A Day in the Life of CASES’ Manhattan FACT Team

In 2016, CASES was selected to operate three of the City’s five new Forensic Assertive Community Treatment (FACT) [1] teams. FACT provides coordinated behavioral health and social support services for people with serious mental illness, a history of high usage of emergency mental health services, and recent involvement in the criminal justice system. The program uses a multidisciplinary, evidence-based treatment model emphasizing mobile, intensive service delivery in clients’ community settings.

Here’s what a typical day looks like for CASES’ Manhattan FACT team.

CASES’ offices in Central Harlem provide a safe space for individuals caught up in the intersection of mental illness and involvement in the criminal justice system. In these offices, every morning at 9 AM, FACT staff assemble in the team room for their daily team meeting. This room features a centered conference table surrounded by workstations, with walls covered by color-coded calendars, schedules, and other service-related documents.

Gathered around the table, the team begins their daily routine of discussing each individual case. Unlike most CASES’ programs, which assign a primary caseworker to each client, FACT emphasizes connecting clients to all program staff. Accordingly, all FACT team members can actively engage in a discussion about each individual client.

“It doesn’t lead to an overwhelming tradeoff,” Erica Kwan, the Manhattan FACT Assistant Team Leader and Wellness Specialist, says. She believes the coordinated approach of different staff members shows clients that there is a whole team of people committed to their well-being. The team-wide awareness of each client’s case fosters a collective strength which optimizes treatment planning and service delivery.

After the morning meeting, FACT staff members head out into different communities to begin the core of their work. Depending on the client, the visit could take place in a home, a supportive residence, or a homeless shelter. The FACT team is prepared to manage a day of diverse clients and communities. Their fieldwork consists of providing supportive services for clients of varied ages, genders, races, and ethnicities. Though it can be challenging to support such a wide variety of clients, it’s the kind of challenge that many FACT team members embrace.

“The learning is a two-way street,” Kwan explains. “Yes, we educate clients on certain topics, but we also have to get them to talk to us. To empower them to share, we need to listen. We know that our clients have been through a lot, so it’s important to be receptive to that and say, ‘Tell me about this specific thing’ in order to really build up the relationship. Once they’re comfortable, they have a lot of stories to share.”

To further encourage engagement, FACT team members often join clients in activities.

“Sometimes a client will just want to take a walk,” says Jesse Irizarry, a FACT Substance Abuse Specialist, “or they’re hungry and we’ll buy them food using the service dollars available. They might want to go shopping and we’ll use those service dollars to buy clothes if they’re in need.” Through these ostensibly routine activities, FACT team members and their clients are often able to leave lasting impressions on one another.

“Once I was headed to meet with a 70-year-old client who was released after a 35-year prison sentence,” Irizarry continues. “As I was approaching his residence, I recognized him outside sitting on the ground under a tree. Though his legs stuck out over tree-guard fencing, he was leisurely drinking soda and eating popcorn. I asked if he wanted to go somewhere more comfortable, but he said he was perfectly fine. He was enjoying the sunny day and, since that made him comfortable, I sat down on the fence next to him. We talked for awhile and he mentioned that he was romantically involved so we ended up talking about safe sex.”

Because all FACT clients have current or recent involvement in the criminal justice system, the team regularly communicates with justice system stakeholders and supports the client in fulfilling court-mandated or probation/parole requirements.

“We usually establish contact with a client’s probation officer and sit in during the client’s probation meetings to provide updates on how treatment is going,” Kwan says. “We also provide support and assistance if a probation officer recommends any additional services or treatments for our clients.”

Similarly, for clients with pending court cases, FACT staff members are sure to stay in contact with their clients’ attorneys and keep clients updated on their court dates. Staff also often escort clients from their residence to the court for hearings, at which FACT staff often appear at the client’s side. This is one more example of FACT’s emphasis on building relationships, fostering communication, and offering a continuum of behavioral health and social support services. Together, these interventions establish a network of support clients can rely on to begin to address their needs and avoid new justice-involvement.

After their last client meeting of the day, FACT team members email the FACT Team Leader an update on all the clients with whom they’ve met that day. The next morning, staff enter client progress notes in the team’s electronic health record database, and the daily meeting begins.

FACT staff includes experts in psychiatry, mental health, nursing, social work, substance use treatment, peer support, housing, employment, family, and criminal justice. FACT is structured to provide the holistic, wraparound services central to the ACT model while also focusing on close coordination with criminal justice agencies to help clients adhere to ongoing system requirements and avoid further justice involvement.