Gathering and sharing information from teams with both front line and managers about the clinical and structural barriers they face in transitioning the individuals they are working with has been a key component of the Eastern Ontario ACT network pilot of the Assertive Community Treatment Transition Readiness Scale (ATR).
What individual teams do with the Team Profile Reports and the ensuing discussion of the clinical and structural barriers to transition an individual, their network of support and the team itself are facing, is critical to evolving both team and system practices. At the 2014 Ontario ACT conference in Kingston, some of the efforts by teams working on transition from ACT were presented.
Our progress on the Eastern Ontario pilot of the ATR was presented focusing on the early ATR score data for participating teams and an in depth exploration of one team’s process (Pinecrest Queensway) in addressing transition.
We distilled the discussion and the role of ethics under the following themes and actions:
- Team Function, & Focus
- Team pilot caseload
- Prime list matrix
- Alternate functionsWorkload Measurement ToolCaseload Balance Reference ToolScheduling & Redistribution
- Transition Risks
- Appropriateness & confidence of transition (referral) for client needs (physical & mental health)
- Discharge to where? (family practitioner, intensive case management, peer groups?)
- Weakness of an integrated mental health system
- Changing needs of person over time
- Fluctuating levels of client need for service i.e.: moving; environmental supports change;
- What happens if sick in a few years?
- Remembering “We” are not the sole support
- Relationship with Client
- Client Recovery – Role of ACTT & relationship with team
- Client anxiety, distress of change/transition
To see presentation, go to powerpoint: http://www.ontarioactassociati...th-ethical-practice/
Scott Pepin’s presentation on the first year of a system’s approach taken by the Central East LHIN for ACT teams is another piece of how ACT teams are responding to the issue of transition from ACT. A Summary Report on ACT integration in broader mental health system with special focus on the first year of Stepped Care (client transition within an ACT team - nurse working one to one) by CE LHIN group.
Please see report at bottom of post and see an updated report here:
https://www.eenetconnect.ca/to...t-stepped-care-model
New York state’s team experience with transition from ACT is outlined in the paper linked below and goes into depth on the emerging issues and strategies to address barriers and our approaches to promoting the recovery model.
(From SAMSHA website: this article appears to have free access, see bottom)
Community Ment Health J. 2015 Jan;51(1):85-95. doi: 10.1007/s10597-014-9706-y. Epub 2014 Feb 14.
Clinicians' perceptions of challenges and strategies of transition from assertive community treatment to less intensive services.
Finnerty MT1, Manuel JI, Tochterman AZ, Stellato C, Fraser LH, Reber CA, Reddy HB, Miracle AD.
Abstract
The study aimed to identify clinical strategies and challenges around transition from Assertive Community Treatment (ACT) to less intensive services. Six focus groups were conducted with ACT team leaders (n = 49). Themes were grouped under four intervention-focused domains: (1) client/clinical, (2) family and natural supports, (3) ACT staff and team, and (4) public mental health system.
Barriers to transition included beliefs that clients and families would not want to terminate services (due to loss of relationships, fear of failure, preference for ACT model), clinical concerns that transition would not be successful (due to limited client skills, relapse without ACT support), systems challenges (clinic waiting lists, transportation barriers, eligibility restrictions, stigma against ACT clients), and staff ambivalence (loss of relationship with client, impact on caseload). Strategies to support transition included building skills for transition, engaging supports, celebrating success, enhanced coordination with new providers, and integrating and structuring transition in ACT routines.
In the context of our evolving mental health system reform we need to share our practices and innovations to support the recovery of individuals. Drawing upon the unique context of individual teams, clients, models of practice, receiving systems and jurisdictional perspectives.
Please feel free to ask a question, share an emerging practice or idea, dispute assumptions, as we work to develop transition and recovery practices for and with the people we work for, each day.