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Assertive Case Management &
Feedback as a Clinical Intervention
Linda May, PhD, MFT – Case Manager
Rachel Loewy, PhD – Clinical Director
Family-aided Assertive Community Treatment
A clinical and employment intervention
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Rapid, crisis-oriented initiation of treatment
Case management using key Assertive
Community Treatment methods
 Integrated, multidisciplinary team
 Outreach PRN; rapid response
 Continuous case review
References (see details of reference on handouts):
FACT: Integrating Family Psychoeducation and Assertive Community Treatment by William R. McFarlane, MD
A Comparison of Two Levels of Family-Aided Assertive Community Treatment by William R. McFarlane, MD, etal.
Moving Assertive Community Treatment into Standard Practice by Susan D. Phillips, MSW, etal.
http://mentalhealth.samhsa.gov/cmhs/communitysupport/toolkits/family/
NAMI SF website print out
- Assertive Community Treatment: Information for Practitioners, Implementation Tips
FACT
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Psychoeducational multifamily groups
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Supported employment and education
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Collaboration with schools, colleges and
employers
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Cognitive assessments used in school or job
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Low-dose atypical antipsychotic medication
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Mood stabilizers, as indicated by symptoms
Practitioners have found...
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Renewed interest in work
Increased job satisfaction
Improved ability to help families and
consumers deal with issues in early
stages
Families and consumers take more
control of recovery and feel more
empowered
Family
practitioners
College
health
services
Pediatricians
School
guidance
counselors,
nurses, social
workers
Employers
Mental health
clinicians
Military bases and
recruiters
Case
Mgt
Clergy
Emergency and
crisis services
General
Public
Case Example
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Prodrome to Psychosis
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History: substance abuse, attention and
motivational problems
Parent with SMI, caretaking parent
evolved to critical, overprotective
Client isolated, decreased function,
increasing symptoms
Client ambivalence re diagnosis, meds
Crisis intervention, team interventions –
minimize trauma of treatment
Providing Feedback to Clients
and Their Families
Rachel Loewy, PhD
Talking about symptoms
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Use client’s words
Identify “thinking problems”
Identify other areas of concern
(anxiety, depression, substance
use, etc.)
Confirm with client/family- ask for
feedback
Identify areas of functioning
impacted by symptoms
Explaining risk for psychosis
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Define “psychosis” in lay language (e.g. can’t tell
the difference between what’s real and what’s not
real)
Identify thinking problems as “high-risk”
symptoms or “psychosis”
Explain that majority of people with UHR
syndrome do not develop a psychotic disorder,
but 20-40% do so within 1 year
Advantages of early intervention and hope for
recovery: describe high level of functioning now
associated with psychosis
Explaining risk for psychosis
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Identify client/family’s strengths that serve as
protective factors
Identify specific risk factors for client (substance
use, refuses treatment, social isolation, etc)
Invite reactions/questions from client & family;
provide empathic support
Discuss feedback again with additional family
members present or after further assessments as
part of an “ongoing dialogue.”
Treatment recommendations
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Commend for seeking help “early”
Medical assessment to rule out other causes
(blood work, EEG, CT scan)
Individual/group therapy for specific symptom
clusters
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(e.g. CBT for depression/anxiety/thinking problems
substance abuse treatment
Psychiatrist evaluation
Treatment recommendations
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Family support through MFGs (provide guidelines
handout). As appropriate, recommend single
family therapy.
Decide on action plan (will provide specific
referrals, etc.)
Encourage client/family to call with any questions.
Repeat feedback at second meeting with more
family members, or after further assessment
Differential diagnosis & treatment
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Bipolar Disorder NOS
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Describe
Describe
Describe
Describe
depression & treatment recommendations
hypomania and risk for mania
social impairment
cognitive impairment
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Describe difference between Bipolar, schizophrenia and
schizoaffective,
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Emphasize diagnostic uncertainty in the face of pressure
regarding diagnosis
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Discuss risk for full psychosis in context of family history
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Medications for bipolar and prodrome
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Identify signs to watch out for and a plan for possible
increase in symptoms (communicate with family member),
despite current refusal of treatment
Thanks for joining us,
Next week – Cognitive Behavioral
Therapy for Early Psychosis