Abstract: Repositioning Assertive Community Treatment (ACT) As a Time-Limited Service: Clinical Activities and Barriers Related to Transition (Society for Social Work and Research 20th Annual Conference - Grand Challenges for Social Work: Setting a Research Agenda for the Future)

Schedule:

Friday, January 15, 2016: 6:15 PM

Meeting Room Level-Meeting Room 10 (Renaissance Washington, DC Downtown Hotel)

* noted as presenting author

Helle Thorning, PhD, Clinical Professor, Research Scientist, Columbia University, New York, NY

Bikki Tran Smith, MA, Project Director, New York University, New York, NY

Lin Fang, PhD, Associate Professor, University of Toronto, Toronto, ON, Canada

Purpose:

Assertive Community Treatment (ACT) is undergoing a significant transformation. Since the initial conception of ACT as a lifelong service, the recovery movement promoting less reliance on treatment and increased community integration has gained recognition among consumers, families, providers and policymakers alike. Moreover, the enactment of the Affordable Care Act (2010), which promotes access to care, improved health and reduced cost, has begun to reshape the US healthcare system. In New York State, ACT programs are moving towards a time-limited service that supports recovery while ensuring that client recovery is sustained during and after the transition from ACT to less intensive services. The purpose of this mixed-methods study is to: 1) understand the clinical activities engaged and valued by ACT providers in promoting transition; and 2) identify provider perceived barriers to transition.

Methods:

An anonymous survey was distributed to 708 ACT providers in New York State. The survey included demographic and provider background questions, the 29-item Clinical Transition Practice measure (Finnerty, 2014) and the 21-item Transition Barrier Questionnaire (Finnerty, 2014). These measures examine the clinical processes essential to transition practices and varying level barriers to transition. Descriptive statistics are used to analyze study data. In addition focus groups (N=3) with providers from across the State were conducted.

Results:

A total of 177 (25%) providers completed the survey. On average, they have served in the mental health field for 166 (SD=116) months. More than half of the clinical transition processes have been utilized by over 75% of the providers. Whether a provider has engaged in the transition processes is positively correlated with their experience in the field (r=.34, p<.001). The greatest perceived challenges to promoting transition were client level factors. These include “the difficulty for client to let go of therapeutic relationship” (M=3.43), followed by “client did not retain stability in the absence of ACT support” (M=2.83), and “client rejected new services” (M=2.73). There was no correlation between provider background variables and the level of perceived barriers. Thematic analysis of focus group data yielded two major themes: 1) the varying perceptions of transition readiness and 2) the lack of adequate step-down services. These themes encompassed individual- and system-level barriers. Provider-level barriers to transition were not brought up during the focus groups.

Implications:

The future of ACT centers on teams’ ability to provide quality care in a new healthcare environment that aims to improve service effectiveness and efficiency. ACT providers in New York State have engaged in a range of clinical activities that promote transition to less intensive care. Still, individual and systemic level barriers to transition persist and thus further research and action are needed to better understand and address these challenges.