Table 1 East and South Team comparisons with ACT and FACT models

Target Population

Adults with serious mental illness (SMI) that seriously impairs their social functioning. Priority given to adults with schizophrenia, other psychotic disorders and bipolar disorder.

Adults meeting ACT admission criteria as well as adults experiencing complex mental, physical and social needs (including homelessness, criminal justice involvement, developmental and substance use disorders), with high utilization of acute care services and poor track record of system engagement.

Youth and adults (16-65 years) with complex mental, physical and emotional needs (including trauma, developmental and personality disorders), with high utilization of acute care services and poor track record of system engagement.

All patients with serious mental illness (SMI) in a particular district or region (including major axis I and severe limitations in social functioning).

Team size

60-100

190-208

90-100

220-250

Caseload

Urban - 1:10

1:13

1:13

1:20

Catchment area

1:200, 000

1:130,000-150,000

1:130,000-150,000

1: 40,000 -50,000

Clinical Human Resources

11 FTE clinical staff excluding team psychiatrist:

20.5 FTE clinical staff excluding team psychiatrists:

11 FTE clinical staff excluding consulting psychiatrist:

11 to 14 FTE clinical staff excluding team psychiatrist:

1 FTE team coordinator; 3 FTE registered nurses; 1 FTE social worker; 1 FTE occupational therapist;1 FTE addiction specialist; 1 FTE vocational specialist;1 FTE peer support specialist; 2 FTE case managers; 0.8 FTE psychiatrist

1 FTE team coordinator;1 FTE psychologist; 5 FTE psychiatric nurses;2 FTE social workers; 2 FTE occupational therapists; 1.5 FTE peer support specialist; 1 FTE personal support worker; 1 FTE addiction specialist;1 FTE rehabilitation therapist;1 FTE vocational specialist;4.0 FTE case managers;1.3 FTE psychiatrists

2.0 FTE care coordinators; 1.0 FTE nurse practitioner, 2.0 FTE behavioral therapists; 0.5 FTE personal support worker; 2.0 FTE social workers; 2.0 FTE nurses; 1.0 FTE registered practical nurse; access to consulting psychiatrist

5 to 8 FTE psychiatric nurses;1 FTE psychologist;1 FTE employment specialist;1 FTE peer support worker;1 FTE social worker; 2 FTE addiction specialists; 1.0 FTE psychiatrist

Team rounds

Daily meeting to discuss clients in crisis or update the team on ongoing issues.

Using the FACT board for daily morning meeting for 30–50 clients requiring daily attention.

Weekly meetings.

Using the FACT board for daily meetings for 20-30 clients requiring daily attention.

Team Vision

ACT services to clients who have not benefited from traditional out-patient programs.

Recovery focused ACT and ICM services within the same team. EBM interventions provided as core component of team function.

Recovery focused ICM level multidisciplinary support to clients, facilitating smooth care transitions within the organization as client support needs change. Select EBM interventions are provided.

Recovery focused ACT and ICM services within the same team. EBM interventions provided as core component of team function.

Step Down /Graduation

Transfer to less intensive service if demonstrated ability to function during gradual reduction in services over approximately 2 years.

Step down from board into the same team; able to move back onto the FACT board as needed. If stable for 2-3 years can be transferred to lower intensity of care in the local community.

Care coordinators facilitate transfer onto other teams within the same organization or other organizations as client support needs change over time.

Step down from board into the same team; able to move back onto board as needed. If stable for 2-3 years, step down to General Practitioner.

Continuity of care

Some teams may be hospital based. A small number may have psychiatrist with admission privileges. Most are community teams with varying types of relationships and arrangements with local hospitals.

Working in “transmural” integrated hospital /community services model. The team is not only a gatekeeper for the hospital, but also stays in touch with the client during his or her admission and retains the overall coordination of the client’s treatment.

Team part of a community support services organization offering case management, ACT, justice prevention and diversion services, short term residential crisis services and group based services. No established relationships with local hospital inpatient units.

Working in “transmural” integrated hospital /community services model. The FACT team is not only a gatekeeper for the hospital, but also stays in touch with the client during his or her admission and retains the overall coordination of the client’s treatment.