Since March 2020, we have been navigating an unpredictable, delicate, and always changing landscape due to the ongoing COVID-19 pandemic. While this has presented its own set of challenges to our work, the model we at Ellenhorn use – Program for Assertive Community Treatment, or PACT, is designed to be improvisational — always changing and adapting in real time to respond to our clients’ day-to-day lives and their shifting needs. This fluid framework allows us to respond to crises in an efficient and individualized manner while also adhering to current safety guidelines. As we face the ongoing surge of the Delta variant, its impact on hospital systems, and the rising threat of the Omicron variant, the PACT model continues to be the best professional model of care for people experiencing complex psychiatric events during the pandemic – especially those individuals who are reluctant to engage in treatment. Here’s why:
PACT is the most researched evidence-based model for the care of people who have been diagnosed with severe and persistent mental illness and is especially effective for individuals who are reluctant to engage in treatment. PACT, however, is not a type of treatment as much as it is a novel approach to organizing how treatment is offered. This highly agile and adaptable model of care is readily able to respond to the ever-evolving and changing nature of living beings – which is more important than ever in today’s climate. We call our organic approach a “living systems” alternative to hospital and residential care. It’s an “organic,” model as opposed to a more “industrial” one that approaches treatment as one-size-fits-all, as if care can be provided effectively in an assembly-line fashion. As Dr. Ellenhorn has explained in detail in the Psychiatric Annals, “when we participate in the living world with an appreciation for its ever-changing, relational and communicative nature, we have a greater chance to support its natural tendency toward growth and survival.”
Nearly 70 percent of our PACT teams’ contacts with clients happens outside the office and in the community and homes where clients already live and experience some level of security. Meanwhile, our PACT team providers meet daily and communicate consistently throughout each day on ways to shift the care of their clients as needed.
Since the start of the pandemic, organizational agility has been the key to staying afloat during this crisis. One significant challenge for all health care organizations continues to be providing organizational agility in the face of new and changing recommendations, new variants, and mandates for keeping individuals safe. Our adherence to PACT prepares us for that challenge, since our model balances significant long-term plans for clients with the understanding that teams must be ready to respond to the inevitability of crises with ad hoc immediate innovations.
As a result, we are able to shift our care immediately to adapt to the course of the pandemic, providing in-person interactions when we can, then immediately turning to more virtual care when that’s necessary due to a reemergence of the virus or new scientific information. We don’t need to create blanket policies about providing care virtually or not; rather, we can adapt to changes on a dime. What’s more, we can do this while remaining focused on accommodating the unique needs of each client.
Because we are able to be flexible and adaptable in this way, it allows us to provide truly individualized care to our clients. With particular regard to mental health care, being able to meet your clients where they are and form a meaningful and collaborative therapeutic relationship is imperative to successful treatment. Research on therapeutic change increasingly shows that this kind of relationship between clinician(s) and client is the central source of recovery. In fact, even applying best practice procedures has little effect if they are deployed without first building a collaboration. A collaborative relationship results from interactions based on seeing the client fully: understanding their dreams, their talents, and their purpose in life.
During the pandemic, our clients need collaborative relationships more than ever–ones in which they feel that someone is by their side ready to help them navigate the challenges ahead. As much as possible, we strive to continue providing this one-on-one and highly collaborative form of care in person.
Coronavirus is transmitted through the air. That means that congregating with groups of people indoors, especially in situations in which a lot of conversation occurs, places individuals at the greatest risk. Without extreme precautions, in-person group therapy fits within this category. While we’ve always offered a few groups at Ellenhorn, our main focus has been to provide clinical care on a one-on-one basis. We are thus able to easily suspend group treatment or move group treatment to virtual mediums without a significantly detrimental effect on clinical care or disruption to the overall process. In fact, we are convinced that we can remain as effective a program without group treatment.
When we meet with clients in person, we conduct our clinical meetings in the safest manner possible: We wear the safest masks (KN95 or N95), meet one-on-one/outdoors as often as possible, and remember to stay six feet apart. Moreover, our fully-vaccinated staff is tested twice a week – adding an additional level of precaution and care. Such an approach places both the client and clinician at minimum risk. It goes without saying that that level of safety simply can’t be duplicated as easily in other treatment settings.
Looking back at the past year, we really shouldn’t have been surprised that a model based on being as organic as possible would be (and still is) the best model for responding to a community-level crisis such as this. The Ellenhorn PACT approach allows us to continue to be present, productive, and creative in the work that we do with clients even in the face of a public health crisis.