Skip to main content

Advertisement

SpringerLink
Log in

Discharge Practices in a Time-Unlimited Intervention: The Perspectives of Practitioners in Assertive Community Treatment

  • Original Paper
  • Published:
Administration and Policy in Mental Health and Mental Health Services Research Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Notes

  1. 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.

References

  • Angell, B. (2003). Contexts of social relationship development among assertive community treatment clients. Mental Health Services Research, 5(1), 13–25.

    Article  PubMed  Google Scholar 

  • Angell, B. (2006). Measuring strategies used by mental health providers to encourage medication adherence. Journal of Behavioral Health Services and Research, 33(1), 53–72.

    Article  PubMed  Google Scholar 

  • Angell, B., & Mahoney, C. (2007). Reconceptualizing the case management relationship in intensive treatment: A study of staff perceptions and experiences. Administration and Policy in Mental Health and Mental Health Services Research, 34(2), 172–188.

    Article  PubMed  Google Scholar 

  • Angell, B., Mahoney, C. A., & Martinez, N. I. (2006). Promoting treatment adherence in assertive community treatment. Social Service Review, 80(3), 485–526.

    Article  Google Scholar 

  • Angell, B., & Test, M. A. (2002). The relationship of clinical factors and environmental opportunities to social functioning in young adults with schizophrenia. Schizophrenia Bulletin, 28(2), 259–271.

    Article  PubMed  Google Scholar 

  • Anthony, W. A. (2000). A recovery-oriented service system: Seeing some system level standards. Psychiatric Rehabilitation Journal, 24(2), 159–168.

    Google Scholar 

  • Backer, T. E., Howard, E. A., & Moran, G. E. (2007). The role of effective discharge planning in preventing homelessness. Journal of Primary Prevention, 28, 229–243.

    Article  PubMed  Google Scholar 

  • Bergman, L. R., & Trost, K. (2006). The person-oriented versus the variable-oriented approach: Are they complementary, opposites, or exploring different worlds? Merrill-Palmer Quarterly, 52(3), 601–632.

    Article  Google Scholar 

  • Calsyn, R. J., Morse, G. A., Klinkenberg, W. D., Trusty, M. L., & Allen, G. (1998). The impact of assertive community treatment on the social relationships of people who are homeless and mentally ill. Community Mental Health Journal, 34(6), 579–593.

    Article  PubMed  CAS  Google Scholar 

  • Carton, A. D., Young, M. S., & Kelly, K. M. (2010). Changes in sources and perceived quality of social supports among formerly homeless persons receiving assertive community treatment services. Community Mental Health Journal, 46(2), 156–163.

    Article  PubMed  Google Scholar 

  • Chen, F. (2008). Working with families in Assertive Community Treatment (ACT): The case manager’s perspective. American Journal of Orthopsychiatry, 78(4), 456–465.

    Article  PubMed  Google Scholar 

  • Chen, F. (2010). Assisting adult clients with severe mental illness to move out of parental homes. Community Mental Health Journal, 46(4), 372–380.

    Article  PubMed  Google Scholar 

  • Clark, R. E. (1997). Financing assertive community treatment. Administration and Policy In Mental Health, 25(2), 209–220.

    Article  PubMed  CAS  Google Scholar 

  • Deegan, P. E. (1988). Recovery: The lived experience of rehabilitation. Psychosocial Rehabilitation Journal, 11(4), 11–19.

    Google Scholar 

  • Deegan, G. (2003). Discovering recovery. Psychiatric Rehabilitation Journal, 26, 368–376.

    Article  PubMed  Google Scholar 

  • Dixon, L. (2000). Assertive community treatment: Twenty-five years of gold. Psychiatric Services, 51(6), 759–765.

    Article  PubMed  CAS  Google Scholar 

  • Drake, R. E., Mueser, K. T., Brunette, M. F., & McHugo, G. J. (2004). A review of treatments for people with severe mental illness and co-occurring substance use disorders. Psychiatric Rehabilitation Journal, 27(4), 360–374.

    Article  PubMed  Google Scholar 

  • Drake, R. E., Wallach, M. A., & McGovern, M. P. (2005). Special section on relapse prevention: Future directions in preventing relapse to substance abuse among clients with severe mental illnesses. Psychiatric Services, 56(10), 1297–1302.

    Article  PubMed  Google Scholar 

  • Essock, S. M., Frisman, L. K., & Kontos, N. L. (1998). Cost-effectiveness of Assertive Community Treatment teams. American Journal of Orthopsychiatry, 68, 179–190.

