January 17, 2012
Assertive Community Treatment
ACT is an intensive, outreach program for people with severe and persistent mental illness, often with a co-morbid substance use disorder. There are generally 70 clients with a low client to staff ratio (about 10:1). The program design favors work at the client’s residence or in the community. Staff observe clients set-up their medications and observe them take eyes-on AM medication. The staff then conducts a mental status exam and offers community support and resources to the client. Staff run different therapy and skills groups (such as DBT Skills or Shopping Group) and also individual therapy. Each team employs case managers, a nurse, psychiatrist, peer support specialist, and mental health practitioner.
Fulfillment of NASW Competencies
Competency #1 – Professional Identity
I maintained client privacy and confidentiality at all times and maintained a professional relationship with clients and staff through mutual respect and by understanding my individual biases. This was measured by feedback from my field instructor.
Competency #2 – Organizational Context
I participated in team meetings to learn how decisions are made and how the organization is structured. I created a list of community resources, so I could provide these to clients when asked.
Competency #3 – Values & Ethics
I read and followed the NASW Code of Ethics when working with clients and when problem-solving. I used the NASW Code of Ethics to guide me professionally and personally, and I maintained confidentiality.
Competency #4 – Critical Thinking
I thought critically when writing progress notes, and when I observed clients during home visits and when conducting mental status exams. I used knowledge from mental health classes, the DSM IV-TR, and the Psychiatric handbook to appraise clients and identify concerns. This was measured by the quality of my progress notes.
Competency #5 – Human Behavior and The Social Environment
I used the theoretical frameworks each day and used my knowledge of person in environment when conducting home visits. This was measured by the quality of care during home visits by my supervisor.
Competency #6 – Diversity
I respected my client’s differences and researched more about mental health and certain cultural groups for which I was unfamiliar. I asked my team members for tips on working with different types of clients.
Competency #7 – Social and Economic Justice
I advocated for my clients to maintain basic human rights by living on their own. I reflected on the PODS and did all I can to free my clients from oppression.
Competency #8 – Social Policy
I researched current mental health policies and discussed them with my team members.
Competency #9 – Engagement
I led a co-occurring group that met on Wednesdays and used active listening when checking-in with clients and listened to them communicate with one another. All members of the group spoke and responded to minimize one person having all the power. The topic of the week was based on research.
Competency #10 – Assessment
I read through and added to the client’s intake forms when new clients joined the A.C.T. program.
Competency #11 – Research
I read all of the packets that my supervisor gave me and took notes. The readings helped me increase my knowledge and skills.
Competency #12 – Intervention
I created a list of community resources. I used appropriate intervention and prevention strategies that are utilized by A.C.T. I coordinated care with other advocates, like PCPs and payees.
Competency #13 – Evaluation
When conducting home visits, I monitored how the client was doing through a mental status exam, and I adjusted my intervention techniques if necessary to better serve my clients.
Competency #14 – Professional Behavior
I was open and honest with my field instructor, field liason, colleagues, and clients, and I was open to receiving constructive feedback.