Purpose

ACT is an approach created in the 1960’s in Madison, Wisconsin to work with severely and persistently mentally ill clients who had been in psychiatric hospitals. The purpose of ACT is to prevent the return of these clients to the hospital by extending the support and multidisciplinary treatment skill of the psychiatric hospital into the community. In addition to maintaining the symptoms of clients at a reduced level and preventing acute episodes, ACT helps them toward recovery by increasing their ability to meet their basic needs and enhance the quality of their lives. ACT service includes improving client functioning in adult social life and in employment. ACT also supports the family and lessens the burden of providing care for the mentally ill person.

Approach 

Assertive --service is provided with energy, persistence and unconditional emotional support, and assumes responsibility for whatever needs to be done to assist a person with mental illness with meeting his or her individual goals and service and treatment needs. This usually involves seeing a client frequently, even every day or multiple times within the same day.  Community--the majority of ACT treatment and rehabilitation interventions take place in the community, i.e. in the client’s residence, and neighborhood, at employment sites, at places where people spend leisure time, etc.  Treatment--rather than coordinating service or referring clients to other agencies for services, ACT professionals provide treatment directly.

Cultural Adaptation of the ACT Model

To our knowledge, implementation of the ACT model has not been attempted with a group of clients wholly of Asian background, much less with a tri-cultural, trilingual group of Southeast Asian clients. While the ACT model emphasizes providing up-to-date Western psychiatric treatment, this treatment is provided by staff who share and understand the language and culture of their clients. Staff members are able to bridge understandings of healing between cultures. Likewise they understand and recognize ways of healing which are important within the culture of their clients.

Multi-Disciplinary Team

The Wilder Southeast Asian ACT team includes a psychiatrist, an advanced practice nurse with authorization to prescribe medications, a registered nurse, a team leader who is a licensed mental health professional and team members who are specialized in evidence-based practices including Supported Employment, Integrated Dual Disorder Treatment and Illness Management and Recovery. The Wilder ACT team is currently in the process of hiring a Peer Recovery Specialist who will be a consumer of mental health services and will bring to the team a direct experience of dealing with mental illness.

Integration of Medical and Psychiatric Treatment 

Clients of the ACT team are seen for psychiatric evaluation and follow-up medication management by the team psychiatrist. Because the team has access to the psychiatrist, any increase in symptoms or side effects can be consulted and addressed immediately by the psychiatrist and team members who have direct knowledge of the patient. The advanced practice nurse is also capable of performing these functions both independently and in collaboration with the psychiatrist. In addition, the registered nurse does an initial nursing assessment and ongoing assessment with each ACT team client, to determine the client’s health needs and learn about the medications the client has been prescribed and how they are taking these medications. The nurse does not directly provide medical treatment, but rather coordinates with the primary care clinic. Taking a holistic approach in teaching clients about their health conditions is an important part of the nurse’s work with clients. The nurse and the ACT team monitor the medications of clients and may decide to do daily monitoring of the client taking medication if needed.  

Procedure to Refer Clients to Wilder SEA ACT

1. In order for a client to be assigned to the Wilder SEA ACT team, or any other Ramsey County ACT or Mental Health Targeted Case Management services, the client must first be qualified by Ramsey County Mental Health Intake, 1919 University Ave. W., St. Paul, MN 55104, FAX: 651-266-7850.

2. The qualification process by Ramsey County Mental Health Intake requires the following documents:

• Rule 79 Verification Information Sheet
• Ramsey County ACT Screening Tool
• Ramsey County Diagnostic Assessment (completed by a mental health professional)
• Ramsey County Rule 79 MH-TCM and ARMHS Statement of Need

3. If referral to Wilder SEA adult mental health services is preferred, a cover letter should be forwarded to Ramsey County Mental Health Intake accompanying the above documents, or phone call made to 651-266-7890 to indicate this.