1. Heidi Herinckx, OCEACT Conference 2016

2. Assertive Community Treatment Model and Recovery ACT model was first created in 1970’s over- 40 years old- still one of the most effective models of mental health treatment we have to offer. The Consumer/Survivor Movement of the 1980s and 1990s brought the recovery model to the forefront and inspired change throughout the mental health system. By 2002 the President’s New Freedom Commission on Mental Health paved the way for a system-wide paradigm shift toward recovery oriented care. President’s New Freedom Commission on Mental Health

3. 2002 the President’s New Freedom Commission on Mental Health President’s New Freedom Commission on Mental Health A life in the community for everyone Increase access to quality mental health care in the community Increase access to affordable housing in integrated community settings for individuals with mental illness Address overrepresentation of individuals with mental illness in the criminal justice system End employment discrimination= competitive employment in the community End unnecessary institutionalization Invest in community support programs that provide comprehensive support services (like ACT)

4. ACT Fidelity and Recovery Dartmouth ACT fidelity scale developed by Teague, Bond, and Drake (1998)- did not - recovery and “consumer choice” as key element Beyond Components: Using Fidelity Scales to Measure and Assure Choice in Program Implementation and Quality Assurance. Community Mental Health Journal (2002, Paulson, R.; Post, R.; Herinckx, H.; Risser, P.) Tool for Measuring Assertive Community Treatment (TMACT) Monroe-DeVita, M., Moser, L.L. & Teague, G.B. (2013) has incorporated recovery as a key component to ACT services

5. Consumer Survivor Movement or Recovery Movement Judi Chamberlin Sally Zinman Howie the Harp First Alternatives Conference 1985 National Empowerment Center Dr. Dan Fisher in 1990 Elyn R Saks Mary Ellen Copeland Sherry Mead Dr. Patricia Deegan

6. Dr. Pat Deegan https://www.youtube.com/watch?v=jhK-7DkWaKE

7. Dr. Pat Deegan’s Recovery Story Medications are not the answer Age 17 and told to retire from life Low expectations of professionals around her to pursue life goals- education, career, proceed with living- Best she could hope for was to try to cope and live in a half-way house Avoid stress and take large doses of meds Prognosis of doom Socialized into the role of mental patient Grandmother support system that inspired her to take “the first active step in her recovery” College became a central organizing principle for her recovery- it was hard, took lots of tries and strategies to cope

8. Patricia Deegan’s Definition of Recovery “….The need is to reestablish a new and valued sense of integrity and purpose within and beyond the limits of the disability; the inspiration is to live, work and love in a community in which one makes a significant contribution.” *Deegan, P. (1988) Recovery: The lived experience of rehabilitation. Psychosocial Rehabilitation Journal. XI (4) 11-19

9. Recovery and Community Integration The goal of recovery is in many ways inseparable from the goal of community integration. Community integration is “the external, concrete manifestation” of the recovery experience (Gary Bond, 2004) Recovery is the opportunity to live in the community and be valued for one’s uniqueness and abilities, like everyone else (Mark Salzer, 2006)

10. Mark Salzer: Community Integration Temple University Collaborative on Community Inclusion of Individuals with Psychiatric Disabilities http://tucollaborative.org/http://tucollaborative.org/ The Temple University Collaborative on Community Inclusion of Individual with Psychiatric Disabilities seeks to identify the policies, programs, and practices that promote connection to and satisfying engagement with community life.

11. Recovery Oriented Services The recovery movement and the promotion of recovery as a central organizing principle for the delivery of mental health services has challenged long held assumptions about the limited capacities and poor prognosis of those with serious mental illness. Recovery is possible How can the mental health system shift from low expectations of recovery to high expectations of recovery?

12. ACT structure well positioned to promoting recovery The structure of ACT is well suited to support recovery principles : with the focus of in vivo services; the longer duration of the service promotes skill building and the achievement of goals that take time (educational goals, employment goals, successful housing or tenancy); and the multidisciplinary team can work using a holistic approach.

13. Spirit of recovery To be most effective, the ACT team must embody the spirit of recovery in its norms, attitudes and values Recovery attitudes are critical in communicating trust, hope and respect (Russinova, Rogers, & Ellison, 2006)

14. Study of High and Low Recovery Oriented ACT teams ACT teams in Indiana- rated 4 or 5 in fidelity on all items on the DACT fidelity scale- comparable in terms of ACT fidelity Recovery orientation – teams rated on the degree to which staff: 1) instilled hope 2) fostered personal responsibility for illness management 3) Helped individuals pursue meaningful life activities This study compared the practice patterns of the “High” recovery orientation team (4.75 of 5) and “Low” recovery orientation team (2.35 of 5) Salyers, Stull Rollins, Hopper (2011)

15. High Recovery Oriented ACT Team View ACT participants as capable Value peer specialists as equal and valuable members of the ACT team Have positive expectations of ACT participants Team collaborates with ACT participants using shared decision making when considering treatment interventions Team intervenes when there is a high risk of danger and after discussion Supports ACT participant choice (balance of dignity of risk and duty to treat) Integrated Illness self-management training (IMR) Frequent examples of strengths based language High Recovery Oriented ACT teams function like the Home Depot motto: “You can do it. We can help.” (Davidson (2007)

16. Low Recovery Oriented ACT Team Often expressed low expectations of ACT participants regarding getting and keeping work; living independently and accomplishing goals. Team takes control early in decision making and gradually gives control back as ACT participant “proved themselves” ACT team makes treatment decisions without ACT participant involvement. ACT team frequently expresses “negative” attitudes about ACT participants and used labeling language like “manipulative,” “non- compliant,” “obstinate” More frequently used control mechanisms like Strict medication monitoring Restricting access to housing and money High use of outpatient commitment Frequent re-hospitalization of participants

17. Recovery Oriented ACT teams: Canada High Recovery Orientation is important because finding from a 2011 study provide some initial evidence that recovery oriented values and practices of ACT teams are associated with better client outcomes (specifically fewer hospital days, less legal involvement, higher levels of employment and higher enrollment in educational training programs), beyond fidelity to the ACT model. Kidd et al (2011)

18. Examine structure of services to ensure recovery orientation Drop in center may be used as a stepping stone but is not true community integration- ultimate goal is to help individuals feel as comfortable in a wide range of community settings as possible Group treatment versus individual skill building in the community- Group treatment has a risk of individuals taking a passive follower role instead of leader role- reduces empowerment and independence- may foster dependency and reliance on mental health system Groups and drop in centers also unintentionally segregate individuals so that they mostly interact with other individuals with a diagnoses of mental illness and don’t build a broad array of natural supports and hinders full community integration

19. Mindful of trajectory of services Engagement- individuals coming into ACT services need a great deal of support- ACT team may be “it”. Stabilization and relationship building (meet basic needs, housing, food, access PCP resolve criminal justice issues)- relationships are building with ACT team Thriving and working toward personally important goals (employment, build social network, restoring valued social roles in the community) Defining recovery and working toward increased self determination and self sufficiency Preparing for a life outside of the mental health system- lessen dependence on ACT team requires focus on building socials supports in the community

20. You Can Do It. We Can Help. Marion County ACT team and Benton County ACT team share their approaches to partnering with ACT participants in their recovery goals and promoting community integration. You Can Do It. We Can Help. (Larry Davidson, 2007)