Perceptions of Assertive Community Treatment Staff on Neighborhood Characteristics and ACT Service Provision and Outcomes

Abstract

Assertive Community Treatment (ACT) programs provide psychiatric treatment and other support services to treatment resistant seriously and persistently mentally ill (SPMI) individuals in their place of residence or other environments (i.e., homeless shelters, park bench or coffee shop). In New York City (NYC) ACT program staff members often have to navigate significant neighborhood challenges (poverty, high rates of crime and drug activity) in their provision of services and treatment outcomes. Furthermore, in recent decades many research studies have been conducted on how these neighborhood characteristics affect the physical health and mental health of its residents. Some of these studies' findings suggest that certain neighborhood characteristics affect resident's physical and mental health. However, few studies have explored the effect of neighborhood characteristics on ACT programs' provision of services and their treatment outcomes. This study is important to the social work profession, other health and mental professionals, seriously mentally ill patients and their families, other governmental and policy makers and ACT workers. The study's findings and observations contribute additional knowledge to the field mental and the social work profession.;This study utilized the qualitative multi-site case study approach to explore the perceptions of staff members of three NYC ACT programs and key neighborhood informants on how the neighborhood characteristics (social supportiveness, trust, poverty, crime, drugs, and other social problems) affects the provision of ACT services and their treatment outcomes (Creswell, 1998 & 2009). Qualitative data were gathered from ACT staff members and neighborhood key informants through the use of semi-structured telephone interview protocols and a neighborhood quality survey. Additional neighborhood characteristics data were obtained from the US 2010 census and other NYC neighborhood social indicators sources for the three neighborhoods studied. The study sample of 38 consisted of 29 ACT staff members and 9 neighborhood key informants.;Qualitative data were analyzed utilizing qualitative data analysis and the case study approach as defined by Creswell (1998 & 2009). Other quantitative data on neighborhood social indicators and New York State Office of Mental Health's (NYS OMH) ACT program treatment outcome data were analyzed. The study was guided by the social capital theoretical framework (Coleman, 1998) which posits that neighborhoods with higher levels of social support and cohesion and trust amongst residents have higher levels of social capital and can accomplish better neighborhood outcomes.;The findings and observations reported by ACT staff members suggest that certain neighborhood characteristics (crime and poverty) negatively affect the provision of ACT program services and treatment outcomes. Specifically, ACT staff members expressed concerns about the dangerousness of the neighborhood and their personal and ACT client's safety and how these neighborhood problems affect their service delivery and treatment outcomes. However, NYS OMH ACT treatment outcome data for the three ACT programs revealed that those programs were equally successful at achieving their treatment outcomes.;The study's findings, observations, and opinions will provide increased knowledge and understanding to the social work profession and other stakeholders on the challenges ACT programs and clients encounter in the neighborhood. The expressed concern by all ACT program staff members on the dangerousness of the neighborhood and for their personal and ACT client's safety are significant study findings. These observations are important for social workers, mental health administrators; policy makers, ACT clients and their families, and advocacy groups to consider with development of future ACT programs, and on how to develop systems to support existing ACT program staff and clients mitigate these neighborhood challenges. This small scale study is a first attempt to explore the effects of neighborhood characteristics on ACT programs and their service provision and treatment outcomes. The observations and findings should help inform larger more comprehensive studies on the topic.