• PACT stands for Program for Assertive Community Treatment
• PACT is an alternative to long term hospitalization for SPMI
• PACT is a community based treatment team
• PACT has been shown to be affective with persons with severe mentally illness, veterans, the homeless, persons who are substance abusers, and families
• PACT has proven capable to engage previously resistant clients
• PACT is the ONLY case management model that meets Managed Care criteria

BRIEF HISTORY

PACT originated in Madison, Wisconsin and was originally called the Training in Community Living Team. 

The program was developed by Stein and Test in the 1970's as an alternative to long term institutionalization for persons with severe mentally illness.

The objective was to provide comprehensive outreach in the community where clients could access the same type of treatment team they would have access to if they were in an inpatient hospital.

PACT however took the treatment team out of the hospital ward and brought it to the client's home. 

This radical new form of treatment has proven to be a best practice in the treatment of SPMI and has spread nation wide.

A 1996 survey found nearly 400 PACT teams in 34 states.

PACT is also being studied in Canada, the United Kingdom and throughout the world.

WHAT MAKES A PACT TEAM?

Traditionally PACT teams consist of:

1. Psychiatrists
2. Nurses
3. Social Workers
4. Vocational Therapists
5. CASACs
6. Recreation Therapists
7. Nurse Aides

There are several unique features that make PACT effective.

• Caseloads are small with an 1 to 10 ratio of workers to cases
• PACT interventions are TIME UNLIMITED
• Treatment is provided by a multidisciplinary team who work together for maximum effectiveness
• Services are comprehensive and intensive
• Services are provided in the home
• PACT provides medication management
• 24 hour access to services
• Vocational assistance
• Daily team meetings for staff

FIDELITY AND THE PACT TEAMS

• Initially PACT was poorly operationalized and fidelity was hard to establish
• Teague and colleagues developed and tested fidelity in PACT and related programs using the DARTMOUTH ACT SCALE, also called the DACTS
• Index of Fidelity to ACT is another scale developed to measure fidelity
• Programs who cut "extraneous" staff are shown to be less affective
• Rosenheck and Neale (2004) found that the most crucial elements for ACT was the team approach and the use of the medical model

GOALS OF PACT 

PACT is designed to provide comprehensive quality treatment to persons with SPMI in the community

PACT teams are able to:

• Reduce the length of hospital stay
• Increase client satisfaction with care
• Improve client quality of life
• Reduce drinking and substance use behavior in people with dual diagnoses
• Increase housing stability
• Provide vocational training and counseling

PACT  vs.  CASE MANAGEMENT

PACT	Case Management
More cost effective	Less expensive initially
Shorter length of hospital stay	Rapid reduction of hospital stay, but at a great cost
Multiple workers with a 1 to 10 ratio	Single worker with caseload of 20-30
Able to focus on SPMI	Difficulty with focusing on all aspects of a person with SPMI
Provide services	Broker services

CONTROVERSIES

• Those who do not favor PACT teams argue that PACT is paternalistic
• Others state that PACT is coercive, confining or intrusive
• Some argue that the PACT model fosters dependency
• PACT initially costs more
• PACT fails to address trauma
• PACT is contraindicated for AXIS II disorders
• The way PACT is being implemented often strays from the initial model, leading to poor outcomes in an attempt to save money

WHO IS NOT ELIGIBLE FOR PACT SERVICES

PACT may be inappropriate for individuals who are higher functioning, are able to take medication independently, are able to work outside of the home without need of support, and who are able to live independently with little support in the home.