Family As Community Extenders for Individuals Participating in Assertive Community Teams: Facilitating and Hindering Factors for Family Involvement

Background and purpose

Assertive Community Treatment (ACT) is an evidence based practice model that provides life-long treatment, rehabilitation and support to persons with severe mental illness (SMI) who experience difficulties in independent living.  Ongoing research indicates that ACT reduces rates of hospitalization and increase independent community living.  However, ACT in New York State (NYS) is no longer considered a service for life, but rather as one service on the road to community integration and recovery.

It is well documented that family involvement facilitates community integration for individuals with SMI and can serve to extend and support care.  Yet, little is understood as to how families of individuals served by ACT can facilitate or hinder involvement in treatment, recovery-oriented goals and transition to community integration.  Thus, we conducted four focus groups with ACT providers across NYS to identify observed and emerging factors associated with both involvement in treatment and subsequent community integration.

Method

The focus groups included forty-five ACT family specialists and team leaders from across NYS.  Guiding questions assessed 1) successes and challenges with participant families and factors that facilitate community integration, and 2) expressed training needs and competencies for effective work with families.  For our purposes, family was defined as anyone the consumer identifies as significant.

We prepared extensive field notes during each focus group. Using framework analysis, we independently identified key concepts within and across these overarching questions.  We then compared and contrasted key concepts until we agreed on core underlying themes.

Results

Families were perceived as essential community extenders through the treatment and community integration processes.  Facilitators included: 1) information and insight provided by family leading to more productive engagement, 2) motivation for recovery gleaned by family involvement, 3) structural and material supports family members offer to ACT participants that provide consistent support in the community, and 4) facilitation and modeling of effective communication from the ACT Team.

Challenges included: 1) disruptions of family relationships and roles, 2) caregiver burnout leading to family disengagement, 3) varying interpretations of recovery expressed by family members, and 4) limited interaction and interagency collaboration (criminal justice, child and adult protective services).

ACT providers report focusing on individual rather on the needs of the whole family given pressing time constraints.  Providers identify the need for professional training regarding facilitation of family psychoeducation groups in an ACT context, approaches to best engage family members, and strategies to mobilize community resources and build interagency care coordination.

Conclusions/ Implication

 

ACT providers view families as effective community extenders and collaborators in the recovery and community integration processes; however, they lack a set of best practices to engage family members.  Results suggest that family focused intervention can foster community integration, which is an essential component of ACT.  Implications for further research include the need to establish fidelity measures to define the family specialist role on ACT Teams to maximize family involvement.  Our findings expand long-standing evidence that families play a critical role as community extenders in community integration among individuals struggling with behavioral health concerns.