Assertive Community Treatment

Assertive Community Treatment

Many individuals with severe mental illness benefit from intensive support, which helps them to succeed in the community. Now 50 years since its inception, assertive community treatment (ACT) remains a standard approach for reducing recurrent use of hospital services, improving community functioning, and maintaining treatment engagement. In ACT, advantages may be bidirectional; patients benefit from working closely with a specialized, multidisciplinary team, and the care team often develops a camaraderie as they provide excellent, person-centered, team-based care. A demand for services that exceeds the limited availability of ACT has led to considering readiness for transition from ACT to increase turnover rates while sustaining individuals’ recovery (versus a model of lifelong enrollment), as well as intentional adaptations to the model to serve larger caseloads and promote efficiency (e.g., flexible ACT). Other adaptations have included developing additional expertise and adding model components to best treat specific populations.

The first section of this collection provides an overview of the staff experience, structure, advantages, and challenges of ACT. The second section examines recent care trends, including a decline in ACT availability across the United States and potential solutions for a more equitable distribution of services. The third section explores potential models for primary care integration in ACT. The final section highlights adaptations to optimize program effectiveness for specific populations, including the elderly population, persons experiencing housing instability, and forensically involved individuals.

OVERVIEW

Assertive Community Treatment: Twenty-Five Years of Gold
Lisa Dixon, M.D., M.P.H.
2000, Volume 51, Issue 6, pp 759–765

ACT for Life: Why Psychiatrists Pound the Pavement to Provide Care
Jeanie Tse, M.D., Raj Chablani, M.D.
2021, Volume 72, Issue 9, pp 1099–1102

TRENDS IN CARE

Availability of Assertive Community Treatment in the United States: 2010 to 2016
Stanislav Spivak, M.D., Bernadette A. Cullen, M.B.B.Ch., B.A.O., Charee Green, L.C.P.C., Tyler Firth, L.C.P.C., Holly Sater, L.C.P.C., Ramin Mojtabai, M.D., Ph.D.
2019, Volume 70, Issue 10, pp 948–951

Time in Assertive Community Treatment: A Statewide Quality Improvement Initiative to Reduce Length of Participation
Steven Huz, Ph.D., M.P.A., Helle Thorning, Ph.D., M.S., Candace N. White, Ph.D., M.Ed., Lin Fang, Ph.D., L.C.S.W., Bikki Tran Smith, M.A., M.S.W., Marleen Radigan, Dr.P.H., M.P.H., Lisa B. Dixon, M.D., M.P.H.
2017, Volume 68, Issue 6, pp 539–541

Patient Outcomes of Flexible Assertive Community Treatment Compared With Assertive Community Treatment
Camilla Munch Nielsen, Ph.D., Carsten Hjorthøj, Ph.D., Benjamin Thorup Arnfred, Ph.D., Merete Nordentoft, Ph.D., D.M.Sc.
2023, Volume 74, Issue 7, pp 695–701

PRIMARY CARE INTEGRATION

Systematic Literature Review of General Health Care Interventions Within Programs of Assertive Community Treatment
Erik R. Vanderlip, M.D., M.P.H., Benjamin F. Henwood, M.S.W., Ph.D., Debra R. Hrouda, Ph.D., L.I.S.W.-S., Piper S. Meyer, Ph.D., Maria Monroe-DeVita, Ph.D., Lynette M. Studer, Ph.D., L.C.S.W., April J. Schweikhard, M.L.I.S., Lorna L. Moser, Ph.D.
2017, Volume 68, Issue 3, pp 218–224

Integrated Primary Care in Assertive Community Treatment
Benjamin F. Henwood, Ph.D., L.C.S.W., Elizabeth Siantz, Ph.D., Debra R. Hrouda, Ph.D., L.I.S.W.-S., Debbie Innes-Gomberg, Ph.D., Todd P. Gilmer, Ph.D.
2018, Volume 69, Issue 2, pp 133–135

Integrating Primary Care Into Assertive Community Treatment
Jeanie Tse, M.D., Jason E. Cheng, M.D., Edward Tabasky, M.D., Emily Kingman, L.C.S.W., Drew LaStella, Ph.D., Gertie Quitangon, M.D., David Woodlock, M.S.
2022, Volume 73, Issue 5, pp 565–569

SPECIFIC POPULATIONS

Cost-Effectiveness of Housing First With Assertive Community Treatment: Results From the Canadian At Home/Chez Soi Trial
Eric A. Latimer, Ph.D., Daniel Rabouin, M.Sc., Zhirong Cao, M.Sc., Angela Ly, M.H.A., Guido Powell, M.Sc., Tim Aubry, Ph.D., Jino Distasio, Ph.D., Stephen W. Hwang, M.D., M.P.H., Julian M. Somers, Ph.D., Ahmed M. Bayoumi, M.D., M.Sc., Craig Mitton, Ph.D., Erica E. M. Moodie, Ph.D., Paula N. Goering, R.N., Ph.D.
2020, Volume 71, Issue 10, pp 1020–1030

A Multiple-City RCT of Housing First With Assertive Community Treatment for Homeless Canadians With Serious Mental Illness
Tim Aubry, M.A., Ph.D., Paula Goering, R.N., Ph.D., Scott Veldhuizen, M.A., Carol E. Adair, M.Sc., Ph.D., Jimmy Bourque, Ph.D., Jino Distasio, Ph.D., Eric Latimer, Ph.D., Vicky Stergiopoulos, M.D., M.H.Sc., Julian Somers, Ph.D., David L. Streiner, Ph.D., Sam Tsemberis, Ph.D.
2016, Volume 67, Issue 3, pp 275–281

A New Model: Psychogeriatric Assertive Community Treatment
Claire Stanley, M.D., Vicky Stergiopoulos, M.D., M.H.Sc., Sarah Colman, B.Arts.Sc., M.D.
2023, Volume 74, Issue 1, pp 104–105

A Randomized Controlled Trial of the Rochester Forensic Assertive Community Treatment Model
J. Steven Lamberti, M.D., Robert L. Weisman, D.O., Catherine Cerulli, J.D., Ph.D., Geoffrey C. Williams, M.D., Ph.D., David B. Jacobowitz, B.S., M.A., Kim T. Mueser, Ph.D., Patricia D. Marks, J.D., Robert L. Strawderman, Sc.D., Donald Harrington, M.S., Tara A. Lamberti, B.A., Erica D. Caine, M.D.
2017, Volume 68, Issue 10, pp 1016–1024

Affordability of Forensic Assertive Community Treatment Programs: A Return-on-Investment Analysis
Daniel Maeng, Ph.D., Zhi-Yang Tsun, M.D., Ph.D., Eric Lesch, M.D., David B. Jacobowitz, M.A., Robert L. Strawderman, Sc.D., Donald K. Harrington, M.B.A., Yue Li, Ph.D., M.S., Robert L. Weisman, D.O., J. Steven Lamberti, M.D.
2023, Volume 74, Issue 4, pp 358–364

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