The UNC Assertive Community Treatment (ACT) team at the Center for Excellence in Community Mental Health is piloting a new program that will fill an important gap in community-based treatment of individuals with severe mental illness in Orange and Chatham counties. A Medicaid-funded service that will be a subset of the current ACT team, the new Step Down program will aid individuals as they transition from the high-intensity treatment of the ACT team to independent office-based care.
UNC’s ACT team is a full-service outpatient mental health program comprised of a comprehensive group of mental health professionals providing psychiatry, vocational support, substance abuse treatment, housing support, nursing, peer support and case management. By going to visit individuals with mental illness in various settings, including home, work and the community, the team works to assist these individuals in receiving medication and other care that will allow them to live a meaningful life, preferably in an independent living situation. Individuals are seen an average of 12 times per month for medication monitoring, symptom monitoring, therapy, and care coordination activities.
If a client does well under the treatment of the ACT team, he or she may eventually be graduated to office-based care and more independent treatment. Despite the efficacy of ACT, however, several members of the team, including Carol VanderZwaag, MD, medical director, Community Services, began to notice new opportunities in the treatment system.
“We found that there is a whole group of individuals who are stable enough to receive less intensive care than what ACT provides, but are not necessarily ready to benefit from office-based treatment,” VanderZwaag explains. “Nothing under the ACT program was providing that middle step between intensive care and standard services, so we wanted to design a program that would fill in the gap.”
VanderZwaag hopes the new Step Down program will help make the current system flow better and give clients the appropriate level of care that they require.
“This program is designed for individuals that still require community-based care, but only on a more general level,” she says. “While they may still require services like benefits management, they do not need the more specialized branches of ACT, such as substance abuse treatment.”
The transition from full ACT care to Step Down involves the reduction of client contact from about 12 visits a month to about four. The doctors and team members who worked with an individual under ACT continue to work with the individual under Step Down, maintaining the important care relationships they initially built. One advantage to moving to the Step Down program is that the individual will be eligible to receive extra services that ACT does not provide, such as specialty psychotherapy. For some clients, Step Down will be a more long-term treatment solution, while others may continue to graduate to office-based care. The program’s availability will also open spaces for more clients to be seen by the ACT team. Currently, the ACT team serves 105 individuals and expects to transfer 10 to the Step Down program.
Matthew Wright, MSW, is the new team leader.
VanderZwaag is optimistic about the future of the program. “I think it will work,” she says. “We designed this program ourselves based on our experience with the current system and its needs. It feels simple to me.”