Assertive Community Treatment Programs: De Facto Medical Homes for People With SMI

“If you work in or with an Assertive Community Treatment [ACT] program, you’re basically working in a medical home,” said Erik Vanderlip, M.D., at a workshop at APA’s 2014 annual meeting describing the evidence demonstrating the many similarities between ACT programs and the popular innovation in primary care workforce redesign known as the medical home. Vanderlip and Maria Monroe-DeVita, Ph.D., both of the University of Washington, just completed a survey of Washington state ACT programs, supplementing national data showing that ACT teams engage in substantial amounts of medical care management and oversight for their clients.

“ACT teams catch a physical deterioration before anyone else in the health care system. They do it because they’re seeing clients in their native environments and understand them like no one else—they can’t help but notice. The trouble is that ACT teams aren’t recognized for this work with additional monetary or staffing support.”

Vanderlip and Monroe-DeVita highlighted emerging opportunities for ACT teams to partner with health homes, but noted common barriers to achieving system-level integration. “Change is hard, and everyone—primary care and mental health—would like someone else to manage whatever they’re unfamiliar with. We estimate that ACT medical staff—nurses and docs—are spending up to half of their time overseeing general medical issues with their clients. What if we just accepted that they’re going to manage physical health within the ACT team, and made that time more efficient and effective by providing the resources and support they need?”

In an interesting comparison, Monroe-DeVita highlighted how meeting the ACT fidelity standards virtually ensures that an ACT team is a medical home. “Mental health discovered and disseminated the key to quality chronic-care management over three decades ago, and we’ve been perfecting it ever since. It’s no coincidence that ACT looks so much like a medical home, since it’s predicated on person-centered, team-based interdisciplinary care of a population. ACT is mental health’s specialty medical home, and it needs more primary care support,” said Monroe-DeVita. >>watch video