Assertive Community Treatment (ACT) is an integrated team-based approach designed to provide comprehensive community-based supports to help people remain stably housed. It is one of the most studied community programs in all of healthcare and has a very strong evidence base. Programs that follow the Pathways model typically offer intensive supports through ACT teams to address the needs of clients with mental health and addictions, and may support individuals in accessing psychiatric treatment and rehabilitation. These teams may consist of physicians and other health care providers, social workers and peer support workers. The latter are deemed to be key members of the team, for their experience of homelessness can become an essential resource for support and recovery. They help bridge the knowledge that other team members bring with knowledge of what it is to be homeless. ACT teams are designed for clients with the most acute needs and may provide support on an ongoing basis. In some cases, individuals will need to have access to supports 24 hours a day.
The following are characteristics of ACT teams:
- A multi-disciplinary team of professionals that provides wrap-around service directly to the client.
- The team members are available 24/7 and provide real-time support.
- The ACT team meets regularly with the client and with each other (could be daily).
- The team is mobile, often meeting clients in their homes.
- The staff to client ration is generally 1 ACT team per 10 clients.
- The program components are informed by client choice, peer support and a recovery-orientation.
- Services are offered on a time-unlimited basis, with planned transfers to lower intensity services for stable clients.
Members of an ACT team include:
- Clinical/medical staff (psychiatrist, doctor, nurse, substance abuse specialists)
- Peer Support workers
- Generalist case managers who have varied professional/experiential qualifications and who broker access to housing and complementary supports.
ACT Teams may also include:
- Housing support/tenancy expertise (landlord support, housing support per securing housing, move-in and maintenance of housing unit, rent subsidy/income support specialist)
- Basic skills training (cooking, cleaning, numeracy per paying rent)
- Education/employment specialist (dedicated to broader goals of social integration and self-sufficiency).
In the At Home/Chez Soi project, the average annual program costs (for housing and support) was $22,000 for ACT participants.
Based on the work of the Mental Health Commission of Canada. Excerpted from Housing First in Canada: Supporting Communities to End Homelessness.