Assertive Community Treatment

What is an assertive community treatment program?

Assertive Community Treatment (ACT) is a type of case management program originally developed by Leonard I. Stein, Mary Ann Test, and several of their colleagues from Mendota Mental Health Institute (a state psychiatric hospital) in Madison, WI, to assist mental/behavioral health patients. It can be defined as an intensive, integrated approach to community mental health service delivery. A care provision plan offered as an alternative to residential or hospital care, this model includes heavy involvement from a case manager and a multidisciplinary team of professionals. As a form of Intensive Comprehensive Care, ACT is designed to provide extensive, in-depth aid to people who need to overcome significant physical or mental hurdles in order to become self-sufficient. Some basic characteristics of ACT are as follows.

Long-term Community-Based Care

Clients in an ACT program often come from underprivileged backgrounds of severe mental illness, abuse, addiction, trauma, homelessness, victimization, incarceration, refugee status, and/or cultural prejudice. These individuals often experience unique physical and mental health challenges that require a strong support system to work through. This is a case management model that relies heavily on community-based treatment from a diverse team of experts and other community resources.

This long-term care plan operates under the assumption that a patient or client will experience the best possible care and outcome from the comfort and stability of a home and community environment rather than a hospital. It’s an evidence-based plan intended to eventually ensure that the client will not require this level of support in the future. There’s no specific time period a client will be enrolled in this care plan. The level of care required and the time it takes to complete the program will depend on the quality of work the care team puts into it and the value the clients get out of it. This is an expensive program, but many nonprofit and government program experts believe that it’s actually cheaper and more beneficial in the long run than continued government-funded hospital care or incarceration.

In-depth, Multi-Disciplinary Case Management

An ACT client requires a heavy amount of support and assistance in daily life. The multidisciplinary team of professionals that works with them stays on-call at all times to provide them with the care they need. The client will often have multiple points of contact with various members of the team each week. Because of the number of people required to make these cases run smoothly, ACT caseloads are often shared among a couple of case managers and several specialized professionals. These professionals work in conjunction with the case managers to provide the following services: counseling, physical therapy, employment skills, daily living skills, crisis intervention, substance abuse treatment, and more. Case loads are small, but each team is likely to serve up to ten ACT clients at once.

Preparation for Real-World Living

While ACT is a time-unlimited case model, the end goal is to help the client thrive in life with reasonable accommodations. Not only does the team work to help the client overcome all of their challenges in a holistic way, they also educate the client on how to take care of these challenges outside of treatment with support from friends and family. ACT workers are trying to prevent homelessness, further hospital visits, and unemployment, which in many cases have been common hurdles throughout the client’s life. This model has been tried and proven for decades. Clients gradually become more stable and self-sufficient, though it does take a significant amount of time.