Abstract
The Assertive Community Treatment (ACT) model for people with severe mental illness has typically been viewed as a time-unlimited intervention. Without a proscribed service duration, discharge from ACT largely depends on individual clients’ situations and practitioners’ discretion. We conducted semi-structured focus groups and interviews with practitioners to explore their discharge practices and considerations. Results highlight the heterogeneity of the clientele served in ACT, and therefore the importance of individualized treatment and discharge planning, guidance on assessing the timing of discharge for individual cases, practice strategies that balance independence and social connectedness to promote recovery, and the need for substantial system reform to facilitate transition after discharge.
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Notes
In New York State, ACT can be provided at either the intensive or supportive level. The intensive level requires a minimum of six visits per month (among which there can be one collateral contact with family, landlord, etc., consistent with the treatment plan) and receives full reimbursement. The supportive level requires a minimum of two visits per month and receives partial reimbursement (New York State Office of Mental Health 2007). The practitioners reported that while the supportive level of services was available and helpful for client independence training, the partial billing condition became a disincentive to use of the supportive level when the organizational finance was concerned.
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Acknowledgments
Funding for this study was provided by the Office of Mental Health Policy Scholars Program, Division of Mental Health Services and Policy Research, New York State Psychiatric Institute. The authors thank Dr. Susan M. Essock, Director of the Division of Mental Health Services and Policy Research New York State Psychiatric Institute and Ms. Candice B. Stellato, Director of Assertive Community Treatment, Bureau of Program Coordination and Support New York State Office of Mental Health, for their support in conducting this research. Earlier versions of the paper were presented at New York State Psychiatric Institute, the Division of Mental Health Services and Policy Research Thursday Series, New York, New York, December 2009, and the Fourteenth Annual Conference of the Society for Social Work and Research, San Francisco, California, January 2010.
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Chen, Fp., Herman, D.B. Discharge Practices in a Time-Unlimited Intervention: The Perspectives of Practitioners in Assertive Community Treatment. Adm Policy Ment Health 39, 170–179 (2012). https://doi.org/10.1007/s10488-011-0344-1
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DOI: https://doi.org/10.1007/s10488-011-0344-1