Modifying the PACT model to serve homeless persons with severe mental illness.
ABSTRACT 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.
Community Mental Health Journal 01/1997; 33(3):251-253. DOI:10.1023/A:1025045729469 · 1.03 Impact Factor
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ABSTRACT: T wo fundamental tenets underlie many intensive case manage-ment programs. The first is that caseload size is a useful index of service intensity. The second is that intensive case management services need to be provided to a consumer in perpetuity because termination of services results in a high rate of decompensation. This study examined these assumptions and their implications for program opera-tion and consumer recovery. Considering the appropriate inten-sity and duration of case management is becoming increasingly important. Initially, intensive case management programs were praised as less costly than hospitalization. But managed care and pressures to increase effi-ciency are causing some to question the need for consumers' lifetime par-ticipation, especially in programs with fixed small caseloads (1–3). This issue is part of the debate about what con-Objective: Two policy issues related to intensive case management pro-grams were examined: limiting caseload size to ensure that services are in-tensive and providing intensive services to the same clients in perpetuity. Method: The Denver Acuity Scale, which indicates need for services on a 5-point scale, was used for determining the service intensity needed by consumers and for increasing case managers' efficiency when caseload size varied. The acuity ratings of individuals in the Denver intensive case management program were examined to evaluate the effects of service duration on decompensation. Each consumer was rated at every service contact. The percentage of individuals readmitted to the program after they graduated was calculated, and the trajectories of 87 individuals who continued to be served by the program after they attained the highest rat-ing of functioning were examined. Results: Of the 112 individuals who graduated from the program in the 29-month study period, four (4 per-cent) were readmitted. More than half of the 87 consumers who achieved the highest functioning level did not deviate from that level for the re-mainder of the study period. Nearly a fifth showed some deterioration shortly after achieving that level but then improved. Slightly more than a fourth continued to deteriorate, but many never reached the lowest levels of functioning. Conclusions: To increase efficiency and ensure appropriate service levels, service intensity should be based on individual consumers' functioning levels. Most consumers are unlikely to need intensive case management in perpetuity. Providing more intensive services than need-ed or providing services longer than needed is inefficient and may even impede consumer recovery.Psychiatric Services 01/1998; 49:1585-1589. · 1.99 Impact Factor
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ABSTRACT: Objectives: This study describes how anAssertive Community Treatment (ACT) team which employsa family outreach worker (FOW) interacts with homelesspersons with severe mental illness and their families. Methods: The team's ratings of thefrequency and importance of clients' and treatmentteam's family contact are summarized and compared withindependent research reports on patients' satisfactionwith family relations, housing and hospitalizationoutcomes. Results: 73% of clients had contact with theirfamilies. ACT worked with families of 61% of clients.ACT had less contact with the families of men (pCommunity Mental Health Journal 01/1998; 34(3):251-259. DOI:10.1023/A:1018713707283 · 1.03 Impact Factor