TY - JOUR
T1 - The Program of Assertive Community Treatment
T2 - Implementation and Dissemination of an Evidence-Based Model of Community-Based Care for Persons with Severe and Persistent Mental Illness
AU - Gold, Paul B.
AU - Meisler, Neil
AU - Santos, Alberto B.
AU - Keleher, Jennie
AU - Becker, Deborah R.
AU - Knoedler, William H.
AU - Carnemolla, Mark A.
AU - Williams, Olivia H.
AU - Toscano, Rich
AU - Stormer, Gene
N1 - Funding Information:
Having already implemented a public mental health service system recognized as one of the most responsive to the needs of persons with SPMI in the United States (Torrey et al., 1990), in the late 1980s, the Rhode Island Division of Integrated Mental Health Services selected the PACT model for treatment of young adults identified as the heaviest users of public mental health, substance abuse, and criminal justice services. A grant from the Robert Wood Johnson Foundation in 1989 supported an initial and successful PACT demonstration. With strong outcomes in hand, the state Division of Integrated Mental Health Services then constructed a highly strategic and systemic PACT dissemination plan. First, the Division created a new office headed by an expert PACT clinician to Oversee PACT implementations and arrange for ongoing consultation to PACT programs by nationally recognized PACT experts to ensure high fidelity to the PACT model. Second, the Division wrote new Medicaid certification standards that operationally defined the PACT model in extensive detail, and introduced strong financial incentives for close adherence to the PACT model via amendments to reimbursement options in the state Medicaid plan. Third, the Division formed a team of its administrators and clinicians, plus clients and their families, to conduct annual accrediting reviews of PACT teams as part of the Medicaid certification process. Presently, 11 teams operate in the state; collectively, these teams serve 14% of the total enrollment of persons with SPMI.
Funding Information:
As part of a large, 8-site cooperative study funded by the Center for Mental Health Services (CMHS), named the Employment Intervention Demonstration Program (Cook, Carey, Razzano, Burke, & Blyler, 2002), the authors, representing the South Carolina site, set out to implement two evidence-based integrated supported employment models, "Program of Assertive Community Treatment-Integrated Vocational Rehabilitation (PACT-IVR)" and "Individual Placement and Support (IPS)," at the rural Santee-Wateree Community Mental Health Center (SWCMHC) of Sumter, South Carolina. The study addressed two specific aims:
Funding Information:
The work reported here was made possible by support from many different sources. These include the Administration for Children and Families (90PD0215/01 and 90PJ0003), Biomedical Research Support (PHS $7RR05403-25), Bureau of Community Health Services, Maternal and Child Health Research Grants Division (MCR-360403-07-0), Carnegie Corporation (B-5492), Colorado Trust (93059, 2001-049 and 99012), Commonwealth Fund (10443), David and Lucile Packard Foundation (95-1842 and 99-8142), Doris Duke Charitable Foundation (20000665), Ford Foundation (840-0545, 845-0031, and 875-0559), Maternal and Child Health, Department of Health and Human Services (MCJ-363378-01-0), National Center for Nursing Research (NR01-01691-05), National Institute of Mental Health (1-K05-MH01382-01 and 1-R01-MH49381-01A1), Pew" Charitable Trusts (88-0211-000), Robert Wood Johnson Foundation (179-34, 5263, 6729, 9677 and 35369), U.S. Department ofJustice (95-DD-BX-0181), and the W. T. Grant Foundation (80072380, 84072380, 86108086, and 88124688).
PY - 2003
Y1 - 2003
N2 - The Program of Assertive Community Treatment (PACT), a multidisciplinary team approach, delivers integrated community-based treatment, rehabilitation, and support services to help persons with severe and persistent mental illness to avoid psychiatric hospitalization and to live independently in natural community settings. Twenty-five randomized clinical trials of PACT and its close adaptations, conducted over the past 30 years in several countries, demonstrate its effectiveness for this population in reducing use of inpatient psychiatric services and sustaining tenure in normalized housing. Programs based on the PACT model now operate in many countries and most states. Several states have disseminated these programs statewide using a mix of standards, financial incentives, monitoring of program performance, and expert training and consultation. However, despite the strong evidence base for PACT, most states have neither committed the resources nor implemented fidelity assurance methods necessary to widely disseminate PACT and/or its close variants. For the PACT model, we offer our hypotheses about behavioral change processes underlying its approach, describe its major operational structure and process elements, briefly review the research evidence of its effectiveness, and summarize statewide dissemination efforts and factors facilitating effective dissemination. Lastly, as a case study of implementation and dissemination, we report our difficulties in implementing PACT in a rural South Carolina community mental health center (1995-2000), discuss how supervision and consultation by national PACT experts prevented a collapse of our project and turned it into a success, and outline our present plans, supported with a federal grant, to disseminate an integrated PACT and supported employment service in South Carolina's community mental health center system.
AB - The Program of Assertive Community Treatment (PACT), a multidisciplinary team approach, delivers integrated community-based treatment, rehabilitation, and support services to help persons with severe and persistent mental illness to avoid psychiatric hospitalization and to live independently in natural community settings. Twenty-five randomized clinical trials of PACT and its close adaptations, conducted over the past 30 years in several countries, demonstrate its effectiveness for this population in reducing use of inpatient psychiatric services and sustaining tenure in normalized housing. Programs based on the PACT model now operate in many countries and most states. Several states have disseminated these programs statewide using a mix of standards, financial incentives, monitoring of program performance, and expert training and consultation. However, despite the strong evidence base for PACT, most states have neither committed the resources nor implemented fidelity assurance methods necessary to widely disseminate PACT and/or its close variants. For the PACT model, we offer our hypotheses about behavioral change processes underlying its approach, describe its major operational structure and process elements, briefly review the research evidence of its effectiveness, and summarize statewide dissemination efforts and factors facilitating effective dissemination. Lastly, as a case study of implementation and dissemination, we report our difficulties in implementing PACT in a rural South Carolina community mental health center (1995-2000), discuss how supervision and consultation by national PACT experts prevented a collapse of our project and turned it into a success, and outline our present plans, supported with a federal grant, to disseminate an integrated PACT and supported employment service in South Carolina's community mental health center system.
UR - http://www.scopus.com/inward/record.url?scp=10744226886&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=10744226886&partnerID=8YFLogxK
U2 - 10.1016/S1077-7229(03)80047-0
DO - 10.1016/S1077-7229(03)80047-0
M3 - Article
AN - SCOPUS:10744226886
SN - 1077-7229
VL - 10
SP - 290
EP - 303
JO - Cognitive and Behavioral Practice
JF - Cognitive and Behavioral Practice
IS - 4
ER -
