Another example, in California, a capitated program (set price per person) named STRIDES (Steps Towards Recovery, Independence, Dignity, Empowerment, and Success), is a close replica to the ACTS model. There is a low caseloads, 24 hour availability, weekly meetings, and medication monitoring. In addition, there are substance abuse counselors and employment specialists available to clients (Chandler, Spicer, Wagner, & Hargreaves, 1999).
Chandler et al., 1999, conducted a study of 60 participants, receiving in-patient care at a long term mental health facility (Chandler et al., 1999). The goal was to show that a capitated ACTS model would lead to early community integration (Chandler et al., 1999). Thirty of the subjects received services from an ACT team and the comparison group received treatment as usual from the county (Chandler et al., 1999). The results for the participants involved with the ACT team shows: all were released into the community within 116 days; the cost of care was about 13 thousand dollars; and had over twice as many days spent in the community (Chandler et al., 1999). In contrast, the comparison group: integrated at a much slower pace; for example, 12 of the comparison group remained hospitalized after 12 months; seven remained after 16 months; and the cost was over 39 thousand dollars (Chandler et al., 1999). The study proves that STRIDES is an economically sound program providing clients tools to function in the community, obtain a better quality of life, and accessing treatment and services (Chandler et al., 1999). Barriers to Implementation There are several barriers that can cause difficulty when implementing the ACT model. In the first place, it is important for programs to follow the ACT model to achieve the same outcomes (SAMSHA, 2008). Frequently, deviations from the ACT model comprises fidelity, costs and the model’s effectiveness (Phillips, Burns, Edgar, Mueser, Linkins, Rosenheck, & McDonel Herr, 2001). Many times programs have difficulty continuing with ACT causing it to falter (SAMSHA, 2008). Secondly, funding can be an issue when trying to establish an ACT model. Medicaid does not always cover the cost for services delivered by the ACT team (Phillips et al., 2001). It is important to learn how Medicaid reimburses for benefits, so additionally funding can be secured if needed (Phillips et al., 2001). Next, one of the greatest concerns in putting an ACT program into practice is coercion (SAMSHA, 2008). In fact, many consumer groups and providers have expressed concerns about the potential for coercive practices within the ACT framework. One in ten consumers felt ACT was too intrusive or coercive. While the ACT model does not advocate using coercive measures, some suggest that a fine line exists between “assertive” and coercive treatment practices (SAMSHA, 2008, p. 17). ACT teams need to insure consumers preferences are recognized and attained in their treatment plans (SAMSHA, 2008). Lastly, it is important that ACT teams have the necessary training especially cultural competence. Lack of training and cultural competence will lead to stigma, misunderstandings, and frustration (SAMSHA, 2008). ACT teams deliver services in the community; therefore, teams need to be diverse as the community they work in. Additionally, lack of training will hinder the team member’s ability to understand, …show more content…
For example, Thresholds, in Chicago, adopted a recovery-based ACT that works in collaboration with clients (Furlong, et al., 2009). Thresholds changed the following designs to the ACT model to fit a recovery model: money no longer a bargaining tool for compliance or choices; no forced medication; team now offers clients alternatives; hope is instilled; and long-term goals are made (Furlong, et al., 2009). Also, to facilitate a recovery role, Thresholds’ team members outlined the following concepts: to believe everyone can and will recover; listen and don’t judge clients; discuss goals and desires; ask the right questions (what do you want?); and allow clients to tell their stories (Furlong, et al., 2009). Drake and Deegan, (2008), recognize ACTS is not a recovery model. However, they concede that the U.S. mental health system is failing clients in many poor and/or rural areas (Drake, & Deegan, 2008). They suggest ACT is necessary in providing outpatient services in states; because, they have a short supply of community based mental health centers and high rates of homelessness, incarceration, and hospitalizations (Drake, & Deegan,
Chandler et al., 1999, conducted a study of 60 participants, receiving in-patient care at a long term mental health facility (Chandler et al., 1999). The goal was to show that a capitated ACTS model would lead to early community integration (Chandler et al., 1999). Thirty of the subjects received services from an ACT team and the comparison group received treatment as usual from the county (Chandler et al., 1999). The results for the participants involved with the ACT team shows: all were released into the community within 116 days; the cost of care was about 13 thousand dollars; and had over twice as many days spent in the community (Chandler et al., 1999). In contrast, the comparison group: integrated at a much slower pace; for example, 12 of the comparison group remained hospitalized after 12 months; seven remained after 16 months; and the cost was over 39 thousand dollars (Chandler et al., 1999). The study proves that STRIDES is an economically sound program providing clients tools to function in the community, obtain a better quality of life, and accessing treatment and services (Chandler et al., 1999). Barriers to Implementation There are several barriers that can cause difficulty when implementing the ACT model. In the first place, it is important for programs to follow the ACT model to achieve the same outcomes (SAMSHA, 2008). Frequently, deviations from the ACT model comprises fidelity, costs and the model’s effectiveness (Phillips, Burns, Edgar, Mueser, Linkins, Rosenheck, & McDonel Herr, 2001). Many times programs have difficulty continuing with ACT causing it to falter (SAMSHA, 2008). Secondly, funding can be an issue when trying to establish an ACT model. Medicaid does not always cover the cost for services delivered by the ACT team (Phillips et al., 2001). It is important to learn how Medicaid reimburses for benefits, so additionally funding can be secured if needed (Phillips et al., 2001). Next, one of the greatest concerns in putting an ACT program into practice is coercion (SAMSHA, 2008). In fact, many consumer groups and providers have expressed concerns about the potential for coercive practices within the ACT framework. One in ten consumers felt ACT was too intrusive or coercive. While the ACT model does not advocate using coercive measures, some suggest that a fine line exists between “assertive” and coercive treatment practices (SAMSHA, 2008, p. 17). ACT teams need to insure consumers preferences are recognized and attained in their treatment plans (SAMSHA, 2008). Lastly, it is important that ACT teams have the necessary training especially cultural competence. Lack of training and cultural competence will lead to stigma, misunderstandings, and frustration (SAMSHA, 2008). ACT teams deliver services in the community; therefore, teams need to be diverse as the community they work in. Additionally, lack of training will hinder the team member’s ability to understand, …show more content…
For example, Thresholds, in Chicago, adopted a recovery-based ACT that works in collaboration with clients (Furlong, et al., 2009). Thresholds changed the following designs to the ACT model to fit a recovery model: money no longer a bargaining tool for compliance or choices; no forced medication; team now offers clients alternatives; hope is instilled; and long-term goals are made (Furlong, et al., 2009). Also, to facilitate a recovery role, Thresholds’ team members outlined the following concepts: to believe everyone can and will recover; listen and don’t judge clients; discuss goals and desires; ask the right questions (what do you want?); and allow clients to tell their stories (Furlong, et al., 2009). Drake and Deegan, (2008), recognize ACTS is not a recovery model. However, they concede that the U.S. mental health system is failing clients in many poor and/or rural areas (Drake, & Deegan, 2008). They suggest ACT is necessary in providing outpatient services in states; because, they have a short supply of community based mental health centers and high rates of homelessness, incarceration, and hospitalizations (Drake, & Deegan,