A four-year retrospective study of Assertive Community Treatment: Change to more frequent, briefer client contact

Abstract

The authors explored the feasibility of providing frequent, brief client contact as a strategy for reallocating Assertive Community Treatment (ACT) staff time to new clients, while preserving relationships with current clients and ACT program fidelity standards. A retrospective analysis of 4 years of service records for a high-fidelity ACT team revealed gradual increases in staff–client contact frequency, and corresponding decreases in contact duration. During these years, fidelity to ACT standards remained moderately high, and clients’ employment and hospitalization outcomes improved.

“You Might Lose Him Through the Cracks”: Clinicians’ Views on Discharge from Assertive Community Treatment

“…1998) examined transitions to less intensive care within the same ACT team, rather than discharge to other clinical services. Gold et al (2012) have shown that ACT clinicians increase visit frequency but decrease visit length for clients with longer tenure in ACT, suggesting that even as clients improve, clinicians remain heavily involved in their lives. Chen and Herman (2012), using focus groups and interviews with ACT clinicians in New York State, identify significant clinician skepticism about ACT discharge, including the belief that ACT works best when time-unlimited because clients can be assured they will not experience rejection, and that a high level of service intensity should be continued-not curtailed-when the client appears to have benefited from it.…”

Graduation practices and outcomes in intensive case management programs for severe mental illness: A systematic review.

“…Moreover, for some clients, intensive approaches as ACT and ICM may not necessarily be consistent with client-centered recovery-oriented care (Anthony, 1993; Salyers & Tsemberis, 2007) because many may not need such intensive services continuously (Salyers et al, 1998; Tsai et al, 2011). Many programs are also not able to provide this level of care with limited resources while also admitting new clients (Cuddeback et al, 2006; Gold et al, 2012). In fact, waiting lists for ICM programs are common, program capacity is often insufficient, and there are questions about the return on investment with keeping clients for extended periods of time (Rochefort, 2019).…”