Implementing assertive community treatment in diverse settings for people who are homeless with co-occurring mental and addictive disorders: A series of case studies
More than 30 years ago, the Assertive Community Treatment model (ACT) was developed to treat individuals with serious and persistent mental illness. This qualitative study identifies practical challenges encountered when establishing ACT teams in diverse settings serving people who are homeless with co-occurring mental and addictive disorders (COD). Program administrators and evaluators from nine programs in seven States completed a survey on implementation challenges, commitments, modifications to the ACT model, and program successes. Staffing, funding limitations, and difficulties with implementing the ACT model without modifications, were reported as the majority of challenges. Several modifications to the model including: emphasizing housing, adding staff positions not prescribed by ACT, implementing mini-teams within the program, delivering in-office services in a group format, and placing time-limited services by transitioning consumers to less intensive settings were believed beneficial to recruiting and retaining consumers. Successes included reduction in hospitalizations, psychiatric symptoms, and substance abuse. Stabilization of consumers was attributed largely to housing assistance and maintenance; medication adherence; and delivery of intensive, multidisciplinary services including substance abuse treatment. Implications of this study suggest that tailoring program staffing and service delivery of the ACT model for people who are homeless with COD is crucial. Also, there is a need for a measure capable of assessing ACT fidelity in the context of both integrated treatment for the homeless population and housing models.
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