BRIDGING THE GAP BETWEEN INPATIENT AND OUTPATIENT PROVIDERS USING ORGANIZATIONAL ELEMENTS OF ASSERTIVE COMMUNITY TREATMENT

Even among comprehensive local public mental health systems, there rem ain large gaps in continuity of care following discharge from inpatien t settings. The authors describe a modification of the assertive commu nity treatment (ACT) program model that links inpatients to ongoing co mmunity-based care, and provide preliminary evidence of its effectiven ess as a component in a rationally organized comprehensive system of c are. Given the recent trend toward managed Medicaid arrangements, ther e will be increased pressure to reduce clients' length of stay in ACT programs. State mental health authorities are cautioned to resist allo wing managed care contractors to radically change the conditions under which ACT programs operate until there is greater evidence of the eff ectiveness of alternative approaches.