Session: Assertive Community Treatment at 50 Years: Current Status and Future Directions (Society for Social Work and Research 28th Annual Conference - Recentering & Democratizing Knowledge: The Next 30 Years of Social Work Science)

At its fiftieth anniversary, Assertive Community Treatment (ACT) is the most widely disseminated and researched evidenced-based practice for persons diagnosed with a serious mental illness (SMI). ACT is a community and team-based intervention that provides evidence-based treatment and rehabilitation through an integrated, interdisciplinary team of professionals. ACT is designed to engage people with SMI in community-based care and foster community integration consistent with legal, clinical, and ethical mandates. A meta-analysis of 64 efficacy trials found robust evidence demonstrating ACT prevents unnecessary hospital use and improves clinical outcomes. As such, ACT has become a cornerstone of the continuum of community mental health care across the U.S. Yet, poor access to quality mental health care continues to be an urgent need for people with SMI who have high-risks and high-use of costly crisis services. As a result, significant health disparities persist for those experiencing the most debilitating forms of mental illness, including up to 25-year reductions in life expectancy; a deadly toll further compounded among people who carry marginalized racial identities and reside in low-resource settings. The current delivery of ACT services occurs within dynamic contexts of community mental health care that have evolved substantially over the last fifty years. Mental health workforce shortages, worsening affordable housing crisis, the COVID-19 pandemic, and climate-related environmental impacts further threaten this already constrained access to health and healthcare for people with SMI. In addition, mental health policy at the national, state, and local levels has shifted dramatically, including substantial changes to the organization, monitoring, and financing of care. Currently, unknown are the impacts of these shifts on the current implementation of ACT and successful strategies to implement ACT effectively. This symposium brings together the leading ACT experts to share current realities and effective strategies for ACT implementation. The symposium will open with findings from the first ever large-scale survey within all 50 U.S. states and territories to identify current variations in ACT implementation, team characteristics, and related local policy influencing ACT delivery. This presentation will answer critical questions about the landscape of ACT and set the stage for the next presentations. Second, a deep case study will illuminate the successful use of a purveyor and intermediary organization strategy to train and expand high quality ACT services. This case study provides a detailed look at a multifaceted implementation strategy that provides actionable and responsive tools within changing contexts. Third, a secondary data analysis will provide evidence of the impact of a key policy shift, the federal initiative funding certified community behavioral health clinics, on the delivery of ACT services. This presentation provides a novel look at how ACT is influenced within dynamic shifts in the context of care delivery. The final study presents findings from a survey examining associations between key ACT team-level implementation strategies, supervision and team leadership, on a critical antecedent to high quality ACT care: workforce retention. Together, this symposium will present state-of-the-art research on where ACT is now and where it may head in the next 50 years.