Modifying the PACT Model to Serve Homeless Persons with Severe Mental Illness

Department of Psychiatry, University of Maryland at Baltimore 21201, USA.
Psychiatric Services (Impact Factor: 2.41). 08/1995; 46(7):684-8.
Source: PubMed


The success of the Program for Assertive Community Treatment (PACT) has led to its replication with different client populations, especially those who are underserved by the traditional treatment system. This paper describes a program in Baltimore that has adapted the PACT model to serve homeless persons with severe mental illness. Although the essential ingredients and philosophy of the original model were maintained, the original team approach has been modified by the use of "miniteams." All staff share knowledge of all program clients through formal mechanisms such as daily meetings; however, each client is assigned to a miniteam composed of a clinical case manager, a psychiatrist, and a consumer advocate. Another deviation from the PACT model is that services can be time limited. The authors describe four phases of treatment and problems, including interventions characteristic of each phase.

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    • "ACT has gone through a variety of adaptations and applications over the last 30 years, including urban and rural adaptations (Becker, Meisler, Stormer, & Brondino, 1999; Calsyn, Morse, Klinkenberg, Trusty, & Allen, 1998; et al., 1998; Dixon, Friedman, & Lehman, 1993; Lehman, Dixon, Kernan, DeForge, & Postrado, 1997), outreach to homeless persons (Dixon, Krauss, Kernan, Lehman, & DeForge, 1995) and adaptations for persons with mental illness and co-occurring substance use disorders (Drake, Mercer-McFadden, Mueser, McHugo, & Bond, 1998). More recently, a number of ACT teams around the country have expanded their focus to prevent recidivism among justice-involved consumers (i.e., forensic assertive community treatment [FACT] teams) (Cuddeback, Morrissey, & Cusack, 2008; Cuddeback, Morrissey, Cusack, & Meyer, 2009; Cusack, Morrissey, Cuddeback, Prins, & Williams, 2010; Lamberti, Weisman, & Faden, 2004; McCoy, Roberts, Hanrahan, Clay, & Luchins, 2001; Morrissey, Meyer, & Cuddeback, 2007). "
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    ABSTRACT: Forensic assertive community treatment (FACT) is a recent adaptation of the assertive community treatment (ACT) model; however, more information is needed about how FACT and ACT consumers differ and how FACT should be modified to accommodate these differences. Linked, multisystem administrative data from King County, Washington, were used to compare the demographic, clinical, and criminal justice characteristics of ACT- and FACT-eligible consumers. FACT consumers were more likely to be male, persons of color, and had more complex clinical profiles. Also, some FACT consumers were incarcerated for sex offenses, and more than half had violent offenses. Traditionally, ACT teams avoid serving consumers with personality disorders, violent consumers, and sex offenders; however, given increased use of mandated outpatient treatment and mental health courts, FACT teams may have less discretion to choose whom they serve. The addition of clinical interventions and other modifications may be particularly important for FACT teams.
    Journal of the American Psychiatric Nurses Association 03/2011; 17(1):90-7. DOI:10.1177/1078390310392374 · 0.98 Impact Factor
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    • "Assertive community treatment (ACT) is one of the most well defined (Allness and Knoedler 1998; Stein and Santos 1998; Test and Stein 2000) and researched (Mueser et al. 1998) community-based treatment models for persons with a mental illness. Since its development in the 1970s (Stein and Test 1980, 1985; Stein et al. 1975), ACT has been modified to reduce costs associated with this intensive service (Lachance and Santos 1995) and to serve certain high risk populations with serious mental illness (Dixon et al. 1995; Teague et al. 1995). These modifications have led researchers to identify vital elements of ACT (Bond et al. 2001; McGrew and Bond 1995; Witheridge 1991) that endure through adaptations of the model and instruments have been developed to measure a program's fidelity to these critical ingredients (e.g., the Dartmouth Assertive Community Treatment Scale; DACTS; Teague et al. 1998). "
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    ABSTRACT: This study examined the extent to which an ACT team employed within a Housing First program conforms to the fidelity standards of the ACT model. The aim was to specifically identify the extent to which accommodations have been made to suit the context and priorities of Housing First. Results indicate that some deviations from the ACT model could be attributed to the consumer choice approach inherent to Housing First. Other deviations may result from serving individuals that are more disconnected from social supports than other individuals with mental illness, with longer street histories, and greater involvement with substance use.
    Community Mental Health Journal 07/2008; 45(1):6-11. DOI:10.1007/s10597-008-9152-9 · 1.03 Impact Factor
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    • "Standard sector (61) (both implementations of ACT) BPR SGAF Schedules for Clinical Assessment in Neuropsychiatry Social Behaviour Schedule Standard sector > Intensive sector Intensive sector > Standard sector Essock and Kontos 1995; Essock, Frisman, and Kontos 1998 ACT Standard case management (N = 262) Client Outcome Scale LQL Scale Symptom Check List ACT > Standard case management ACT < Standard case management Dixon et al. 1995; Lehman et al. 1997, 1999 "
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    ABSTRACT: The authors review the methodology and findings of economic evaluations of 42 community mental health care programs reported in the English-language literature between 1979 and 2003. There were three substantial methodological problems in the literature: costs were often not completely specified, the quality of econometric analysis was often low, and most evaluations failed to integrate cost and health outcome information. Well-conducted research shows that care in the community dominates hospital in-patient care, achieving better outcomes at lower or equal cost. It is less clear what types of community programs are most cost-effective. Future research should focus on identifying which types of community care are most cost effective and at what level of intensity they are most effective.
    Medical Care Research and Review 11/2005; 62(5):503-43. DOI:10.1177/1077558705279307 · 2.62 Impact Factor
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