Modifying the PACT model: preserving critical elements.

Few agencies have the resources to replicate the Program for Assertive Community Treatment (PACT) model pioneered in Madison, Wisconsin, which calls for around-the-clock, comprehensive treatment and rehabilitation services for persons with serious mental illness. Most agencies modify the model program, and little is known about patient outcomes in such altered programs. This paper discusses issues in modifying the PACT model, especially for use in rural areas. The authors focus on six basic elements of the PACT model: multiservice teams, 24-hour service availability, small caseloads that do not vary in composition, ongoing and continuous services, assertive outreach, and in vivo rehabilitation. They describe how programs in South Carolina that are adaptations of the PACT model have retained these elements and achieved desired outcomes with smaller teams operating on modified schedules.