1.6 ACT and Multi-Disciplinary Teams


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Assertive Community Treatment (ACT) initiatives and other models can be essential to serving people who experience chronic homelessness. This workshop will present information on how to establish effective multi-disciplinary teams.

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1.6 ACT and Multi-Disciplinary Teams

  1. 1. Pathways to Housing DC Assertive Community Treatment Teams
  2. 2. Pathways DC <ul><li>Formed as a partner to Pathways to Housing New York in 2003 </li></ul><ul><li>Targets the most visible and vulnerable —those people living on the streets or other public places who have psychiatric disabilities, co-occurring substance abuse disorders, or other challenges. </li></ul><ul><li>Provides immediate housing in independent apartments without any requiring “housing readiness” </li></ul><ul><li>Currently housed more than 200 people, with plans to house an additional 150 over the next year </li></ul>
  3. 3. Pathways DC Programs <ul><li>Outreach </li></ul><ul><li>Permanent Supportive Housing Program (100) </li></ul><ul><li>ACT (Assertive Community Treatment) Teams (250) </li></ul><ul><li>Community Support </li></ul><ul><li>Supported Employment </li></ul>
  4. 4. ACT Clients <ul><li>Referrals from both Outreach and PSH programs as well as DC DMH </li></ul><ul><li>Must have a serious mental illness such as schizophrenia or bipolar disorder as a primary diagnosis </li></ul><ul><li>ACT is the highest level of outpatient care a person can receive </li></ul><ul><li>Most clients also have a substance use disorder and/or a severe medical condition </li></ul><ul><li>All clients have been homeless (staying on the street or in a shelter) for at least one year </li></ul><ul><li>Mostly single adults, some mothers with children </li></ul>
  5. 5. ACT Team Members <ul><li>Team Leader </li></ul><ul><li>Psychiatrist </li></ul><ul><li>Registered Nurse </li></ul><ul><li>Addictions Specialist </li></ul><ul><li>Wellness Specialist </li></ul><ul><li>Peer Specialist </li></ul><ul><li>Employment Specialist </li></ul><ul><li>Family Specialist </li></ul><ul><li>Housing Specialist </li></ul>
  6. 6. Supervision <ul><li>Both the Team Leader and Psychiatrist supervise team members </li></ul><ul><li>Team Leaders are typically Master’s level clinicians </li></ul><ul><li>Team Leaders spend 50% of time on direct service and 50% on admin </li></ul><ul><li>Team Leaders meet weekly which each member of the team </li></ul>
  7. 7. Core Components of ACT <ul><li>In vivo services </li></ul><ul><li>Low client to staff ratio (10:1, not including the team psychiatrist) </li></ul><ul><li>Shared caseload </li></ul><ul><li>24/7 availability </li></ul><ul><li>Services provided by the team (outside referrals are rare) </li></ul><ul><li>Time unlimited </li></ul>
  8. 8. Funding Sources <ul><li>Housing Vouchers </li></ul><ul><li>Housing Choice Set-Asides </li></ul><ul><li>Shelter Plus Care </li></ul><ul><li>HUD contracts </li></ul><ul><li>Local Rent Subsidies </li></ul><ul><li>Services </li></ul><ul><li>Medicaid </li></ul><ul><li>Fee-for-Service on all Mental Health Rehab Services </li></ul>
  9. 9. Housing <ul><li>All clients admitted to the team receive a housing voucher </li></ul><ul><li>Scattered site </li></ul><ul><li>Internal housing department to manage landlord relations and voucher maintenance </li></ul><ul><li>Require monthly home visit reports </li></ul><ul><li>Clients given multiple opportunities to succeed </li></ul>
  10. 10. Services <ul><li>Skill building- cooking, cleaning, transportation, etc </li></ul><ul><li>Symptom Management </li></ul><ul><li>Medication Management </li></ul><ul><li>Supported Employment </li></ul><ul><li>Integrated Dual Disorder Treatment </li></ul><ul><li>Health Care Coordination and Education </li></ul><ul><li>Individual and Group Therapy </li></ul>
  11. 11. The Shared Caseload <ul><li>All team members are responsible for all clients on the team (typically between 50- 75 clients) </li></ul><ul><li>Teams meet daily to briefly discuss each client </li></ul><ul><li>Weekly case conferences </li></ul><ul><li>Documentation and chart management responsibilities are shared </li></ul><ul><li>Team members must be equipped to provide services outside of their discipline </li></ul>
  12. 12. The Shared Caseload <ul><li>Benefits </li></ul><ul><li>Engagement strategies </li></ul><ul><li>Less disruption of services due to turnover, vacations, etc </li></ul><ul><li>Holistic view of the client </li></ul><ul><li>Prevents staff burnout </li></ul><ul><li>Challenges </li></ul><ul><li>Chart management </li></ul><ul><li>“ Closing the Loop” </li></ul><ul><li>Building trust amongst the team members </li></ul>
  13. 13. Contact Information <ul><li>Amanda J. Harris, LGSW, MPP </li></ul><ul><li>Director of Quality Improvement </li></ul><ul><li>Pathways to Housing DC </li></ul><ul><li>Email: [email_address] </li></ul><ul><li>Phone: (202) 529-2972 ext 194 </li></ul>