ACT Team: In the Community

12/21/2011: Stop by the ACT Team office on the second floor of CMHC, and you’ll feel the heat.

Tucked into a windowless suite at the center of the building, these clinicians wear short sleeves in winter and keep the fans oscillating all year. When it’s time to meet with clients, they put on their winter coats, hats, and gloves, rev up the CMHC vans, and head out into the community.

“We provide service to people wherever they are,” says Monica Kalacznik, MD, the ACT Team psychiatrist. “If they want to come to CMHC, that’s fine. If not, we can see them at home. If they don’t have a home, we’ll see them on the street corner, or in a restaurant.”

Assertive Community Treatment (ACT) evolved in Madison, Wisconsin in the late 1960s. Researchers noticed that although patients made gains during hospitalizations, many gains were lost when they were discharged to live in the community. ACT targets people with severe and persistent mental illness who have not responded well to traditional outpatient treatment.

For the ACT Team, referrals usually come from an outpatient clinical team within CMHC.

“Our clients are pretty well known to the system,” explains Debra Bloom, LCSW, ACT Team leader. “But not everybody rises to the ACT level of care. We have clients with the most severe illnesses—those who, when they’re not in treatment, become so disabled that they’re a risk to themselves or others.”

“I think it’s a privilege for us to be let into people’s homes,” she adds. “We’re able to understand people on a deeper level because we come in contact with the reality of their lives.”

Not all ACT clients have homes; some are homeless or become homeless during treatment. Many are in and out of the hospital, and some have frequent run-ins with the criminal justice system. For clients in hospitals, courts, or jails, the ACT Team is there.

They function as an integrated whole. “The persistence of the team makes this work,” says clinician Nadine Lewis. “If I’m not here, I know somebody else will pick up.”

Today, the ACT Team is full to capacity with 70 clients and a staff-client ratio of 1-to-10. Team members say the essential ingredient of their work is highly individualized care.

Clinicians will meet clients multiple times per week, if clients wish. They assist with basic needs, such as laundry and transportation to medical appointments. They help clients find housing and will even help them relocate. The level and type of engagement is up to the client.

“Some patients may not want to be bothered by you,” explains Athena Jenkins, LCSW. “You always start where the client is.”

Despite the intensity of the work and the severity of clients’ illnesses, Bloom says that for clinicians, there’s a certain luxury to serving on the ACT Team.

“I don’t feel any rush in the work we do with clients,” she explains. “We know this is going to be a long-term process, and we’re not expecting to see huge signs of recovery right away. We really don’t have any place to transfer them to. Our goal is not to lose them in treatment.”

Bloom estimates that 85% of ACT clients have a “dual diagnosis”—substance abuse and mental illness.

“I understand the reason behind most people’s substance abuse,” says Liz Lobotsky, the ACT Team’s Recovery Coach. “It’s because of things they’ve gone through. They want to self-medicate. They don’t want to deal with those issues, or with the pain.”

Lobotsky, a Certified Recovery Support Specialist, joined the ACT Team in November 2010. She is one of two peer providers collaborating with clinical teams at CMHC (the other works with Young Adult Services at the West Haven Clinic).

“Even though I may not have had the exact same experiences as our clients—the homelessness or the repeated traumatic experiences—I know that feeling of pain,” she says.

Lobotsky, age 22, first experienced depression as a child, and by the time she was sixteen she planned to commit suicide. Instead of carrying out her plan, she sought help. She was hospitalized and later began self-medicating with marijuana.

Lobotsky cites education as a key factor in her recovery. After finishing high school she graduated from the University of New Haven with a BA in psychology and plans to attend graduate school. She is employed by South Central Behavioral Health Network and contracted to work with the ACT Team at CMHC, where she joins clinicians for client meetings and helps clients achieve their treatment plan goals. At the ACT office, she co-leads the Women’s Group and the WRAP (“Wellness Recovery Action Plan”) Group.

Like all peer specialists in Connecticut, Lobotsky is trained to work with clients in clinical settings. But although she’s expert at telling her own story, she usually doesn’t.

“I try not to get too in-depth about my recovery journey,” she says. “I never want to turn it into what happened to me.” Instead, she keeps the focus on clients, who are sometimes more willing to talk to her because they know she has her own history with mental illness and substance abuse.

For ACT Team clinicians, she’s a valuable colleague with a special skill set. “We were taught not to self-disclose,” Bloom explains. “Liz is trained to self-disclose, and she does it well.” Her presence on the team offers clients hope that life can be better and their dreams are achievable.

“It’s a great job and I feel so thankful to have it,” says Lobotsky. “I work with a great team of people.”

According to Chyrell Bellamy, PhD, MSW, Director of Peer Services and Research at the Yale Program for Recovery and Community Health and an assistant professor in the Department of Psychiatry, research has shown that peer support can be as effective as case management in promoting recovery. The peer model has been used in other fields as well. "The idea behind peer support, no matter what group you're working with," says Bellamy, "is that when people have shared or similar life experiences, they are better able to connect with and learn from each other."

The benefits move in both directions. "When peers work with others, they have the opportunity to give back, which is very important to a person's recovery process," notes Bellamy.

This article contributed by Connecticut Mental Health Center
Lucile Bruce, Communications Specialist, lucile.bruce@yale.edu