Models of how to organize housing, clinical and complementary supports

Information about the Housing First Service Delivery Models

Intensive Case Management (ICM) and Assertive Community Treatment (ACT)are two case management models under Housing First that have well-defined standards and a strong evidence base. These models represent the two major ways by which housing, clinical and complementary supports are organized and provided to Housing First clients. It should be noted that each of these models is intended to be understood on a continuum rather than as absolute standards. It is fully expected that communities would adapt these models to fit their local situation.

In practice, most communities apply Intensive Case Management and Assertive Community Treatment very broadly, organizing housing and clinical and complementary supports provided to homeless Housing First clients based on the particular community setting and the self-determined needs of the client.

Intensive Case Management

Intensive Case Management is a team model in which case workers, working alone or in teams, link individual clients to mainstream housing, clinical and complementary supports. Case managers provide outreach, develop relationships and coordinate with other services to help people access needed services. Intensive Case Management teams may include housing and complementary support workers, with a link provided to mainstream clinical services.

Specific characteristics of Intensive Case Management include:

  • One-on-one case manager to client relationship using a recovery-oriented approach (the team of case managers may include housing and complementary support workers).
  • The case manager brokers access to mainstream services that the client identifies as needed to attain his or her goals.
  • The case manager links clients to health professionals (e.g. family doctor) and other services.
  • The case manager often accompanies clients to meetings and appointments in support of their goals/needs.
  • Case managers are available on a regular schedule; caseloads are often shared to assure coverage of 7 days per week, 12 hours a day.
  • The staff to client ratio is generally 1 case manager per 20 clients.
  • The duration of the service is determined by the needs of the client, with the goal of declining supports and transitioning to mainstream services as soon as possible. In some cases, it may be possible to transition clients within 12 to 16 months.

Assertive Community Treatment

Assertive Community Treatment is a recovery-oriented, comprehensive, multi-professional model that usually includes comprehensive clinical supports, such as a psychiatrist, doctor, nurse and substance abuse specialists on a single team, and that team serves all of the client's needs. Housing and complementary supports may also be provided by the team; alternatively, the Assertive Community Treatment team may link the client to mainstream housing and complementary supports. An Assertive Community Treatment team provides a client-centred, intensive service for people with significant mental health and/or addictions issues. They provide a range of supports directly to individuals who would not be ready for integration into the mainstream for some time (e.g. recovery and wellness services; peer support; integrating mental health and addictions supports).

Characteristics of Assertive Community Treatment teams include:

  • A multi-disciplinary team of health professionals that provides wrap-around service directly to the client.
  • The team members are available 24/7 and provide real-time support.
  • The Assertive Community Treatment team meets regularly with the client and with each other (could be daily).
  • The team is mobile, often meeting clients in their homes.
  • The staff to client ratio is generally 1 Assertive Community Treatment team per 10 clients.
  • The program components are informed by client choice, peer support and a recovery-orientation.
  • Services offered on a time-unlimited basis, with planned transfers to lower-intensity services for stable clients.
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