How Ellenhorn’s PACT Model is Built for the Pandemic
Since March 2020, Ellenhorn has 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 Ellenhorn uses – Program for Assertive Community Treatment, or PACT – is designed to be improvisational, always changing and adapting in real-time to respond to clients’ day-to-day lives and their shifting needs. This fluid framework allows Ellenhorn to respond to crises in an efficient and individualized manner while also adhering to current safety guidelines. As they 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.
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. Ellenhorn calls their 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 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, 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. Ellenhorn’s adherence to PACT prepares them for that challenge since the 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, the program is able to shift care immediately to adapt to the course of the pandemic, providing in-person interactions when they can, then immediately turning to more virtual care when that’s necessary due to a reemergence of the virus or new scientific information. Ellenhorn doesn’t need to create blanket policies about providing care virtually or not; rather, they can adapt to changes on a dime. What’s more, they can do this while remaining focused on accommodating the unique needs of each client.
Because the program is able to be flexible and adaptable in this way, it allows them to provide truly individualized care to 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, all of Ellenhorn’s 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, the program strives 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 Ellenhorn has always offered a few groups, the main focus has been to provide clinical care on a one-on-one basis. They 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, success has convinced Ellenhorn that they can remain as effective a program without group treatment.
When meeting with clients in person, clinicians conduct clinical meetings in the safest manner possible, wearing the safest masks (KN95 or N95), meeting one-on-one/outdoors as often as possible, and remembering to stay six feet apart. Moreover, the 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, Ellenhorn says they 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 them to continue to be present, productive, and creative in the work done with clients, even in the face of a public health crisis.
Ellenhorn was founded in Boston in 2005, with the belief that psychiatric recovery and recovery of a sense of purpose, hope and faith in oneself go hand-in-hand. In 2016, Ellenhorn opened a second office in New York which treats adolescents and adults. Ellenhorn provides psychiatric care while supporting clients’ pursuit of life goals and their connections to the larger community. As an alternative to traditional residential settings and hospitals, Ellenhorn is the most intensive program in the U.S. focused on a “treatment without walls” approach to psychiatric needs. Ellenhorn serves clients in the metro Boston and New York areas.