Program Planning and Staff Competencies for Forensic Assertive Community Treatment: ACT-Eligible Versus FACT-Eligible Consumers

Abstract

Purpose 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. Methods 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. Results 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 over half had violent offenses. Conclusions 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.

Essential Elements of Forensic Assertive Community Treatment

“…Staffing was examined with an emphasis on identifying team members not routinely found within standard ACT teams, such as forensic peer specialists, mental health court liaisons, or probation officers. Special training, requisite experience, or other competencies were also recorded, as research suggests that FACT patients have special needs compared to ACT patients 32 . Admission criteria were likewise noted, with an emphasis on identifying both mental health and criminal justice criteria.…”

“…74,75 To help overcome cultural and language barriers to their engagement, the racial/ethnic demography of FACT service providers should approximate that of their service recipients. 32 Although ACT is an essential element of FACT, research has consistently suggested that ACT alone has little or no effect at preventing arrest and incarceration among ACT service recipients. 30,31,76 Still, some mental health professionals have continued to suggest that ACT is sufficient to prevent criminal recidivism among justice-involved patients.…”

“…In addition, it should be recognized that persons of color are highly overrepresented within the criminal justice system 74,75 . To help overcome cultural and language barriers to their engagement, the racial/ethnic demography of FACT service providers should approximate that of their service recipients 32 …”

“…Special training, requisite experience, or other competencies were also recorded, as research suggests that FACT patients have special needs compared to ACT patients. 32 Admission criteria were likewise noted, with an emphasis on identifying both mental health and criminal justice criteria. Consistent with the riskneed-responsivity model, 33 the predominant model of crime prevention today, 34 programs were surveyed to determine whether they had incorporated methods to identify and address criminogenic needs.…”

Differences Between Clients and Professionals of Forensic and Nonforensic Flexible Assertive Community Treatment

“…Clients of ForFACT services are distinctly different from clients of non-ForFACT teams. ForFACT clients were, for example, more likely to have experienced homelessness (Cuddeback & Morrisey, 2011). ForFACT clients were also shown to have higher rates of psychotic disorders and more antisocial personality disorders, whereas non-ForFACT clients showed higher rates of affective disorders, panic disorder, and posttraumatic stress disorder (Cuddeback & Morrisey, 2011).…”