ACT Teams: When the legislature passed a law to serve persons with complex needs in Iowa, a key recommendation was to develop more ACT teams. Additionally, the law recommended at least 22 of them.

teams

One family in my legislative district always attended our forums and townhalls on mental health and disability issues. Their son lived with a disability at home. The families greatest concern focused on what would happen to their son when they became too old to care for him. He wanted to live in the community. But, would the community support him?

What is an ACT team?

ACT is short for Assertive Community Treatment. It represents a team of providers that wrap around a person in a community to support them. It is an evidence-based treatment, meaning that data collected shows that the service is effective and useful at stabilizing persons in the community.

According to the Iowa Administrative Code, ACT is defined as:

“a program of comprehensive outpatient services consistent with evidence-based practice standards published by the Substance Abuse and Mental Health Services Administration (SAMHSA), provided in the community and directed toward the amelioration of symptoms and the rehabilitation of behavioral, functional, and social deficits of individuals with severe and persistent mental illness and individuals with complex symptomology who require multiple mental health and supportive services to live in the community”

How Do they Know How Many ACT Teams We Need?

The Department of Human Services determined that ACT services are needed for .06 of the adult population in a region. The region identifies the clients that need intense wrap around services. These decisions are based on need and desire to live in the community. Then, the region pinpoints the geographical areas that work together to build a team. Regions work together to ensure coverage is available to their clients.

Per the Iowa Administrative Code (IAC), ACT services provide a set of comprehensive, integrated, intensive outpatient services delivered by a multidisciplinary team.

Who is part of the ACT treatment team?

According to the IAC, the team of a minimum of 6 members must fill all roles and consists of a combination of the following professionals:

  • Psychiatrist, Advanced registered nurse practitioner, or physician assistant under psychiatrist supervision must supervise the team
  • An administrator must have authority to sign documents and complete billing
  • Other members of the team include:
    • Team leader
    • Registered nurse
    • Mental health professional
    • Substance abuse treatment provider
    • Community support specialist
    • Peer support specialist, and a
    • Employment specialist

In addition to the team make-up, the IAC lists the standards that providers must meet in order to have a successful ACT team. Also, the law outlines those eligible for services in Iowa including those who are age 17 and older. They must be medically stable and  low risk to self, others and property. Finally, they must live independently in the community or express desire to live in the community.

What are ACT Services?

ACT services to wrap around a person in the community include the following services:

  • Initial assessment and treatment planning
  • Evaluation and medication management
  • Integrated therapy and counseling for mental health and substance abuse
  • Skill teaching
  • Community support
  • Medication monitoring
  • Case management for treatment and service plan coordination
  • Crisis response
  • Work-related services
  • Peer support services
  • Support services, and
  • Education, support and consultation to family members and other major supports of individuals

What are the Challenges to Developing ACT teams?

Just like we discussed with Access Centers, Iowa has challenges in two main areas in development: workforce and population distribution. First, Iowa has a shortage of psychiatrists and prescribing providers needed to supervise teams according to SAMHSA standards. Second, the number of team members required can also be challenging to fill each role. The rural nature of the state makes it difficult to sufficiently wrap around people in areas further from treatment options and workforce.

Next Steps:

Reimbursement for ACT services is challenging with managed care. At present, managed care companies pay for ACT as a 5 day a week service when by design it is a 24/7 service. This puts pressure on regions to fund the “delta” or difference. Addressing this funding inequity is critical to the ongoing development of this program.

Discussion:

What ACT service do you think is most lacking in supporting persons in their community?