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Assertive Community Treatment as Community Change Intervention

Anna Scheyett, Carrie Pettus-Davis, and Gary Cudderback (2010). Assertive Community Treatment as Community Change Intervention. Journal of Community Practice, 18 (1): 76-93.

Assertive Community Treatment (ACT) is a wrap-around case management intervention for persons with serious mental illness (SMI). However, as this article's authors, observe, little attention has been given to the impact of ACT on community services; similarly studies of community corrections programs have typically avoided assessment of these initiatives on community services. According to Scheyett, Petrus-Davis and Cudderback, who teach social work at the University of North Carolina at Chapel Hill, the purpose of this article is to use focus group data "to understand the changes that occurred in the community service systems and informal community resources as a result of the presence of ACT teams and the processes by which these changes occurred."

The ACT program model consists of team-centered, home- and community-oriented, long-term intensive care to divert persons with SMI from psychiatric hospitalization and penal incarceration. ACT teams typically consist of case managers, nurses, psychiatrists, social workers, and vocational rehab specialists who engage in an individualized planning process for providing appropriate services in community settings. As Scheyett and her colleagues note, studies have shown that ACT effectively reduces psychiatric hospitalization and homeless, while improving access to community housing. ACT team members frequently interact with a full range of formal and informal resources within communities, including probation and parole officers.

For this study, the authors of this article conducted semi-structured interviews with 33 ACT staff members in five Ohio teams and one Indiana team. Criminal justice was at the core of these teams' work: "Three teams served individuals with SMI from their local jails, one team served individuals with SMI from the state's prison system, and two teams served traditional and justice-involved individuals with SMI." Six focus groups lasting one to two hours were held with these ACT staff members, mostly case managers and clinical or program directors who were predominantly white females. The most common diagnosis for individuals in these programs was bipolar disorder, depression, schizophrenia, and psychotic disorder; three-quarters of the program participants were substance abusers and one-half had been homeless prior to receiving services.

Results of these interviews focused on the process of establishing ACT teams, changes stemming from the implementation of these teams, changes occurring outside their agencies after implementation of these teams, and "overall experiences" with these teams. Changes occurred, according to focus group staff members, in the larger mental health centers wherein ACT teams were located, in community-based human services agencies, with primary care providers, in the criminal justice system, and with community members who interacted with SMI persons. These changes included "increased awareness and understanding of persons with SMI, increased access to services and resources, increased collaboration across service systems, and decreased stigma from service providers and community members towards individuals with SMI." As a result of the program, for example, one interviewee suggested that criminal justice personnel "were bringing more and more awareness of what case management does (and) that's really increasing mitigation for people who are non-violent offenders and who have mental health issues. So they're working to take people out of jail to be connected with treatment."

Significantly, Scheyett, Petrus-Davis and Cudderback conclude that ACT promotes change in local community service systems: "Prior to ACT presence, community service systems were described as having fragmented services and gaps among community agencies and systems. Individuals with SMI, particularly those who were justice-involved, were either invisible and outside of provider awareness or stigmatized and seen as dangerous, difficult, and unable to succeed. After ACT teams began working in the community, things changed. Providers and community systems created new ways of communication, collaboration, and negotiation, reconstructing the community systems' responses to the needs of people with SMI. The individuals themselves were redefined as well, seen as in need of treatment and 'worthy' of accessing both formal and informal community resources."

For further information, contact Anna Scheyett, School of Social Work, University of North Carolina at Chapel Hill, 325 Pittsboro St., CB #3550, Chapel Hill, NC 27599-3550, (919)962-4372, (email)

Posted Wed, Mar 2 2011 9:07 AM by Tracey Vessels


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