On February 1, Places for People launched another ambitious program designed to help those living with serious and persistent mental illness. The agency has implemented an Assertive Community Treatment (ACT) program that targets men and women with untreated psychiatric disorders who also have a history of substance abuse, chronic homelessness and frequent psychiatric hospitalization.

This new effort is being funded by the Missouri Department of Mental Health and is being tested statewide. The $1.8 million program was approved by the state legislature and was announced by Governor Matt Blunt in January.

The ACT program aims to reach people who are not only extremely ill, but also those who have been deemed “high users” – people who utilize a disproportionate amount of publicly funded health services.

“They are among the most challenging in our system, “explains Joe Parks, M. D., Director of the Division of Comprehensive Psychiatric Services for Missouri’s Department of Mental Health, “…they are hard to reach and to keep in treatment.”

PfP Executive Director Francie Broderick notes that the ACT program should not be viewed as a punitive program, “It’s important to understand that these individuals are not ‘bad people’ who are ‘abusing’ the system….they’re simply people who are very sick, very poor, and who have no access to healthcare. The people we will be reaching are people who have not been able to maintain relationships with community providers, because of paranoia, substance abuse problems, inability to stay housed…or a combination of the three. Many times, their illness is so severe, so extreme, that traditional treatment methods have failed.”

Broderick continues, “Even when they have been linked with service providers, the time and resources needed to get them stabilized have not been available.”

PfP’s ACT program is designed to dramatically reduce the number of costly psychiatric hospitalizations by providing an extremely aggressive and comprehensive level of individualized care. These services include:

• Assistance in finding, getting and keeping housing
• Assistance with community integration, creating supportive relationships and overcoming fear of others
• Assistance with establishing life and individual recovery goals, e.g. school, work, parenting
• Assistance with managing Medicaid, Social Security and other public assistance
• Coordination of all medical and psychiatric care
• Medication management
• Money management
• Parenting Supports
• Problem solving and crisis intervention
• Social skills training
• Substance abuse services
• Teaching and supporting people in activities of daily living
• Treatment planning

These services are very similar to the supports that PfP’s existing continuous treatment teams have been utilizing since 1992. PfP has six teams of trained social workers to provide vital mental health and community support services 24-hours a day, 365 days a year.

Where the ACT approach differs is that the team also includes substance abuse and vocational rehabilitation specialists, as well as a dedicated nurse and psychiatrist. This team will address the needs of the 75 clients who are expected to enter the program in its first year.

The ACT model utilizes a ten-to-one ratio of clients to support workers, a ratio that PfP employs on all of its support teams. While many healthcare and social service programs are burdened with caseloads of hundreds of clients per social worker, the ACT method focuses on extremely individualized services.

The ACT project is being managed by the agency’s HOME team, a community support program started in 1998 to provide mental health outreach services to St. Louis’ homeless population.

“Our team of community support workers have an amazing track record of helping people stabilize their lives,” explains Broderick. “We’re hopeful that the addition of highly specialized and trained medical specialists will allow us to reach and to help people we’ve been unable to reach before.”

Developed in Wisconsin in 1978, the ACT model has proven to be effective in treating severe mental illness, especially schizophrenia and bipolar disorder.

According to the National Association of Mental Health, six states have implemented ACT programs on a statewide level.

Labels: Assertive Community Treatment, Homeless Outreach, Winter-Spring 2008

A Circle of Hope  

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Celebrating 30 Years at Places for People and a Lifetime of Memories

Pictured above: Gertrude reflects on her 30 years at PfP and reviews her daily medical needs with Team Leader Barbara Taylor. Gertrude shared a congratulatory hug with Club staff member Daisy Scruggs at her 83rd birthday party.

Since 1977, Gertrude has been a member of The Club, PfP's day program. For more than 20 years she worked on the kitchen crew, preparing thousands of free lunchtime meals and participating in countless celebrations. The day she sat down for this interview, she shared that she was commemorating a special event of her own -- her upcoming 83rd birthday.

"We're having pork steak, potatoes, lettuce-tomato salad," she said, adding with special emphasis "and cheesecake."

During the conversation, she settles comfortably into a chair, recalling a story about her grandmother, who owned a soul food restaurant. "We could visit my grandmother at home, anytime we wanted too -- and there was always something good to eat. But if we stopped by the restaurant she'd say, 'You have to pay, just like everybody else'."

She twinkles as she tells that story -- and every story, for that matter. And while she claims that she "sometimes forgets," she remembers the exact day when a staff person at the State Psychiatric Hospital approached her with some life-changing news. "It was September 3, 1965 when they came up to me and said, 'Gertrude, it's time to for you to go.'"

