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Daniel Leone Mountains

  • Hospitals
  • Nursing homes
  • Rest homes
  • Group homes
  • Family care homes
  • Jails

In creating any policy and funding in support of ACT intersecting with any institution, it’s best to consider the “spirit” of the program and how to support that best practice, and also consider the many ways it can be abused.  Overlaying ACT on institutional settings as a longer term practice is often not good (I can always identify an exception — where if it were not for ACT on top of a residential placement, that person would end up in even more of a restrictive setting).  The focus should be on community inclusion and integration, not community segregation, which is what many supervised residential placements feel like.  (Check this out — nod to Mark Salzer at Temple for pointing me towards this.)

In the emergence of practices like Critical Time Intervention (CTI), I considered how ACT was designed to serve this role — going into institutions to identify people who would benefit from more intensive, wrap-around community supports, and then assisting with that transition and then providing the longer term care (and, per CTI model, if the person is found to actually not need ACT level of care, facilitate the transfer to another better fitting service — which sadly doesn’t exist in many communities (!)).

Not sure if it remains true, but I believed Delaware was a state that actually had financial incentives (or consequences) for both ACT/ICM and hospital inpatient staff coordinating care — they basically were paid to communicate with each other when someone was inpatient.  I always loved that idea.

– Lorna


Photo by: Daniel Leone