Lamberti J Steven, Weisman Robert L
From the Department of Psychiatry, University of Rochester Medical Center, Rochester, NY.
Harv Rev Psychiatry. 2021;29(4):278-297. doi: 10.1097/HRP.0000000000000299.
After participating in this activity, learners should be better able to:• Assess characteristics of forensic assertive community treatment programs.
Forensic assertive community treatment (FACT) has emerged internationally as an intervention strategy for people with serious mental disorders who are involved with the criminal justice system. Studies to date have shown marked variability, however, in FACT program design and operation. Based upon a literature review and relevant experience, the authors present their perspective on the essential elements of FACT. Given that FACT is an adaptation of the evidence-based assertive community treatment (ACT) model, it is recommended that FACT programs maintain a high-fidelity ACT component. FACT programs should also have both mental health and criminal justice admission criteria because service recipients are involved in both service systems. For optimal effectiveness, FACT team clinicians must partner with criminal justice agencies that provide community-based supervision to their patients. Prospective FACT enrollees should receive a clear explanation of the program, including how their respective mental health and criminal justice service providers will work collaboratively with them to prevent incarceration. FACT programs should also use risk/need assessment to inform treatment planning, evidence-based mental health and community correctional practices to promote both wellness and public safety, and shared training to promote effective collaboration. Additional elements to consider include housing, medical care, and transitional services. These elements are presented and discussed, including a rationale and evidence to support each component. The article concludes with introduction of a FACT fidelity scale, the Rochester Forensic Assertive Community Treatment Scale (R-FACTS). By operationalizing essential FACT elements, the R-FACTS is designed to support FACT program development, implementation, and dissemination in a more consistent and measurable manner.
参与本活动后，学习者应能更好地：
• 评估法医积极社区治疗项目的特点。
法医积极社区治疗（FACT）在国际上已成为针对涉及刑事司法系统的严重精神障碍患者的一种干预策略。然而，迄今为止的研究表明，FACT项目的设计和运作存在显著差异。基于文献综述和相关经验，作者阐述了他们对FACT基本要素的看法。鉴于FACT是基于循证积极社区治疗（ACT）模式改编而来，建议FACT项目保持高保真的ACT组成部分。FACT项目还应具备心理健康和刑事司法准入标准，因为服务对象同时涉及这两个服务系统。为实现最佳效果，FACT团队的临床医生必须与为患者提供社区监管的刑事司法机构合作。FACT的潜在参与者应得到关于该项目的清晰解释，包括他们各自的心理健康和刑事司法服务提供者将如何与他们合作以防止监禁。FACT项目还应使用风险/需求评估来为治疗计划提供信息，采用循证心理健康和社区矫正实践来促进健康和公共安全，并开展共享培训以促进有效合作。其他需要考虑的要素包括住房、医疗保健和过渡性服务。本文将介绍并讨论这些要素，包括支持每个组成部分的基本原理和证据。文章最后介绍了一个FACT保真度量表，即罗切斯特法医积极社区治疗量表（R-FACTS）。通过将FACT的基本要素具体化，R-FACTS旨在以更一致和可衡量的方式支持FACT项目的开发、实施和推广。
