CLINICAL HANDBOOK OF SCHIZOPHRENIA

33. Assertive Community Treatment 337ACT services, practitioners must not only adhere to the structural features of the modelbut also develop the necessary skills to deliver integrated, comprehensive treatment thatpromotes recovery for the clients they serve.KEY POINTS• ACT is a clearly defined model that, when carefully implemented, has been shown to reducepsychiatric hospitalizations greatly and increase housing stability, while moderatelyimpacting psychiatric symptoms and quality of life.• ACT is appropriate for individuals with schizophrenia spectrum disorders, with the most persistentand devastating levels of impairment, who have not successfully engaged with lessintensive, office-based mental health services.• Well-run ACT programs must attend to both clinical skills development and model specifications.• The ACT organizational framework is well suited to implementation of evidence-based clinicalinterventions, such as illness self-management, medication guidelines, supported employment,integrated dual-disorder treatment, and family psychoeducation.• Ongoing quality improvement efforts based on monitoring fidelity to the ACT model and valuedclient outcomes should be a part of any ACT team’s practice.• In providing ACT services, it is important to promote client choice, recovery, and meaningfulcommunity integration, and to be particularly sensitive to the promotion of these valueswhen considering the intensive, assertive nature of ACT services.• A good ACT team requires an empowered team leader, and sufficient organizational supportto implement the model fully.REFERENCES AND RECOMMENDED READINGSAdams, N., & Grieder, D. (2005). Treatment planning for person-centered care: The road to mentalhealth and addiction recovery. Burlington, MA: Elsevier Academic Press.Allness, D. J., & Knoedler, W. H. (2003). The PACT model of community-based treatment for personswith severe and persistent mental illness: A manual for PACT start-up (2nd ed.). Arlington, VA:National Alliance on Mental Illness.Assertive Community Treatment Implementation Resource Kit. (2003). SAMHSA Center for MentalHealth Services. Available online at www.mentalhealth.samhsa.gov/cmhs/communitysupport/toolkits/community/Backlar, P., & Cutler, D. L. (Eds.). (2002). Ethics in community mental health care: Commonplaceconcerns. New York: Kluwer Academic/Plenum Press.Bond, G. R., Drake, R. E., Mueser, K. T., & Latimer, E. (2001). Assertive community treatment forpeople with severe mental illness: Critical ingredients and impact on patients. Disease Managementand Health Outcomes, 9, 141–159.Coldwell, C. M., & Bender, W. S. (2007). The effectiveness of assertive community treatment forhomeless populations with severe mental illness: A meta-analysis. American Journal of Psychiatry,164, 393–399.Corrigan, P. W. (2002). Empowerment and serious mental illness: Treatment partnerships and communityopportunities. Psychiatric Quarterly, 73(3), 217–228.Coursey, R. D., Curtis, L., Marsh, D. T., Campbell, J., Harding, C., Spaniol, L., et al. (2000). Competenciesfor direct service staff members who work with adults with severe mental illnesses: Specificknowledge, attitudes, skills, and bibliography. Psychiatric Rehabilitation Journal, 23(4),378–392.Krupa, T., Eastabrook, S., Hern, L., Lee, D., North, R., Percy, K., et al. (2005). How do people who receiveassertive community treatment experience this service? Psychiatric Rehabilitation Journal,29, 18–24.Monahan, J., Redlich, A. D., Swanson, J., Robbins, P. C., Appelbaum, P., Petrila, J., et al. (2005). Use