Solutions: Assertive Community Treatment (ACT) Teams

York University
November 10, 2014
Categories: Solutions

Assertive Community Treatment (ACT) is an integrated team-based approach designed to provide comprehensive community-based supports to help people remain stably housed. It is one of the most studied community programs in all of healthcare and has a very strong evidence base. Programs that follow the Pathways model typically offer intensive supports through ACT teams to address the needs of clients with mental health and addictions, and may support individuals in accessing psychiatric treatment and rehabilitation. These teams may consist of physicians and other health care provides, social workers and peer support workers. The latter are deemed to be key members of the team, for their experience of homelessness can become an essential resource for support and recovery. They help bridge the knowledge that other team members bring with knowledge of what it is to be homeless. ACT teams are designed for clients with the most acute needs and may provide support on an ongoing basis. In some cases, individuals will need to have access to supports 24 hours a day.

The following are characteristics of ACT teams:

  • Implementing a Housing First program involves establishing strategies for supporting participants.
    Media Folder: 
    A multi-disciplinary team of professionals that provides wrap-around service directly to the client.
  • The team members are available 24/7 and provide real-time support.
  • The ACT team meets regularly with the client and with each other (could be daily).
  • The team is mobile, often meeting clients in their homes.
  • The staff to client ration is generally 1 ACT team per 10 clients.
  • The program components are informed by client choice, peer support and a recovery-orientation.
  • Services are offered on a time-unlimited basis, with planned transfers to lower intensity services for stable clients.

Members of an ACT team include:

  • Clinical/medical staff  (psychiatrist, doctor, nurse, substance abuse specialists)
  • Peer Support workers
  • Generalist case managers who have varied professional/experiential qualifications and who broker access to housing and complementary supports.

ACT Teams may also include:

  • Housing support/tenancy expertise (landlord support, housing support per securing housing, move-in and maintenance of housing unit, rent subsidy/income support specialist)
  • Basic skills training (cooking, cleaning, numeracy per paying rent)
  • Education/employment specialist (dedicated to broader goals of social integration and self-sufficiency).

In the At Home/Chez Soi project, the average annual program costs (for housing and support) was $22,000 for ACT participants.

Based on the work of the Mental Health Commission of Canada. Excerpted from Housing First in Canada: Supporting Communities to End Homelessness.

Stephen Gaetz is a Professor in the Faculty of Education and is the Director of the Canadian Observatory on Homelessness and the Homeless Hub. He is also President of Raising the Roof, a leading Canadian charity that focuses on long term solutions to homelessness. 

Dr. Gaetz is committed to a research agenda that foregrounds social justice and attempts to make research on homelessness relevant to policy and program development. His research on homeless youth has focused on their economic strategies, health, education and legal and justice issues, and more recently, he has focused his attention on policy and in particular the Canadian Response to homelessness.  He has recently edited two volumes on homelessness in Canada, including: Housing First in Canada – Supporting Communities to End Homelessness. (2013) and Youth homelessness in Canada: Implications for policy and practice (2013). In addition, he has published a book on community-based responses to youth problems in Ireland and written numerous reports and articles published in a wide range of peer reviewed journals. Dr. Gaetz was Associate Dean of Research and Professional Development in the Faculty of Education Prior to his time at York University, Dr. Gaetz worked in the Community Health Sector, both at Shout Clinic (a health clinic for street youth in Toronto) and Queen West Community Health Centre in Toronto.

Dr. Gaetz has played a leading international role in knowledge dissemination in the area of homelessness. York played host to 2005’s Canadian Conference on Homelessness – the first research conference of its kind in Canada. In addition, York University now hosts the Canadian Observatory on Homelessness and the Homeless Hub the first comprehensive and cross-disciplinary web-based clearinghouse of homelessness research in the world. The focus of this network is to work with researchers across Canada to mobilize research so that it has a greater impact on homelessness policy and planning.  Through the CHRN Dr. Gaetz is publishing policy relevant research, including two recent reports on youth homelessness: A Safe and Decent Place to Live: Towards a Housing First Framework for Youth. (2014) and Coming of Age:  Reimagining our Response to Youth Homelessness in Canada. (2014), as well as The Canadian Definition of Homelessness (2012), The Real Cost of Homelessness. Can we save money by doing the right thing? (2012), Can I See Your ID?  The Policing of Homeless Youth in Toronto (2011), and  Family Matters: Homeless youth and Eva’s Initiatives “Family Reconnect” Program. (2011).

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The analysis and interpretations contained in the blog posts are those of the individual contributors and do not necessarily represent the views of the Canadian Observatory on Homelessness.