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Assertive community treatment, or ACT, is an intensive and highly integrated approach for community mental health service delivery.〔Dixon, L. (2000). Assertive community treatment: Twenty-five years of gold. ''Psychiatric Services'', ''51'', 759-765.〕 ACT programs serve outpatients whose symptoms of mental illness result in serious functioning difficulties in several major areas of life, often including work, social relationships, residential independence, money management, and physical health and wellness. == Definition == The defining characteristics of ACT include: * a clear focus on those participants (clients) who require the most help from the service delivery system; * an explicit mission to promote the participants' independence, rehabilitation, and recovery, and in so doing to prevent homelessness, unnecessary hospitalization, and other negative outcomes; * an emphasis on home visits and other ''in vivo'' (out of the office) interventions, eliminating the need to transfer newly learned skills from an artificial rehabilitation or treatment setting to the "real world";〔Test, M. A., & Stein, L. I. (1976). Practical guidelines for the community treatment of markedly impaired patients. ''Community Mental Health Journal'', ''12'', 72-82.〕 * a participant-to-staff ratio that is low enough to allow the ACT "core services team" to perform virtually all of the necessary rehabilitation, treatment, and community support tasks themselves in a coordinated and efficient manner—unlike traditional case managers, who broker or "farm out" most of the work to other professionals; * a "total team approach" in which all of the staff work with all of the participants, under the supervision of a mental health professional who serves as the team's leader; * an interdisciplinary program of assessment, service planning, and intervention that typically involves a psychiatrist and one or more social workers, nurses, substance abuse specialists, vocational rehabilitation specialists, occupational therapists, service coordinators, and peer support specialists (individuals who have had personal, successful experience with the recovery process); * a willingness on the part of the team to take ultimate professional responsibility for the participants' well-being in all areas of community functioning, including most especially the "nitty-gritty" aspects of everyday life; * a conscious effort to help people avoid crisis situations in the first place or, if that proves impossible, to intervene at any time of the day or night to keep crises from turning into unnecessary hospitalizations or other negative outcomes; and * a promise to work with people on a time-unlimited basis, as long as they continue to demonstrate the need for this type of professional help.〔For a definitive analysis of the essential components of the ACT approach, see: Linkins, K., Tunkelrott, T., Dybdal, K., & Robinson, G. (2000, April 28). ''Assertive community treatment literature review''. Report prepared for Health Care Financing Administration & Substance Abuse and Mental Health Services Administration. Falls Church, VA: The Lewin Group. Retrieved online October 2, 2012, at: http://www.dhs.state.mn.us/main/groups/disabilities/documents/pub/dhs_id_027776.pdf〕〔Allness, D. J., & Knoedler, W. H. (2003). ''A manual for ACT start-up: Based on the PACT model of community treatment for persons with severe and persistent mental illnesses.'' Arlington, VA: National Alliance on Mental Illness.〕〔Witheridge, T. F. (1991). The "active ingredients" of assertive outreach. In N. L. Cohen (Ed.), ''Psychiatric outreach to the mentally ill'' (pp. 47-64). San Francisco: Jossey-Bass. (''New Directions for Mental Health Services'', no. 52.)〕〔McGrew, J. H., & Bond, G. R. (1995). Critical ingredients of assertive community treatment: Judgments of the experts. ''Journal of Mental Health Administration'', ''22'', 113-125.〕〔Bond, G. R., Drake, R. E., Mueser, K. T., & Latimer, E. (2001). Assertive community treatment for people with severe mental illness: Critical ingredients and impact on patients. ''Disease Management & Health Outcomes'', ''9'', 141-159.〕 In the array of standard mental health service types, ACT is considered a "medically monitored non-residential service" (Level 4), making it more intensive than "high-intensity community-based services" (Level 3) but less intensive than "medically monitored residential services" (Level 5) on the widely accepted LOCUS utilization management instrument.〔American Association of Community Psychiatrists (2000). ''Level of Care Utilization System for Psychiatric and Addiction Services'', Adult Version 2000. Erie, PA: Deerfield Behavioral Health. Available online at: www.locusonline.com.〕 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「assertive community treatment」の詳細全文を読む スポンサード リンク
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