    Article  PubMed  CAS  Google Scholar 

  • Fisher, D. B., & Ahern, L. (2000). Personal assistance in community existence (PACE): An alternative to PACT. Ethical human Sciences and Services, 2(2), 87–92.

    Google Scholar 

  • Friedrich, R., Hollingsworth, B., Hradeck, E., Friedrich, H., & Culp, K. (1999). Family and client perspectives on alternative residential settings for persons with severe mental illness. Psychiatric Services, 50(4), 509–514.

    PubMed  CAS  Google Scholar 

  • Gomory, T. (1999). Programs of Assertive Community Treatment (PACT): A critical review. Ethical human Sciences and Services, 1(2), 147–163.

    Google Scholar 

  • Green, C. A., Polen, M. R., Janoff, S. L., Castleton, D. K., Wisdom, J. R., Vuckovic, N., et al. (2008). Understanding how clinician-patient relationships and relational continuity of care affect recovery from serious mental illness: STARS study results. Psychiatric Rehabilitation Journal, 32(1), 9–22.

    Article  PubMed  Google Scholar 

  • Henry, A. D., & Lucca, A. M. (2004). Facilitators and barriers to employment: The perspectives of people with psychiatric disabilities and employment service providers. Work, 22(3), 169–182.

    PubMed  Google Scholar 

  • Jacobson, N., & Greenley, D. (2001). What is recovery? A conceptual model and explication. Psychiatric Services, 52, 482–485.

    Article  PubMed  CAS  Google Scholar 

  • Kilbourne, A. M., Irmiter, C., Capobianco, J., Reynolds, K., Milner, K., Barry, K., et al. (2008). Improving integrated general medical and mental health services in community-based practices. Administration and Policy in Mental Health and Mental Health Services Research, 35(5), 337–345.

    Article  PubMed  Google Scholar 

  • Macias, C., Jones, D. R., Hargreaves, W. A., Wang, Q., Rodican, C. F., Barreira, P. J., et al. (2008). When programs benefit some people more than others: Tests of differential service effectiveness. Administration and Policy in Mental Health and Mental Health Services Research, 35(4), 283–294.

    Article  PubMed  Google Scholar 

  • McGrew, J. H., & Bond, G. R. (1995). Critical ingredients of assertive community treatment: Judgments of the experts. The Journal of Mental Health Administration, 22(2), 113–125.

    Article  CAS  Google Scholar 

  • McGrew, J., Pescosolido, B. A., & Wright, E. R. (2003). Case manager perspectives on assertive community treatment: Critical ingredients, clinical ingredients, and variations in implementation”. Psychiatric Services, 54, 370–376.

    Article  PubMed  Google Scholar 

  • McRae, J., Higgins, M., Lycan, C., & Sherman, W. (1990). What happens to patients after five years of intensive case management stops? Hospital & Community Psychiatry, 41, 175–179.

    CAS  Google Scholar 

  • Monroe-DeVita, M., Teague, G. B., & Moser, L. L. (2011). The TMACT: A new tool for measuring fidelity to Assertive Community Treatment. Journal of the American Psychiatric Nurses Association, 17(1), 17–29.

    Article  PubMed  Google Scholar 

  • Moyse, H. S., & Osmun, W. E. (2004). Discharges against medical advice: A community hospital’s experience. Canadian Journal of Rural Medicine, 9(3), 148–153.

    Google Scholar 

  • Mueser, K. T., Torrey, W. C., Lynde, D., Singer, P., & Drake, R. E. (2003). Implementing evidence-based practices for people with severe mental illness. Behavior Modification, 27(3), 387–411.

    Article  PubMed  Google Scholar 

  • National Advisory Mental Health Council. (2006). The road ahead: Research partnerships to transform services: A report by the National Advisory Mental Health Council’s Workgroup on services and clinical epidemiology research. USA: National Institute of Mental Health.

    Google Scholar 

  • Neale, M. S., & Rosenheck, R. A. (2000). Therapeutic limit setting in an assertive community treatment program. Psychiatric Services, 51, 499–505.

    Article  PubMed  CAS  Google Scholar 

  • New York State Office of Mental Health. (2007). ACT certification manual. Albany, NY: New York State Office of Mental Health.

