About TACT Service

What is ACT? (Assertive Community Treatment)

Adapted from the Best and Promising Practices Fact Sheet: Assertive Community Treatment (ACT) developed by Global Mental Health Transfer Technology Center (MHTTC) Northwest MHTTC

Assertive Community Treatment (ACT) was developed to meet the complex needs of individuals with serious mental illness (SMI) who also experience continuous high service needs (e.g., repeated or long-term hospitalizations or crisis service use) and challenges with role functioning (e.g., maintaining housing or employment). This outreach-oriented team provides a range of clinical treatment, psychiatric rehabilitation, and case management services and, where possible, diverts escalation to higher levels of care (e.g., inpatient hospital, emergency department) or involvement with the justice system. Services are typically delivered in person at a high intensity and frequency, while also delivered flexibly based on each individual’s needs and preferences. Most services are provided in individuals’ homes and communities, and in locations that maximize skills generalization (e.g., in the kitchen to learn to cook, at their place of employment to learn specific job skills). 

ACT teams typically consist of the following multidisciplinary team roles: (1) a psychiatric care provider who prescribes medication and supports integrated healthcare; (2) nurses who administer medications and promote health and wellness; (3) a co-occurring disorders specialist who provides integrated, stagewise substance use disorder treatment; (4) an employment specialist who utilizes the individual placement and support (IPS) model of supported employment to help individuals pursue employment goals and supported education; (5) a peer support specialist who partners with service recipients on identifying and promoting their own recovery journey and using wellness management strategies to pursue their self-identified goals; (6) mental health clinicians who deliver evidence-based psychotherapy and skills coaching; (7) case managers who facilitate access to services and supports in the community; (8) an in-office program assistant who supports team operations and facilitates communication and support between service recipients, natural supports, and team members; and (9) a team leader who leads the management and supervision of the team, while also dedicating a portion of time to direct practice.

What is the evidence for this practice?

ACT is one of the most well-studied service programs for people with SMI, with more than 50 published empirical studies and several reviews and meta-analyses (Baronet & Gerber, 1998; Bedell et al., 2000; Bond et al., 2001; Burns et al., 2007; Coldwell & Bender, 2007; Gorey et al., 1998; Herdelin & Scott, 1999; Marshall & Lockwood, 2000; McDonagh et al., 2022; Morrissey et al., 2013; Mueser et al., 1998; Ziguras & Stuart, 2000).

Across studies, nearly all have found positive outcomes related to improved community integration for people served by ACT teams. The most robust findings have been in four outcome domains: 

• Decreased hospital utilization
• Increased independent living and housing stability
• Retention in treatment, and 
• Individual and family satisfaction

Personalized & Flexible

Given its target population and core mission, ACT is typically implemented within community behavioral health care agency settings. Most services are delivered outside the office; ACT team members support individuals they serve at health and social service appointments and provide skills training and support in other community settings such as in individuals’ homes, school, work, and other community settings (e.g., helping with grocery shopping). ACT team members often liaise with acute inpatient and state hospitals, emergency departments and crisis services, jails, services for unhoused, and other community agencies for the purposes of both identifying eligible participants and coordinating care. 

ACT services are delivered flexibly and are personalized to individuals’ needs and preferences as specified in their person-centered treatment plan. There is no specific service dosage; however, given the population served, most individuals receive an average of three face-to-face and approximately two hours of service contact per week. The multidisciplinary staffing and comprehensive range of services offered also means that often multiple team members (typically at least three) provide those individualized services in the community during the week and that clients have access to someone on the team anytime of the day or night to help address emerging needs.

Collaborative Treatment

While there is no time limit on someone’s enrollment in ACT, the team works collaboratively with service recipients toward transition to less intensive services. ACT clients identify what is important to them in their life and the team offers clinical services and skills teaching that help them reach those goals. Graduation from the program is discussed early and transparently with clients. As clients gain independence, accomplish goals, and learn to manage mental health symptoms, ACT clinicians facilitate their transition to a less intensive level of care.

ACT services are primarily delivered in person, with the vast majority of services delivered in the community. Because of this, the team is able to outreach and engage individuals where they are, as well as ensure that clinical services and skills training are tailored to the situations in which they will be applied. Depending on client preference or staff availability, some services such as groups may also be offered in an office setting.

Since ACT is a team-based service program it is intended that all team members work together to support each other’s work. Teams meet daily to review the status of all clients served by the team, discuss previous and planned service contacts, address emerging clinical needs and need for proactive contacts, and coordinate scheduling and service coverage. While a subset of the team may work more closely with a certain client depending on that client’s needs and preferences, it is expected that all team members be familiar with the entire caseload of people served so that they can step in to support them as needed. Similarly, delivering ACT services with high fidelity to the model involves regular cross-training between roles on the team to facilitate collaboration and ensure a uniform, team-wide approach to supporting client recovery.