Name of the Procedure:

Assertive Community Treatment (ACT) Program, Per Diem
Common Names: ACT, Intensive Community-Based Treatment
Technical/Medical Term: H0040

Summary

Assertive Community Treatment (ACT) is an intensive, community-based mental health program designed to help individuals with severe psychiatric disorders live independently. The program offers comprehensive and personalized care on a per diem basis.

Purpose

Medical Conditions/Problems Addressed:

• Severe mental illnesses such as schizophrenia, bipolar disorder, major depressive disorder, and other psychotic disorders.

Goals/Expected Outcomes:

• To reduce hospitalizations and emergency room visits.
• To enhance the individual's quality of life.
• To promote independence and community integration.

Indications

Symptoms/Conditions:

• Persistent and severe psychiatric symptoms.
• Frequent hospitalizations or emergency room visits due to mental health crises.
• Difficulty managing daily activities and achieving independence.

Patient Criteria:

• Diagnosed with a severe mental illness.
• History of non-compliance with outpatient treatment.
• Significant functional impairment requiring intensive support.

Preparation

Pre-Procedure Instructions:

• No specific fasting or medication adjustments required.
• Initial comprehensive assessment to determine eligibility and individualized care plan.

Diagnostic Tests/Assessments:

• Psychiatric evaluation.
• Medical history review.
• Functional assessments to evaluate daily living skills and needs.

Procedure Description

Step-by-Step Process:

1. Enrollment: Patient is enrolled in the ACT program after initial assessments.
2. Team Assignment: A multidisciplinary team is assigned to the patient, including psychiatrists, social workers, nurses, and therapists.
3. Individualized Care Plan: Development of an individualized treatment plan based on patient needs.
4. Service Delivery: Regular visits to the patient's home or community settings to provide services such as medication management, therapy, crisis intervention, and daily living support.
5. Ongoing Monitoring: Continuous evaluation and adjustment of the care plan based on patient progress.

Tools/Equipment:

• Mobile treatment kits for home visits.

• Communication devices for remote coordination.

  Anesthesia/Sedation:

• Not applicable.

Duration

• Ongoing, intensive care provided on a daily basis (per diem).

Setting

• Community-based settings including the patient's home, public areas, or community centers.

Personnel

Healthcare Professionals Involved:

• Psychiatrists
• Nurses
• Social workers
• Occupational therapists
• Peer specialists

Risks and Complications

Common Risks:

• Initial resistance or non-compliance from the patient.
• Emergent crises requiring hospitalization.

Rare Risks:

• Potential for boundary issues between patient and providers.
• Risk of inadequate response requiring escalation of care.

Management of Complications:

• De-escalation techniques, crisis intervention, and possible temporary hospitalization.

Benefits

• Improved mental health stability.
• Enhanced quality of life and independence.
• Reduced need for hospitalization and emergency services.
• Strong support network fostering community integration.

Recovery

Post-Procedure Care/Instructions:

• Regular follow-up visits as per the individualized care plan.
• Continuous monitoring and adjustments to treatment.
• Coordination with other healthcare providers as needed.

Expected Recovery Time:

• Varies, as the program is ongoing and tailored to individual needs.

Restrictions/Follow-Up Appointments:

• No specific restrictions; follow-up is continuous.

Alternatives

Other Treatment Options:

• Standard outpatient psychiatric treatment.
• Partial hospitalization programs.
• Residential treatment programs.

Pros and Cons:

• Standard Outpatient Treatment: Less intensive, lower cost, but may not meet needs of severely ill patients.
• Partial Hospitalization Programs: Higher intensity during the day but lacks 24/7 support.
• Residential Treatment: Comprehensive care but can be more restrictive and costly.

Patient Experience

What Patients Might Experience:

• Continuous support and frequent interactions with the care team.
• Personalized care leading to improved symptom management.
• Possible initial discomfort with home visits but increased comfort over time.

Pain Management and Comfort Measures:

• Emotional and psychological support.
• Crisis intervention to manage acute stress and discomfort.
• Regular evaluation to ensure the patient's needs are being met effectively.