(Client names have been randomly changed to a letter to protect their identity.)

To an outsider, it’s a pretty casual meeting on a recent late summer morning. It would be easy to assume clinicians Ashley Hammond, Angela Saitta, and Tara Dennis, and Clinical Supervisor Brian Lindner are discussing family or friends or catching up after a holiday weekend. Until you listen a little closer.

“She’s been stable, but she does have an upcoming (appointment), so we want to follow up on what her plan is for that,” Angela says of Client D, who they’ll be seeing today.

“I’m concerned he may be drinking again because I got a text from him … after missing his home visit,” Ashley says about Client H, who she’ll be seeing this morning.

They celebrate another client who has taken the initiative to contact the Social Security administration on his own: “He is capable of that.”

Another client may not be able to make their rent payment this month, and the team explores programs that may be able to help her.

The team shares a moment of victory as they hear a client will be returning after being out of contact for a while after a medication change.

“Yes, we found him!” Brian says.

“He’s back in (the area),” Angela shares, before the conversation shifts to the best way to connect with him.

“He likes music,” Angela says. “I’ve talked to him about Game of Thrones.”

For clients served by the Idaho Department of Health and Welfare’s Region 3 Assertive Community Treatment (ACT) team, mental health support and treatment doesn’t look like what many people may think of as typical counseling or medication management. The team isn’t preparing for a day of office hours and appointments; they are planning for the 16 clients they will be meeting in the community on this day – some at home, some at work, others in challenging living situations because of their serious and persistent mental illnesses and resulting symptoms.

Tara leaves the staffing meeting shortly after and will be working to get a housing voucher for a client who lives in a shed.

“We have to find ways to connect with them,” Ashley explains as she prepares to head out to see Client D.

ACT programs rely on teams of professionals with expertise in psychiatry, nursing, social work, counseling, and addiction services to keep people engaged in their communities. ACT teams across the state provide continuity of care to some of Idaho’s most vulnerable adults. Support by an ACT team improves people’s ability to function in their communities and reduces the need for future hospitalization.

ACT Teams plan and monitor treatment, accompany patients to medical and dental appointments, attend court hearings, and help them manage money, pay bills, and apply for services. Clients also receive help with housekeeping, shopping, cooking, transportation, finding and keeping jobs, and finding housing. Team members educate the patients about mental illness, provide counseling, and help patients cope with psychotic episodes and other psychiatric crises. They also order, deliver, and supervise the use of medications.

The ACT team based in Caldwell is on a first-name basis with all their clients, “and their plus-ones, pets, their friends, and landlords,” Ashley says. She has clients who send her pictures of their cats. The Caldwell team currently serves 45 clients. All of the clients have frequent contact with the ACT team; the relationships can last years to even decades. One client has been with the ACT team for 20 years.

A weekly visit looks different for everyone. One client who struggles with extreme paranoia goes willingly without utilities or services to his home and has devised a way to charge his phone using a car battery.

“Self-determination is very important for him. We make sure he is as stable as he can be and able to make decisions he is comfortable with,” Angela said. Their goal: To ensure he can take care of himself and is not a risk for harm to himself or others.

Sometimes they take people to the grocery store, to the laundromat, or to update their Food Stamps applications. “Sometimes it’s just to take them for a walk in the park,” Tara said.

Many patients receive weekly medication deliveries, and that is one of the first things Ashley does as she pulls up to Client D’s home. She has been stable for a while, Ashley says, before she steps inside to talk to her for about 45 minutes.

During their visit, Client D is very soft-spoken with a frequent, if slight, smile. They discuss her upcoming dental appointment, for which she’s been saving for months, and whether fluoride treatments are worth the expense. They talk about her progress in a weight-loss program, her bad dreams, the soup she had the last time she was at Olive Garden, and knee pain she’s been struggling with. She’s already planning for the holidays, and Ashley quickly reminds her – with no notes – of how social she was able to be last year on her limited income.

Even though Client D is worried she may be isolating herself, Ashley easily reminds her of the work she’s been doing to help at her church, and the Bible study she’ll be returning to. Client D has been supported by the ACT team for about seven years and enjoys her meetings with the clinicians. She tries to write down things she wants to discuss before the team arrives, so she doesn’t forget.

After saying their goodbyes, Ashley, a seven-year ACT team clinician and Idaho native, is headed to her next stop to meet with Client H. Ashley’s ability to recall the specifics of everyone she works with is impressive.

Ashley likes being able to meet the people she helps where they are, to help them get through “the next day, the next hour.”

“Not only do I enjoy the work, I know what we’re doing is helping,” Ashley says of the ACT model, which reduces hospitalizations and helps patients recover.

Client H meets Ashley, or “Ash” as he calls her, at the car, coffee cup in hand and ready to chat. He receives his meds and starts discussing the work being done at his apartment building. A new unit just became available – something which Ashley seizes on and sends a quick text about to another team member to see if it may fit another client, all without breaking stride in conversation. Like other team members, her two phones rarely leave her hand.

Client H has had stable housing for years. Stable housing can be difficult to find because many landlords are reluctant to accept housing vouchers or clients with the struggles of those on the ACT team – many of whom have been homeless and have no benefits. But housing, Ashley says, is the easiest ways to keep clients stable and limit their usage of emergency services.