"Go where?" she asked, uncertain and unsure why she was being removed from a safe, secure and structured environment she'd lived in for more than eight years. "I liked it there," she said, referring to the state hospital. "I made lots of friends and everyone was real good to me."

Gertrude was among the first round of patients in state care who were affected by the deinstitutionalization process that resulted in thousands of people being discharged from supervised psychiatric care. She left the hospital and lived in an apartment subsidized by the Department of Mental Health. "We got along pretty good," she says, speaking of her two roommates who were also former patients. She admits it was very lonely at times, as there were few supports at that time for people living with serious mental illness.

It was not until 1975, when PfP opened the first psychiatric rehabilitation facility in Missouri, that daily social and community-based psychiatric support services became more accessible.

When her psychiatrist told her about PfP in 1977, she jumped at the opportunity to have something to do every day. "I'd never been in an organization like that before, but I met so many people and so many of them became my friends. Places helped me to be more sociable and to be more courteous. I liked to stir the pot in more ways than one when I was a little bit younger."

She chuckles and smiles again, going on to say that a bout with stomach cancer (that is now in remission) impacted her life in many ways. She's especially appreciative of the flexible levels of support provided by her community support team during her 30 years with the agency. Monthly and weekly visits have transitioned into a daily visit when a community support worker assists her with managing 10 prescription medications. Tuesdays are the dedicated to grocery shopping and though she's admitted to staff that she still prefers her grandmother's oxtail and spaghetti recipes, she chooses canned and fresh fruits and vegetables more often now.

"I have a lot of friends and I know I'm blessed," she says reflectively as the conversation draws to a close.

As she opens the door and waves to the neighbor across the hall, she adds, "I sure hope I'll see you at my party."

It's an invitation that most certainly cannot be refused.

Labels: Client Stories, Fall-Winter 2007

Celebrating 30 Years at Places for People and a Lifetime of Memories  

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Patience and Persistence: A Story Every Parent Knows

Pictured above: Tina beams when she talks about her daughter Nellie, who at age two is already enrolled in a pre-school program that Tina takes her to five times a week

It's 7 a.m. and two-year old Nellie is much more interested in her toy guitar than she is in getting dressed for preschool.

"C'mon little woman, it's time to get ready," her mother Tina says, walking into the room carrying a crisp purple outfit. Nellie looks at her mother, drops the guitar and bounds across the room. She jumps onto a miniature Big-Wheel and zips toward her mother who quickly scoops up the little girl, triggering peals of laughter from them both.

It's clear that Nellie understands play time is over as she cocks her head and sticks out her arms when her mother slides on her shirt. The pants, however, are a different matter.

"I think she's putting on a show this morning," Tina notes, but in no time, Nellie is dressed, her hair is combed and she's slipped on her shoes, which Tina tightens after she shuts and locks the front door of her apartment. The two then head down the street and around the corner where a bus is scheduled to arrive within five minutes.

An hour later, Tina will have dropped Nellie off at an advanced pre-school program and will have made her way to PfP's offices. Tina has scheduled a review of her monthly budget and has a list for her month's stock of grocery shopping.

Tina and Nellie live in one of PfP's apartment buildings that is supported by a subsidy from the Department of Housing Urban Development. The apartment is a spacious two-bedroom that offers a gated back yard, a washer and dryer, a sizeable kitchen and plenty of room for Nellie's Big-Wheel activities.

Tina has been a client at PfP for little more than eight years and she says that the agency's level of care "feels wonderful." She also notes that her team of community support workers provides her encouragement to develop and strengthen her parenting skills and energies. "They've never given up on me," she explains when she talks about her team and how she's matured as a person and as a parent during her time with the agency. "They've helped me to become more independent, they're always positive and encouraging."

Tina's team insists that Tina's being modest when it comes to her own successes, especially when it comes to raising her daughter. "She asks a lot of questions and takes a lot of initiative," notes Team Leader Karen Slaven-Reynolds.

"You've always been there for me," Tina replies, "like I always want to be there...for Nellie."

Currently, there are more than 50 minor children whose parents are PfP clients. Providing parenting services, teaching and supporting parenting skills and assisting in arranging child care and medical care is not covered by PfP's Medicaid contract. These services are funded through support from the Trio Foundation, Pi Beta Phi Alumnae Club of St. Louis and individual donations.

Labels: Client Stories, Fall-Winter 2007, Parenting

Patience and Persistence: A Story Every Parent Knows  

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