TRISH
I’m the program coordinator for the Alachua County FACT team. I’ve been with the program since the enrollment of our first client in September 2001. The staff was hired in August 2001. We started finding an office, setting up desks, chairs, phone systems and computers. Some of us had lived and worked in the community for many years; other people had just come to the community and didn’t really know the resources. During the first two weeks, we went out into the community to gather information about resources for our future clients. We visited places like the food stamps office, Medicaid office, the Center for Independent Living, Vista, Meridian, the jail and homeless shelters. At the same time, we wanted to let the community know who we were, so we could best coordinate services for our clients. That was a pretty good start. We also began going to the state hospital because our focus from the beginning was to enroll clients being discharged from that institution.

Every client is an individual; therefore, the treatment is individualized. That’s the beauty of this program. When a client is leaving the state hospital, they probably need a place to live along with other things. We often try to work with the client while they’re still in the hospital and tell them about available apartments in the area. Some may get a day pass so they can actually look at apartments themselves. They sign their lease and everything is ready before discharge from the hospital. We even like to ask them their preferred colors and we try to buy them their furniture. Usually, their initial needs are basic needs--housing, food, transportation and getting acquainted with the community. We try to teach them how to go to the store so they can eventually do some of their shopping. As time goes on, treatment issues change and needs change--they want to go to school; they want to go to work; they get back involved with drugs. You have to work with whatever you’re dealing with.

FACT team has been called “a hospital without walls.” The structure of the FACT team is like a state hospital. Our charts are set up like an inpatient unit. There are orders and treatment plans just like in inpatient charts. Orders are flagged and faxed to the pharmacy and shipped to us by the following day. The wards are equivalent to the client’s apartments. We go to them just like we would to their room on a ward. The big difference is that the campus is larger and has more interference now—family members, other people, drugs, beer in the grocery store. The milieu is more difficult to maneuver in the community setting.

We meet everyday as an interdisciplinary team. In an hour, we discuss all ninety-five patients. Sometimes we go over or under depending on the situation. The reason for the daily meeting is to keep everyone informed on the status of a client. If someone reports that a client is not doing well, I may say, “let’s go check on him tomorrow.” If they’re really bad, we might go that same day to do an assessment to see if the client needs to be hospitalized. This is called continuous treatment planning. Every day we make decisions about the client’s needs and adjust accordingly.

We really try to put an emphasis on independent living and integration into the community. It’s really difficult for clients who have been long-term institutionalized to become integrated into society. We’re doing a treatment plan now with a young man who wants to increase his social contacts. I suggested he get involved in some kind of interest group because he sings and has a nice voice. He said he’s afraid to meet people that aren’t mentally ill, because that’s what he knows. We’re going to have to work with him on getting through some of those fears before he can begin to develop friends that aren’t considered mentally ill. All these things come up in treatment. The goal is to get them to participate in activities just like the rest of us--mainstream living, mainstream employment, church involvement. It’s a challenge. It’s tough for us and it’s tough for the clients.

The goal is rehabilitation. But it’s an ongoing process. We go from meal planning to eventually dealing with your boss. People will go back in the hospital and we’ll start over. That’s fine--it’s a lifetime program. Sometimes the first part of the plan is to develop a plan for our clients. Then we implement things little by little--small steps at a time. The most important part of this process is building rapport. The staff at FACT knows every client and vice versa so the client doesn’t fall apart if a staff member leaves. This is not the case in the traditional mental health system. The other important thing is to include the client in the treatment plan or else it won’t work as well. The more collaboration we have the higher the likelihood that the client will focus on the treatment plan.