● Significant difficulty doing the everyday things needed to live independently in the community

6. WHO determines eligibility? ● Eligibility is based on the previous criteria ● Referrals come from inpatient units, emergency rooms, outpatient clinics, community at large, detention centers, mental health courts, and yes, from families ● A licensed mental health clinician meets with the individual to complete an evaluation to determine if that person meets eligibility criteria

7. WHAT are ACT Team Staffing Requirements ● A full-time licensed clinical mental health worker (social worker, licensed professional clinical provider, masters level nurse, psychologist, etc.) ● A prescriber (psychiatrist or psychiatric nurse nurse practitioner) ● Nurses ● Employment Specialists

8. WHAT are ACT Team Staffing Requirements ● Substance use specialists ● Peer counselors ● Case managers ● Counselors / Therapists

9. WHAT are the ACT Core Principles? ● Small caseloads, with a ratio of 1:10 ● Team approach ● 24/7 access to a team member ● Assertive engagement skills and approaches ● Working with families ● Service provision in the community ● Recovery focused

10. WHAT do ACT services look like? ● ACT is different than Case Management ● ACT operates as a Transdisciplinary Team – Interdisciplinary team – Multidisciplinary team ● WHAT guides ACT services?

11. Case Management v ACT ● Case Management is time limited ● Case Management refers individuals to existing community resources ● Case Managers have their own case load of clients the are responsible to serve

12. Case Management v ACT ● ACT services are time unlimited ● ACT provides all services without brokering to other providers (except for services they are not equipped to handle, such as somatic care, physical therapy, etc.) ● ACT functions as a team with every staff member familiar with every client

13. ● Multidisciplinary

14. ● Interdisciplinary

15. ● Transdisciplinary

16. WHO does WHAT? ● Specialists ● Generalists ● Working as a Team – Different discipline perspective – Continuity of care – Meeting clinical and rehabilitative needs – Sharing responsibility – Decreasing staff-burnout

17. WHAT ACT services include: ● Person-centered approach to service delivery ● Access to multiple levels of care ● A strong focus on wellness and recovery ● Help finding and keeping employment ● Assistance with substance use ● Finding and maintaining (keeping) housing ● Finances (accessing benefits, budgeting, explaining how work will affect benefits, etc.)

18. WHAT ACT services include: ● Self-management skill development ● Medication management ● Attention to and coordination of care for other medical needs ● Building a community network of support for the individual

19. HOW do we know ACT is effective? ● Evidence-based Practice ● Research outcomes – Decreased hospitalizations and incarcerations – Improved housing stability, quality of life, client satisfaction, and vocational outcomes ● FOLLOW THE MODEL TO GET THE ROBUST OUTCOMES SEEN IN THE RESEARCH!

20. WHAT guides ACT services? ● Code of Maryland Regulations (COMAR) 10.21.19.01 ● Fidelity Assessments by the Behavioral Health Administration Monitors – DACTS – TMACT ● Model adherence tied to reimbursement rate

21. HOW did ACT start and WHY continue with ACT? ● Mendota State Hospital; Madison, WI ● From “Training in Community Living”, to “Hospital without Walls”, to a Recovery Model of Care ● Hospitals are charged with getting the person back to the community ● People may need hands on support and side-by-side supports to be successful

22. Maryland ACT Teams ● Anne Arundel ● Baltimore City ● Baltimore County ● Frederick County ● Harford County ● Howard County ● Lower-Shore ● Mid-Shore ● Montgomery County ● Prince George's County ● Washington County

23. ● THANK YOU FOR CHOOSING MY WORKSHOP TODAY! ● FOR QUESTIONS OR WANT ADDITIONAL INFORMATION PLEASE CONTACT ME, BETTE STEWART AT ● bstewart@psych.umaryland.edu bstewart@psych.umaryland.edu ● 410-646-5181