Assertive Community Treatment (ACT) and Forensic ACT (FACT)
Center of Excellence: The Public Mental Health Partnership at the UCLA Semel Institute for Neuroscience and Human Behavior
Summary
ACT:
ACT is a community-based, team-based service to support members living with complex and significant behavioral health needs and a treatment history that may include psychiatric hospitalization and emergency room visits, residential treatment, involvement with the criminal justice system, homelessness, and/or lack of engagement with traditional outpatient services.
ACT is delivered by a multidisciplinary ACT team and includes a full range of clinical treatment, psychosocial rehabilitation, care coordination, and community support services designed to support recovery. ACT is designed to promote recovery by helping individuals cope with the symptoms of their behavioral health conditions and acquire the skills they need to function and remain integrated in the community, including the ability to obtain and maintain employment and housing and build strong social relationships.
FACT:
Forensic ACT (FACT) introduces forensic adaptations into the ACT model to address the complex needs of members living with significant behavioral health needs who are also involved with the criminal justice system. In practice, FACT is the ACT model with additional training and staffing requirements to serve the needs of justice-involved members.
Clinical Appropriateness
Appropriate for: Adults with serious mental illness (SMI) or co-occurring substance use disorder (SUD), including individuals that have:
- Significant functional impairment.
- An indicator of continuous, high-service needs.
- Complex treatment history that includes psychiatric hospitalizations, emergency service use, residential treatment episodes, involvement with the criminal justice system, homelessness, and/or difficulty engaging with traditional outpatient services.
FACT is typically only appropriate for members with the most complex and significant behavioral health needs who require the highest level of services, exhibit high risk for reincarceration or detention, and are willing to engage in frequent, intensive community-based contacts.
Age
18 years or older
Other Considerations
May not be appropriate for: Individuals solely diagnosed with SUD, personality disorder(s), or intellectual/developmental disabilities (I/DD).
ACT includes a full range of clinical treatment, psychosocial rehabilitation, care coordination, and community support services designed to promote recovery. All services should be culturally informed and recovery oriented. The ACT service model is comprised of core components that emphasize a team-based approach with shared caseloads; field-based and flexible service delivery; a person-centered approach to care; and 24/7 crisis availability.
- Assessment.
- Crisis intervention.
- Employment and education support services.
- Medication support services.
- Peer support services.
- Psychosocial rehabilitation.
- Referral and linkages.
- Therapy.
- Treatment planning.
FACT includes the same covered service components and teams should perform the same key functions. In addition, FACT teams should incorporate strategies that address criminogenic risks and needs, such as:
- Screening for criminogenic risk and needs.
- Providing trauma-responsive care for people who are justice involved.
- Using cognitive behavioral approaches for addressing criminogenic needs.
- Offering specialized community resource navigation and benefit acquisition assistance.
- Understanding confidentiality laws governing information sharing between criminal justice and health systems.
Each ACT and FACT multidisciplinary team should include a diverse array of behavioral health practitioners, including:
- Licensed practitioner to serve as the ACT team lead.
- Psychiatrist or psychiatric prescriber.
- One or more registered nurses.
- One or more employment specialists.
- Peer support specialist.
FACT teams include lived experience expertise and forensic adaptations to the ACT approach to address the needs of ACT-eligible individuals with historical or current involvement with the criminal justice system.
All FACT teams should have similar staffing structures to ACT teams. Additionally, FACT teams are expected to include at least one practitioner with lived experience with the criminal justice system.