Evidence-Based Practices: Shaping Mental Health Services Toward Recovery

Assertive Community Treatment

Implementation Tips for Mental Health Program Leaders

An Assertive Community Treatment team is different from other programs that may be operating in your agency. First, the consumers targeted by this program are those who have the most severe and persistent psychiatric symptoms and who, consequently, have the most severe problems with social functioning. People served by an assertive community treatment program are typically those who have extensive histories of psychiatric hospitalization, are homeless, have co-occurring substance abuse or medical problems, and/or involvement in the criminal justice system. They are also people whose needs have not traditionally been well met by the mental health system.

One of the reasons an Assertive Community Treatment program is able to help individuals with these types of challenging needs live safely and autonomously in the community is because the program staff assumes responsibility for providing all the services the person might need. This might be assistance with housing, parenting, benefits, symptom management, medical care, substance abuse treatment, and/or employment. Rather than referring people to other providers for these services, the team itself provides them. To do this, the program is staffed by experts with a variety of skills and experience who carefully integrate interventions and provide support around the clock if necessary.

The program is run by a team leader who is a mid-level manager, clinical supervisor, and practicing clinician. The team psychiatrist also actively provides clinical leadership. It is these two individuals who are responsible on a day-in, day-out basis for assuring that the program follows the Assertive Community Treatment model. We encourage you to make this section of the Resource Kit available to candidates for these positions during the hiring process so they will understand what they will be asked to do. It will also be important for the people who are selected for these positions to have an active role in setting up the structures needed to support the Assertive Community Treatment team and in establishing the processes that channel the team’s dynamic energies and abilities.

This section of the Resource Kit is intended to help the leaders of a new program think through and prepare for developing an Assertive Community Treatment team. In preparing this section, we could think of no one better to advise new team leaders on the tasks involved in starting a new team then people who have worked successfully with Assertive Community Treatment programs. Therefore, the information in this manual is based on the experience of veteran team leaders and administrators.

Because building an effective, well-functioning team is very much a developmental process, we encourage you and the team leader to revisit this secton periodically throughout the first year of the new program. We believe that these materials will take on new meaning as the process of implementing an Assertive Community Treatment team evolves.

Resources and Processes

Part I describes the resources and administrative processes that will need to be in place before consumers can be admitted to the program. This material is adapted from The PACT Model of Community-Based Treatment for Persons with Severe and Persistent Mental Illnesses: A Manual for PACT Start-up which was written by Deborah Allness, MSSW and William Knoedler, MD - two of the originators of the assertive community treatment model. This book is more commonly referred to as The PACT Start-up Manual. Many of the processes you will need to understand, as well as forms, position descriptions, and model policies and procedures are provided in The PACT Start-up Manual. We encourage you to order copies of the manual for your own use and for use by the team leader and program staff. Copies of The PACT Start-up Manual are available from The National Alliance on Mental Illness (NAMI) and can be ordered by calling (703) 524-7600 or emailing elizabeth@nami.org.

Voices from Experience

Part 2 is a series of three interviews with people familiar with assertive community treatment programs. The interviews contain information that we believe will help team leaders anticipate some of principles and practical challenges associated with leading an assertive community treatment team.

The Assertive Community Treatment Team as a Complex Adaptive System

Part 3 addresses the building and nurturing of the team process. The team leader will find that while assertive community treatment teams are made up of people from multiple disciplines, it is not technically a multidisciplinary team, but rather a transdisciplinary team. Section 3 is an article explaining key organizational functions of such teams and the role of the team leader in enhancing team behaviors that support this type of a team.

How Ready Are You?

Part 4 contains checklists to help you and the team leader check on your understanding of important aspects of assertive community treatment and make concrete plans for the work that will need to be done to implement this service.

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