Challenges Faced by Service Providers in the Delivery of Assertive Community Treatment

Abstract

This qualitative study examined the delivery of Assertive Community Treatment from the perspective of service providers of 4 ACT teams in southeastern Ontario. Overall, providers were positive about their involvement with ACT. Eight tensions experienced in the context of delivering services emerged: negotiating governance structures; providing 24-hour coverage; balancing the clinical-administrative responsibilities of team leaders; accessing hospital beds; meeting local population needs; integrating treatment and rehabilitation; changing services to meet changes in the population being served; and implementing ambiguous ACT standards. Framing these challenges in the context of ACT structures and the broader community mental health system, the study suggests possibilities for the ongoing development of the model to facilitate the realization of the ACT vision.

Randomized Controlled Pilot Study of an Occupational Time-Use Intervention for People With Serious Mental Illness

“…The development of integrated treatment, rehabilitation, and support services, such as assertive community treatment (ACT) and intensive case management, represent efforts to address the comprehensive range of daily living needs experienced by people with SMI. However, a growing body of evidence has suggested that the design and delivery of these services tend to be dominated by attention to clinical treatment issues, constraining the ability of occupational therapists and other service providers to address occupational and related issues (Horgan, 2007;Krupa et al, 2004). People with SMI are likely to live in conditions of poverty and disadvantage, conditions that restrict access to socially important occupations and the resources essential to maintain adequate levels of personal self-care (Boydell, Gladstone, Crawford, & Trainor, 1999).…”

Adopting Best Practices: Lessons Learned in the Collaborative Initiative to Help End Chronic Homelessness (CICH)

“…44 The complexity of the skills that providers must master in order to implement best-practice models such as ACT and MI are another source of challenge. [44][45][46][47][48] Phillips et al 45 notes the importance of training on the specific elements of ACT along with ongoing monitoring of staff performance. To be successful, training should be directed toward the full team of providers, including the agency directors and senior clinical staff to ensure their support for carrying out the critical elements.…”

Exploring the ideal practice for occupational therapists on assertive community treatment teams

“…In their study, Krupa et al (2004) found that ACT practitioners were astonished by their clients’ limited family support and lack of opportunities for involvement in organized social and leisure occupations. The participants of our study felt that occupational therapists are well-positioned to address these client needs by creating educational support groups for caregivers and families and occupation-based groups for clients located within community spaces.…”