TY - JOUR
T1 - Distribution and correlates of assertive community treatment (ACT) and ACT-like programs
T2 - Results from the 2015 N-MHSS
AU - Spivak, Stanislav
AU - Mojtabai, Ramin
AU - Green, Charee
AU - Firth, Tyler
AU - Sater, Holly
AU - Cullen, Bernadette A.
N1 - Funding Information:
offered all core ACT services and those that did not (Table 3). Facilities offering all the core services had higher odds of being publicly owned or operated (OR=2.27) than facilities with fewer ACT or ACT-like services. Facilities offering all the core services also had higher odds of being funded by federal (OR=3.33) and grant funds (OR=1.67). Overall, there was a trend for facilities that offered all the core ACT services to have higher odds of funding across all sources other than Medicaid (Table 3).
Funding Information:
Compared with facilities without ACT, facilities with ACT have higher odds of being owned and operated by public agencies, per-haps suggesting that in certain states, the legislative and administrative environments are more favorable to ACT programs by directing public agencies to promote the dissemination of these programs. Facilities with ACT also had higher odds of receiving federal funds, including military and VA funding, and higher odds of being funded by grants. Funding sources have long been thought to influence the distribution of cer-tain types of services, including ACT (34). The VA system has funded a national net-work of programs in an effort to disseminate ACT services to veterans (35). It is also pos-sible that the increase in funding stability and consistency that comes with grants might promote dissemination of ACT, although programs that rely exclusively on grant funding might not be sustainable in the long term. This possibility underscores the importance of increased state funding, for example through Medicaid. Relying on Medicaid funding has traditionally been a challenge for ACT in most states, given that many of the services provided by ACT are not covered by Medicaid (36). Some states have specifically revised their regulations to better align Medicaid reimbursement with ACT services, but they remain in the minority (36). Overall, the wide variability in ACT availability across states suggests that in parts of the country, significant challenges to wider ACT adoption and availability remain.
Publisher Copyright:
© 2019 American Psychiatric Association. All rights reserved.
Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2019/4
Y1 - 2019/4
N2 - Objective: The study examined the availability and characteristics of assertive community treatment (ACT) programs across mental health treatment facilities in the United States. Methods: Prevalence and correlates of facilities that reported offering ACT, broadly defined as intensive community services for serious mental illness provided by multidisciplinary teams in the clients' natural settings and including both ACT and "ACT-like" programs, were examined by using data from the National Mental Health Services Survey. Availability of services essential to the ACT model in these facilities was also examined. Results: Of the 12,826 surveyed facilities, 13.4% reported offering ACT, with significant variability among states. Of the facilities with ACT, 19.2% reported offering all core ACT services. Few facilities offered peer support, employment, and housing services. Compared with programs at facilities that did not offer all core ACT services, facilities with ACT programs that offered these services had higher odds of being publicly owned (odds ratio [OR]=2.12, 95% confidence interval [CI]=1.64-2.74) and of receiving federal (OR=3.60, CI=2.17-5.98) or grant funding (OR=1.87, CI=1.45-2.41). Facilities with ACT that offered all core services also had higher odds of offering other services important to individuals with serious mental disorders. Conclusions: Substantial differences existed in availability of ACT and ACT-like programs among states, with evidence of a large unmet need overall, even when a very broad and inclusive definition of ACT was used. Few ACT programs offered all core services. Legislative, administrative, and funding differences may explain some of the variability.
AB - Objective: The study examined the availability and characteristics of assertive community treatment (ACT) programs across mental health treatment facilities in the United States. Methods: Prevalence and correlates of facilities that reported offering ACT, broadly defined as intensive community services for serious mental illness provided by multidisciplinary teams in the clients' natural settings and including both ACT and "ACT-like" programs, were examined by using data from the National Mental Health Services Survey. Availability of services essential to the ACT model in these facilities was also examined. Results: Of the 12,826 surveyed facilities, 13.4% reported offering ACT, with significant variability among states. Of the facilities with ACT, 19.2% reported offering all core ACT services. Few facilities offered peer support, employment, and housing services. Compared with programs at facilities that did not offer all core ACT services, facilities with ACT programs that offered these services had higher odds of being publicly owned (odds ratio [OR]=2.12, 95% confidence interval [CI]=1.64-2.74) and of receiving federal (OR=3.60, CI=2.17-5.98) or grant funding (OR=1.87, CI=1.45-2.41). Facilities with ACT that offered all core services also had higher odds of offering other services important to individuals with serious mental disorders. Conclusions: Substantial differences existed in availability of ACT and ACT-like programs among states, with evidence of a large unmet need overall, even when a very broad and inclusive definition of ACT was used. Few ACT programs offered all core services. Legislative, administrative, and funding differences may explain some of the variability.
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U2 - 10.1176/appi.ps.201700561
DO - 10.1176/appi.ps.201700561
M3 - Article
C2 - 30602345
AN - SCOPUS:85063988818
SN - 1075-2730
VL - 70
SP - 271
EP - 278
JO - Psychiatric Services
JF - Psychiatric Services
IS - 4
ER -