By combining an Assertive Community Treatment (ACT) team approach with a Housing First model, Horizon House, Inc of Philadelphia, PA has pioneered a program that integrates housing with services to help individuals experiencing chronic homelessness, severe mental illness, and/or co-occurring disorders.
After four years, the success of this initiative has sparked development of three new ACT teams within Horizon House. One of these is the “Home First” team, funded by the Chronic Homelessness Initiative (CHI). To learn more, we talked with Juliana Walker, Clinical Director for the Horizon House ACT teams. In her view, this approach provides the highest levels of treatment and support to people who need it most.
How it Works: A multi-disciplinary ACT team (often including a psychiatrist, nurse, case manager, case aides, employment or benefits specialist, substance abuse treatment specialist, and peer specialist) share responsibility to care for all of the team’s clients. For clients who are accustomed to receiving fragmented services from multiple providers, this approach is refreshing because everything is provided by the same team.
Although many chronically homeless individuals seem difficult to engage and are resistant to services, Horizon House has found that they can use the ACT approach to build rapport and trusting relationships with their client. When clients are ready for housing, medical, mental health or rehabilitation services, they receive encouragement and support from trusted team members.
In addition to successfully stabilizing clients’ lives, Ms. Walker describes cost savings to city agencies such as hospitals, jails and shelters. She believe the diverse perspectives generated by the ACT model are invaluable to the success of her work.
What are the Challenges? With a recommended client to staff ratio of 10:1 and a team who is accessible 24/7, the ACT approach is one of the most resource-intensive service models in use today. Ms. Walker observes that the composition of any particular ACT team depends on local realities.
For example, an ACT team in a rural area might easily maintain a client to staff ratio of 10:1, while an inner city team may need a higher ratio to accommodate demand and effectively utilize available resources. The possibility of sustainable funding for an ACT team is also dictated by local realities, such as Medicaid regulations, public service infrastructures and political climates.
Despite these challenges, Ms. Walker strongly endorses this approach for both clients and team members. As Team Leader for the “Home First” program, she has provided both individual and group supervision to team members.
The success Horizon House has experienced with ACT to help chronically homeless people in Philadelphia makes this a model that service providers might replicate. But, as Ms. Walker notes, the appropriate model for any agency depends on a number of factors, including the needs of the clients.