    Google Scholar 

  • New York State Office of Mental Health. (2008). NYS Office of Mental Health Awarded $1.9 Million Grant to Research and Pilot ACT Step-Down Approaches. http://www.omh.state.ny.us/omhweb/News/pr_act_step_down.html. Retrieved 1 Sep 2010

  • Peladeau, N. (2004). QDA miner qualitative data analysis software, user’s guide. Montreal: Provalis Research.

    Google Scholar 

  • Phillips, S. D., Burns, B. J., Edgar, E. R., Mueser, K. T., Linkins, K. W., Rosenheck, R. A., et al. (2001). Moving assertive community treatment into standard practice. Psychiatric Services, 52(6), 771–779.

    Article  PubMed  CAS  Google Scholar 

  • Prowse, L., & Coombs, T. (2009). The use of the Health of the Nation Outcome Scales (HoNOS) to inform discharge and transfer decisions in community mental health service. Australian Health Review, 33(1), 13–18.

    Article  PubMed  Google Scholar 

  • Ritsher, J. B., Lucksted, A., Otilingam, P. G., & Grajales, M. (2004). Hearing voices: Explanations and implications. Psychiatric Rehabilitation Journal, 27(3), 219–227.

    Article  PubMed  Google Scholar 

  • Rosenheck, R. A., & Dennis, D. (2001). Time-limited assertive community treatment for homeless persons with severe mental illness. Archive of General Psychiatry, 58(11), 1073–1080.

    Article  CAS  Google Scholar 

  • Salyers, M. P., Masterton, T. W., Fekete, D. M., Picone, J. J., & Bond, G. R. (1998). Transferring clients from intensive case management: Impact on client functioning. American Journal of Orthopsychiatry, 68(2), 233–245.

    Article  PubMed  CAS  Google Scholar 

  • Salyers, M. P., & Tsemberis, S. (2007). ACT and recovery: Integrating evidence-based practice and recovery orientation on assertive community treatment teams. Community Mental Health Journal, 43(6), 619–641.

    Article  PubMed  Google Scholar 

  • Siegel, C. E., Samuels, J., Tang, D., Berg, I., Jones, K., & Hopper, K. (2006). Tenant outcomes in supported housing and community residences in New York City. Psychiatric Services, 57(7), 982–991.

    Article  PubMed  Google Scholar 

  • Solomon, P., & Stanhope, V. (2004). Recovery: Expanding the vision of evidence-based practice. Brief Treatment and Crisis Intervention, 4(4), 311–321.

    Article  Google Scholar 

  • Stanhope, V., Henwood, B. F., & Padgett, D. K. (2009a). Understanding service disengagement from the perspective of case managers. Psychiatric Services, 60(4), 459–464.

    Article  PubMed  Google Scholar 

  • Stanhope, V., Marcus, S., & Solomon, P. (2009b). The impact of coercion on services from the perspective of mental health care consumers with co-occurring disorders. Psychiatric Services, 60(2), 183–188.

    Article  PubMed  Google Scholar 

  • Stanhope, V., & Matejkowski, J. (2010). Exploring client-provider relationships within a team case management model. Community Mental Health Journal, 46(4), 309–318.

    Article  PubMed  Google Scholar 

  • Stein, L. I., & Test, M. A. (1980). Alternative to mental Hospital treatment. I. Conceptual model, treatment program, and clinical evaluation. Archives of General Psychiatry, 37(4), 392–397.

    Article  PubMed  CAS  Google Scholar 

  • Substance Abuse and Mental Health Services Administration. (2005). National Consensus Statement on Mental Health Recovery. http://mentalhealth.samhsa.gov/publications/allpubs/sma05-4129/. Retrieved 2 Jan 2009.

  • Teague, G. B., Bond, G. R., & Drake, R. E. (1998). Program fidelity in assertive community treatment: Development and use of a measure. American Journal of Orthopsychiatry, 68(2), 216232.

    Article  Google Scholar 

  • Teague, G. B., Monroe-DeVita, M., & Moser, L. (June 2009). Enhancing ACT fidelity assessment: Introducing the TMACT. Presented at the Annual Assertive Community Treatment Conference, Arlington, VA.

Download references

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.

Author information

Authors and Affiliations

  1. Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, 10027, USA

    Fang-pei Chen

  2. Division of Mental Health Services and Policy Research, New York State Psychiatric Institute, New York, NY, USA

    Daniel B. Herman

  3. College of Physicians and Surgeons, Columbia University, New York, NY, USA

    Daniel B. Herman

Authors
  1. Fang-pei Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daniel B. Herman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fang-pei Chen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

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

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10488-011-0344-1

Keywords

Search

Navigation