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.
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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
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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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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 · 2.57 Impact Factor