Assertive Community Treatment (ACT) for Schizophrenia

Status: Strong Research Support

Description

ACT is a multidisciplinary team approach to intensive case management in which the team members share a caseload, have a high frequency of patient contact (typically at least once a week), low patient to staff ratios, and provide outreach to patients in the community. ACT teams include psychiatrists as well as other mental health clinicians. This team approach allows for integration of medication management, rehabilitation, and social services. ACT treatment is typically ongoing rather than time-limited, available 24 hours a day, and highly individualized to each client’s changing needs. The goals of ACT are to reduce hospitalization rates and help clients adapt to life in the community. ACT is most appropriate for individuals who are at high risk for repeated hospitalizations and have difficulty remaining in traditional mental health treatment.

Key References (in reverse chronological order)

• Rosenheck, R. & Dennis, D. (2001). Time-limited assertive community treatment for homeless persons with severe mental illness. Archives of General Psychiatry, 58(11):1073-1080, 2001.
• Salkever, D.; Domino M.E.; Burns B.; Santos A.B.; Deci P.A.; Dias J.; Wagner H.R.; Faldowski R.A.; Paolone J. Assertive community treatment for people with severe mental illness: the effect on hospital use and costs. Health Services Research, 34(2): 577-601, 1999.
• Lehman A.F.; Dixon L.B.; Kernan E.; DeForge B.R.; Postrado L.T. A randomized trial of assertive community treatment for homeless persons with severe mental illness.Archives of General Psychiatry, 54:1038-1043, 1997.
• Scott J.; Dixon L. Assertive community treatment and case management. Schizophrenia Bulletin 21(4):657-68, 1995.
• Burns B.J.; Santos, A.B. Assertive community treatment: an update of randomized trials. Psychiatric Services, 46:669-675, 1995.
• Stein LL, Test MA (1980). An alternative to mental hospital treatment: I. conceptual model, treatment program, and clinical evaluation. Archives of General Psychiatry 37:392–397.

Clinical Resources

• Allness D.J. & Knoedler W.H. (1998). The PACT Model of Community-Based Treatment for Persons With Severe and Persistent Mental Illness: A Manual for PACT Start-Up. Arlington, VA: National Alliance for the Mentally Ill.
• Stein, L. (1998) Assertive Community Treatment Of Persons With Severe Mental Illness. Norton Professional Books.
• SAMHSA (2003, draft) Assertive community treatment implementation resource kit: Information for practitioners and clinical supervisors.
• Burns, T. & Firn, M. (2002). Assertive outreach in mental health: A manual for practioners. New York: Oxford University Press.

Training Opportunities

NAMI Assertive Community Treatment (ACT) Technical Assistance Center http://www.nami.org/about/pact.htm ACT@NAMI.org 866-229-6264