National Alliance to End Homelessness ~ Targeting for Success: Serving Families  with the Highest Needs Karen Batia, Ph.D....
What is Assertive Community Treatment (ACT)? <ul><li>Developed in the 1970s </li></ul><ul><li>Mendota Mental Health Instit...
Why was ACT needed? <ul><li>Mental health system was complex and services were fragmented </li></ul><ul><li>Difficult to a...
Who typically receives ACT services? <ul><li>According to SAMHSA – individuals with the most serious and intractable sympt...
Philosophy of ACT <ul><li>Individualized, comprehensive and flexible treatment, support and rehabilitation services </li><...
Philosophy of ACT <ul><li>Team is the fixed point of responsibility for services </li></ul><ul><li>Service provided as lon...
Heartland “ACT” Teams <ul><li>ACCESS (ACT  -> Community Support Treatment Teams) </li></ul><ul><li>Street Outreach </li></...
Family Assertive Community Treatment Heartland Alliance for Human Needs & Human Rights <ul><li>Strengthening At-Risk Homel...
ACT Fidelity Scale Criteria (Dartmouth Fidelity Scale 2003) Traditional Assertive Community Treatment (ACT) Family Asserti...
ACT Fidelity ACT FACT Program Meeting Team meets frequently to plan and review services for each participant (daily)  Team...
ACT Fidelity ACT FACT Substance Abuse Specialist on Staff 1 FTE per 50 – 72 participants 1 FTE per 50 – 72 participants Vo...
ACT Fidelity ACT FACT Explicit Admission Criteria Clearly identified mission to serve a particular population and has and ...
ACT Fidelity ACT FACT Intake Rate Program takes participants in at a low rate to  maintain a stable service environment Fu...
ACT Fidelity ACT FACT Responsibility for Hospital Admissions and Discharge Planning Program is involved in admissions and ...
ACT Fidelity ACT FACT Intensity of Service High total amount of service time as needed (average of 2 hours of contact per ...
ACT Fidelity ACT FACT Dual Disorders Model Program uses a stage-wise treatment model that is non-confrontational and has g...
Harm Reduction Housing & Residential <ul><li>Supervisor(s) ~ Masters level licensed LSW/LCSW 0.50 FTE direct service/0.50 ...
International FACES ~ Refugee ACT <ul><li>Supervisors ~ Masters level licensed LCSW 0.50 FTE direct service/0.50 FTE super...
Comprehensive & Targeted Services Are Not Enough <ul><li>Systems Integration ~ Process by which dedicated systems integrat...
Why systems integration? <ul><li>Populations with complex needs experience barriers to accessing services and resources </...
Systems integration process Heartland Alliance for Human Needs & Human Rights Coalition formation Identify systems and lea...
Systems integration toolbox <ul><li>Coalition building </li></ul><ul><li>Align and connect cross-system initiatives </li><...
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6.10 Karen Batia