During their appointment, Ashley addresses the text the client sent her recently and asks if he was drinking. He assures her he was not. He said he was extremely worried about missing an appointment he’d had for Ashley to drive him to the courthouse. He took the bus instead to avoid missing the appointment and apologizes to Ashley, saying “I was freaking out” about receiving punishment from the court.

Overall, they spend about half an hour talking on the lawn, going over his coping skills.

Ashley’s next client of the morning is a contrast to the previous two. The visit lasts maybe three minutes and the client barely cracks the door to briefly speak with Ashley. She is in the process of applying for Supplemental Security Income (SSI) and has a phone interview set up for the next day.

Ashley, who is an advocate for the SOAR (SSI/SSDI Outreach, Access, and Recovery) program and has helped many people access benefits through SSD, provided her with a list of her medications and hospitalization history for her to use during her phone interview. The records will help the Social Security Administration verify her claim through Disability Determination Services.

“It’ll give her the best chance,” Ashley says.

Before heading back to the office, Ashley pulls over to the side of the road a few blocks away to take notes on her morning appointments and discuss the relationships they build over time with their clients.

“Nothing else matters if you don’t have a relationship,” she says. “We have to be able to discuss difficult things sometimes, but in a way that still maintains the relationship.”

The family-type dynamic of the early staffing meeting is not necessarily far off. As Tara noted, if clients don’t have friends or family, the ACT team can become that type of support for them.

“We see them so frequently, we get to know the whole story,” Brian says.

Their ability to work outside the concept of billable hours is something Ashley enjoys. “The quality of care we provide is not available elsewhere in the community,” she says.

A few members of the team meet up around lunch time at the office before heading back out again for the afternoon. They rotate so all the clinicians meet with each of the clients, and typically each person would have a day each week for paperwork. The rotation helps because each of the clinicians has their own strengths and opinions, and it can help the clients get used to seeing new people. The rotation also helps avoid burnout among clinicians. The job can be emotionally challenging.

Angela is meeting with four clients today, two this afternoon.

She’s been with the ACT team for about a year but has a contagious aura of positivity as she drives and discusses what she likes about the evidence-based ACT model.

“You have a built-in safeguard being part of the ACT team. They (clients) have built-in trust in the team,” she said. “For a lot of people, it’s stability where they didn’t have it before.”

Angela greets Client W at the door and comments on his dog’s new haircut. After receiving his meds, he says that he needs to brush his hair, so they can go to Albertsons to cash a check he needs to pay his final supervision fee now that he has completed probation.

He’s lost 24 pounds, and with supervision and treatment does very well. Angela thinks he’s capable of even more than he sometimes admits.

“If you can take a strengths-based approach with the clients, you can get further,” Angela says. “The clients are the experts in their lives, and part of our jobs is to help support them in their choices.”

Client W has been with the ACT team about three years. He enjoys their visits and their occasional trips around town. He hasn’t been hospitalized since his involvement with the ACT team.

During the drive, they discuss the construction around town, his plans for a trip to California, and whether they can help him coordinate a repair to some siding on his home. They get a parking spot close to the probation office.

“It’s our lucky day,” she says. When Client W comes out after paying his fee, Angela is still brimming with encouragement.

“I think we should have a little party,” she says, urging him to go get an ice cream later. “You should do something. That’s two years of your life. That’s big. You should be proud of yourself!”

“I checked the bill. It said 000,” Client W says. “It feels good.”

They make plans for the next week to get his driver’s license corrected – there’s an error in his date of birth. He says the ACT team helps him make good choices.

“Are you going to stay sober?” Angela asks.

“Oh yeah,” he says without hesitating.

Angela meets her final client of the day, Client T, at her place of work, and her boss leaves them while they talk. It’s a difficult day for her. It’s been two years since a family member passed away, and a good friend from high school recently died as well.

Client T has already made plans to spend the evening with family because she “didn’t want to be alone.”

“You’ve had a pretty impactful week,” Angela said. “How are you dealing with that?”

She admits to thinking about drinking but doesn’t “want to feel more depressed than I am.” The life she used to live scared her, and she doesn’t want to go back.

“When I had babies, it was the happiest time of my life,” she shares.

Angela discusses the upcoming memorial for her friend, and Client T is encouraged to reach out to the ACT or crisis team any time she needs help.

“You have our 24-hour line. If you need it, will you use it?” Angela asks. Client T says she will.

Angela’s reminder about the 24-hour line speaks to the stability and trust that the ACT team brings to their clients. Even if it’s outside business hours, crisis workers are available and team members are on-call at different times of the night. She reassures her client: “Twenty-four hours a day, there’s someone there for you, in your darkest moments.”

The ACT team in Region 3 meets people where they are, in their most difficult times, and as they move toward recovery and achieving their goals. It’s a relationship that benefits clients and is rewarding for the clinicians who work with them every day.

“The ACT team is such a great way to be involved in people’s lives,” Clinical Supervisor Brian Lindner said. “It’s rewarding to get people from a place where they are very ill to a place where they’re more functional.”

By Jon Meyer, Division of Behavioral Health
Jonathan.Meyer@dhw.idaho.gov

A Day in the Life is an occasional series of stories highlighting Department of Health and Welfare employees and the work they do every day to help vulnerable Idahoans and those in crisis gain stability to live their best lives.