Several years ago the original Program of Assertive Community Treatment (PACT) in Madison began working with individuals as young as 15 rather than requiring people to be at least 18 years old before they could take part in PACT. Mental illness treatment programs for adults generally only serve people 18 or older.
NAMI: Why is PACT now serving people younger than 18?
Dr. Frey: We saw that most of our referrals were of 18 to 21 year olds. Several times we felt that if we could have provided services earlier we would have helped them stay in high school, prevented worsening of psychiatric symptoms, avoided homelessness and trauma. Since severe mental illnesses often begin much younger than 18, it makes sense to provide help earlier. We know individuals, with schizophrenia for example, who are going to be getting services from the adult system and may use mental health services for many years. By starting earlier we can help them better prepare for adulthood, especially in the rehabilitation areas of school and work.
NAMI: How have you adapted assertive community treatment for teens?
Dr. Frey: We do a tremendous amount of work with schools and provide more education and support to families. More systems (schools, juvenile justice, social services) are involved and we spend more time coordinating with them. An advantage of ACT is that while working with all other systems involved, we assume responsibility for providing and coordinating the person's overall care. With a single agency being clearly accountable, care is less fragmented.
NAMI: How do you work with the schools?
Dr. Frey: School systems often don't recognize or understand mental illnesses. The school may think that a symptom of the mental illness is under the child's control when it is not. We work with the school to build consensus. We provide clinical problem solving to reduce conflict and distress to help the child remain in school.
NAMI: What other adaptations have you made in assertive community treatment?
Dr. Frey: We provide more structured time with staff and peers. During the summer when school is out we hired a teacher for tutoring and graduate students as recreational staff to mentor teens and encourage social opportunities.
NAMI: How do you support families?
Dr. Frey: We try to help the young person remain with their family, if possible. We meet with the family frequently, educating about what is mental illness and what is expected behavior. We help the family to provide feedback and set limits. We want to enable the teen to be at home. We help the family solve problems on issues such as chores and homework to reduce conflict. With the PACT team available every day, we can be responsive to the family.
NAMI: Is substance abuse a problem?
Dr. Frey: Less so than with the adults we serve. PACT services may lessen the likelihood of kids being on the fringe at school and getting into a group that uses drugs.
NAMI: How will you measure success with kids?
Dr. Frey: We're collecting information on academic achievement, such as completing high school; juvenile justice involvement; hospitalization; living situation, including remaining at home with their family. Sometimes for older teens, living in their own apartment with substantial oversight and support from the team and the family works well too. We're now serving 17 people under 18 and are seeing improvement is these areas.
NAMI: Will more ACT teams start serving people under 18?
Dr. Frey: If an assertive community treatment team has mastered the ACT approach, it makes perfect sense to intervene earlier to maximize the benefits of individualized, rehabilitation oriented care.
Dr. Frey is Director of the Program of Assertive Community Treatment at Mendota Mental Health Institute in Madison, Wisconsin. Ms. Rouse is the parent of a son who began receiving PACT services at age 16.