Assertive Community Treatment (ACT) Teams

Assertive Community Treatment (ACT) is an intensive approach to mental illness that offers rigorous, comprehensive support to individuals suffering from severe and persistent mental illness. ACT's goal is to keep vulnerable, at-risk mentally ill individuals out of hospitals and in stable housing while encouraging development of useful life skills. It is a "recovery-oriented, comprehensive, multi-professional model that usually includes comprehensive supports, such as a psychiatrist, doctor, nurse and substance abuse specialists on a single team, and that team serves all of the client's needs”

ACT is an evidence-based, multi-disciplinary approach to mental health treatment. It offers multiple types of support, including "service coordination, crisis intervention, psychiatric/psychological treatment and supports, prescription and management of psychiatric medication, services and supports for concurrent substance use disorder, psychosocial rehabilitation, work-related services, social/interpersonal relationships and leisure-time skill training, peer support services, other support services, and family-centered services".

ACT's goal is to support those suffering with mental illnesses so that their lives are not driven by their illness. It encourages "recovery through community treatment and rehabilitation.".

Practice

Assertive Community Treatment is administered by comprehensive, multi-disciplinary ACT Teams made up of "social service workers, public health professionals, and administrative staff. Vancouver Coastal Health (VCH) ACT teams are comprised of a team coordinator, registered nurse, social worker, occupational therapist, substance abuse specialist, vocational specialist, peer support worker, psychiatrist, nurse practitioner, administrative assistant, and other clinical staff (i.e. Aboriginal Cultural Support)".

Intake

ACT aims to serve only the most vulnerable clients. Under the Housing First model, this is done using the Vulnerability Assessment Tool.

Vulnerability Assessment Tool (VAT)

Developed in 2003 by the Downtown Emergency Service Center of Seattle, “the DESC Vulnerability Assessment Tool provides a structured way of measuring a homeless person’s vulnerability to continued instability.” The tool aims to rate an individual’s level of functioning or severity of conditions across 10 areas. They are: Survival Skills, Basic Needs, Indicated Mortality Risks, Medical Risks, Organization/Orientation, Mental Health, Substance Use, Communication, Social Behaviors, and Homelessness. According to proponents, this creates “a comprehensive assessment of vulnerability [which] can [be] compared with vulnerability assessments of other homeless people.” By quantifying the “vulnerability” of a homeless person, we can then rank them according to who is most in need of services.

Admission

According to British Columbia's Program Standards for ACT Teams, in order to be admitted into the program, clients must:

1. Have a severe, persistent mental illness. Priority goes to those with illnesses like schizophrenia that cause long-term psychiatric disability.
2. Have functional impairments like the inability to perform daily living activities (basic housekeeping, meal preparation, personal hygiene, banking, etc.), inability to acquire and maintain employment, and inability to acquire and maintain a safe living situation.
3. Consistently make use of hospital pyschiatric services, or other emergency psychiatric care services.
4. Have other high service needs (substance abuse problems, criminal involvement due to illness, poor survival skills, inability to use traditional out-patient services)

Discharge

Discharge occurs when clients and staff agree to termination of services. This occurs when:

1. Clients have successfully reached their goals.
2. Clients have successfully demonstrated ability to function independently in major roles, like work, social behaviour, and self-care.
3. Clients move out of geographic area of ACT's responsibility.
4. Clients decline or refuse service.

Vancouver Coastal Health's ACT

Vancouver Coastal Health (VCH)

Vancouver Coastal Health (VCH) is a regional health authority that serves 25% of British Columbia: the residents of Vancouver, Richmond, the North Shore and Coast Garibaldi, Sea-to-Sky, Sunshine Coast, Powell River, Bella Bella and Bella Coola. VCH provides integrated care in public health, primary care, acute care, home and community services, and mental health.

VCH and ACT

VCH launched its first ACT teams in 2011. There are now five ACT teams serving over 250 clients in the lower mainland.

ACT and Housing First

Housing First

Housing First is a widely used approach to tackling homelessness in urban areas. It is deeply rooted in the idea that housing is a human right, that individuals should have access to permanent affordable housing, and that community services should be readily available to aid in the maintenance of stable housing. Housing First is said to give people "direct access to permanent housing, along with the services they need and want to maintain that housing".

This model of housing opposes the traditional Continuum of Care approach to homelessness, which funnels homeless individuals through gradual stages of housing that work towards a goal of obtaining and maintaining safe and stable housing. These stages typically begin with placement in emergency shelters, to transitional or supportive housing, to independent living.. Housing First argues that the transition from street to home is so institutionalized that it actually perpetuates the cycle of poverty. Because of this, Housing First's policy focuses on housing and invests funds into building low income housing, providing intensive case management for clients, and aims to provide housing and keep people in it. What is unique about Housing First is that housing is seen as the first step in helping people overcome their obstacles; “Housing First is based on the idea that issues that may have contributed to a person’s homelessness, such as a lack of employment, addiction, poor mental or physical health, can be best addressed once a person has stable housing.”

Evidence-based studies demonstrate that Housing First is largely successful, although its success is disputed.

Intensive Case Management (ICM) and ACT

Intensive Case Management (ICM) and ACT are two pivotal components of Housing First. Similar to ACT, ICM's goal is to provide comprehensive case management to clients through a team of case workers whose goal is to link clients to "mainstream housing, clinical, and complementary supports". ICM is meant to provide an intensive service for a short period of time to help individuals get on their feet, to help them navigate the system, and to help them achieve independence.