Assertive Community Treatment

To use the assertive community treatment model to reorganize or enhance existing services for persons with severe mental illnesses in Brown County

Severe Mental Illness

Brown County, OH

$293,823

2000

18 months

The ACT team provides community-based services including frequent client contacts, medication management, counseling, social support, crisis intervention, assistance with housing and finances, vocational support, family advocacy and support, and transportation. The ACT team consists of a psychiatrist, a team leader, a masters-level clinician with vocational expertise, a registered nurse, two bachelor-level case managers, and a peer specialist. As of October 2002, the ACT team is serving 24 clients.

The project team measured the following outcomes:

• Empowerment: The team administered the Empowerment Questionnaire upon admission to the ACT team and at six-month intervals. There was an increase in self-reported sense of empowerment.
  
• Missed Appointments: The team measured missed appointments one year prior to admission to the ACT team and one year after. Missed appointments went from 114 to 37, a 68% reduction.
  
• Cost of Missed Appointments: In the year prior to the ACT team, missed appointments cost the agency $14,448 and in the year after ACT, the cost was $3,901.
  
• Symptoms: The team compared client’s symptoms prior to admission to the ACT team, after six months, and after one year on the ACT team. Results showed reductions in manic episodes, hallucinations, and depression.
  
• Housing Stability: All ACT clients maintained stable housing after one year of ACT services.
  
• Vocational Status: None of the ACT clients were employed in the year prior to ACT and in the year after admission to ACT, five clients were either seeking employment, employed part-time, or continuing education.
  
• Psychiatric Hospitalization Days: Comparing the year before to the year after ACT, psychiatric hospitalizations went from 623 days to 49 days, a 92% reduction.
  
• Psychiatric Hospitalization Costs: Costs associated with the reduction in hospitalization went from $243,294 in the year prior to ACT to $22,866 in the year after ACT.
  
• Helpline Crisis Calls: Comparing the year before ACT to the year after, helpline crisis calls went from 83 to 54, a 35% reduction.
  
• Incarcerations: There were four arrests in the year prior to ACT and two arrests in the year after the ACT team served the clients.
  
• Client Satisfaction: There was a modest increase in client satisfaction after ACT team services. Because it takes time for clients to develop relationships with new caregivers, the satisfaction scores are expected to gradually increase as relationships are built.
  
• Family Satisfaction: Attempts to survey family members were not successful. Reasons included families not understanding the illness or being uninvolved with the client.
  
• Dollars Billed: In the year prior to ACT compared to the year after, billing for services to insurance providers and Medicaid increased from $71,813 to $183,457. This billing increase is due to the fact that the ACT team saw clients more frequently.