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  • 6.10 Karen Batia

    1. 1. National Alliance to End Homelessness ~ Targeting for Success: Serving Families with the Highest Needs Karen Batia, Ph.D. [email_address] July 2011
    2. 2. What is Assertive Community Treatment (ACT)? <ul><li>Developed in the 1970s </li></ul><ul><li>Mendota Mental Health Institute in Wisconsin </li></ul><ul><li>Arnold Marx, M.D., Leonard Stein, M.D., </li></ul><ul><li>and Mary Ann Test, Ph.D. </li></ul><ul><li>Goal – treatment model for individuals with severe mental illness - remain in the community and minimize impact of mental illness, improve quality of life </li></ul>Heartland Alliance for Human Needs & Human Rights
    3. 3. Why was ACT needed? <ul><li>Mental health system was complex and services were fragmented </li></ul><ul><li>Difficult to access needed services, if they existed </li></ul><ul><li>Services were time-limited </li></ul><ul><li>People cycled in and out of the hospital with no continuity of care </li></ul><ul><li>Skills learned in the hospital were not transferred to the community </li></ul>Heartland Alliance for Human Needs & Human Rights Heartland Alliance for Human Needs & Human Rights
    4. 4. Who typically receives ACT services? <ul><li>According to SAMHSA – individuals with the most serious and intractable symptoms of mental illness and experience the greatest impairment in functioning </li></ul><ul><li>People who are homeless, co-occurring substance use disorders, involvement with criminal justice system </li></ul>Heartland Alliance for Human Needs & Human Rights
    5. 5. Philosophy of ACT <ul><li>Individualized, comprehensive and flexible treatment, support and rehabilitation services </li></ul><ul><li>Multidisciplinary team </li></ul><ul><li>Majority of contacts with participants are in community settings </li></ul><ul><li>Team leader provides direct services </li></ul>Heartland Alliance for Human Needs & Human Rights
    6. 6. Philosophy of ACT <ul><li>Team is the fixed point of responsibility for services </li></ul><ul><li>Service provided as long as needed rather than on a pre-determined timeframe </li></ul><ul><li>Shared and small caseload </li></ul><ul><li>Assertive outreach and approach </li></ul>Heartland Alliance for Human Needs & Human Rights
    7. 7. Heartland “ACT” Teams <ul><li>ACCESS (ACT -> Community Support Treatment Teams) </li></ul><ul><li>Street Outreach </li></ul><ul><li>FACT </li></ul><ul><li>Harm Reduction Housing/Residential </li></ul><ul><li>International FACES (Refugee Mental Health) </li></ul>Heartland Alliance for Human Needs & Human Rights
    8. 8. Family Assertive Community Treatment Heartland Alliance for Human Needs & Human Rights <ul><li>Strengthening At-Risk Homeless Families </li></ul><ul><li>Conrad N. Hilton Foundation; Polk Brothers; McCormick Foundation; Prince Charitable Trust; City of Chicago </li></ul>
    9. 9. ACT Fidelity Scale Criteria (Dartmouth Fidelity Scale 2003) Traditional Assertive Community Treatment (ACT) Family Assertive Community Treatment (FACT) Small Caseload <ul><li>Participant provider ratio of 10 - 12 to 1 </li></ul><ul><li>Participant = single adult </li></ul><ul><li>Participant provider ratio of 10 - 12 to 1 </li></ul><ul><li>Participant = a family (see admission criteria for definition), or </li></ul><ul><li>Participant = a child in the family who has a serious emotional disorder and individual treatment plan separate from the family plan requiring intensive services </li></ul><ul><li>Participant = a child with DCFS involvement </li></ul>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
    10. 10. 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)
    11. 11. 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)
    12. 12. 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
    13. 13. 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
    14. 14. 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
    15. 15. 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
    16. 16. 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
    17. 17. Harm Reduction Housing & Residential <ul><li>Supervisor(s) ~ Masters level licensed LSW/LCSW 0.50 FTE direct service/0.50 FTE supervision </li></ul><ul><li>Mental health clinician(s) - licensed </li></ul><ul><li>Substance use specialist(s) - certified </li></ul><ul><li>Housing specialist(s) </li></ul><ul><li>Person(s) in recovery </li></ul><ul><li>Employment specialist </li></ul>Heartland Alliance for Human Needs & Human Rights
    18. 18. International FACES ~ Refugee ACT <ul><li>Supervisors ~ Masters level licensed LCSW 0.50 FTE direct service/0.50 FTE supervision </li></ul><ul><li>Mental health clinicians - licensed </li></ul><ul><li>Refugees from home country ~ cultural & language broker </li></ul><ul><li>Housing & resettlement specialists </li></ul><ul><li>Employment, vocational & school specialists </li></ul><ul><li>Trauma specialists </li></ul>Heartland Alliance for Human Needs & Human Rights
    19. 19. Comprehensive & Targeted Services Are Not Enough <ul><li>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 </li></ul>Heartland Alliance for Human Needs & Human Rights
    20. 20. Why systems integration? <ul><li>Populations with complex needs experience barriers to accessing services and resources </li></ul><ul><li>Many social issues cross service sectors </li></ul><ul><li>Collaborative efforts often fail because staff is not dedicated to managing the collaboration </li></ul><ul><li>Potential for larger-scale impact </li></ul><ul><li>Promotes efficient use of resources </li></ul>Heartland Alliance for Human Needs & Human Rights
    21. 21. Systems integration process Heartland Alliance for Human Needs & Human Rights Coalition formation Identify systems and leaders Work plan development Identify focus Outcomes
    22. 22. Systems integration toolbox <ul><li>Coalition building </li></ul><ul><li>Align and connect cross-system initiatives </li></ul><ul><li>Cross-training </li></ul><ul><li>Targeted training and technical assistance </li></ul><ul><li>Advocacy </li></ul>Heartland Alliance for Human Needs & Human Rights

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