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How to Care for Existing Clients While Making Time for New Ones


There are a number of services available to community members who have mental health issues. Assertive Community Treatment (ACT) is one such resource that provides invaluable assistance to individuals who are at risk for homelessness or hospitalization. This program was created to help these people maintain their own residence, while reducing the risk for relapse and increasing employability. The program has proven to be quite effective, in part due to the intense and continuous interaction that counselors have with clients. But this level of interaction requires an immense investment of time and energy. Because of that, the program is often at capacity and cannot serve other clients in need. Although the program has shown great results, Dr. Paul B. Gold believes that counselor involvement could be altered without compromising care to existing clients, while freeing up time for new clients in immediate crisis.

Gold conducted a study that examined four years of data from ACT that detailed intense and frequent sessions in the first two years with an emphasis on decreasing session duration and increasing session frequency in the next two years. This was a novel approach which, based on Gold’s findings, appeared to produce positive results. The clients in ACT did not suffer as a result of shorter, but more regularly occurring, visits with their counselors. In fact, rates of employment increased and hospital admittances decreased.

The success of the shift in service was based on several factors. First, the staff counselors had developed relationships with their clients over time, and by the third and fourth years, were better able to predict and meet the needs of their clients in shorter time periods. Second, the clients had gains in functionality that improved their ability to live independently and rely on their own coping strategies and adjustment skills. Taken together, these gains on both the client and staff sides allowed for sustained positive momentum over time with decreased time costs. Gold believes these time surpluses can be reallocated to meet the needs of other clients. He hopes that his study will motivate other community based programs to review ways that they can maximize their services. “This retrospective analysis of 4 years of agency service billing records illustrates the insights that program administrators can gain from longitudinal analyses of their own program data,” said Gold.

Gold, Paul B., Danson R. Jones, Cathaleene Macias, Leonard Bickman, William A. Hargreaves, and Jana Frey. A four-year retrospective study of assertive community treatment: Change to more frequent, briefer client contact. Bulletin of the Menninger Clinic 76.4 (2012): 314-28. Print.

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  • Raina January 14th, 2013 at 3:11 PM #1

    This is a tricky balance to maintain. You don’t want to ignore the clients that you already have, but the tendency when you are trying to grow a practice could be to ignore a little more then ones that you feel are doing alright and who will be fine if you have to put a little bit of distance between you and them for the sake of meeting others and beginning to address others’ needs too. You have to find a way though to still care for those who have been with you all along because we all still need a little help every now and then no matter how well we are doing on most days.

  • vaughn jones January 15th, 2013 at 3:52 AM #2

    I see this a lot in my business, which is hair, which I know ain’t quite the same, but some girls become so focused on getting new people in that they sort of forget about those that got them there in the first place

  • DARLA January 15th, 2013 at 1:16 PM #3

    I’m surprised to be honest.I thought the shorter visits and thus interacting with more clients would mean a lot more stress for the counselors.That should be the general trend isn’t it?What coping methods are the counselors themselves equipped with?

  • Ellie January 15th, 2013 at 8:46 PM #4

    As a supervisor of a Community support Program, Wisconsin’s version of the ACT model, I really appreciate this post. It confirms the trend we have seen- people often stabilize in CSP and their needs become less intense.

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