Date of Conferral



Doctor of Nursing Practice (DNP)




Diane Whitehead


This project explored the challenges confronting clinicians who work with the Assertive Community Treatment Program (ACT), a government-sponsored clinic-based program providing services for individuals with persistent and recurrent mental health challenges in a large metropolitan city in the southern United States. The project involved semi-structured interviews with 15 health care clinicians to explore what they perceived as challenges and their recommendations for addressing them. Themes were organized around the 6 dimensions of the the relationship-based care model: leadership, teamwork, professional nursing, care delivery, resources, and outcomes. Identified patient challenges included transportation, lack of health insurance, housing, acceptance of certified peer specialists, the stigma of seeking help for mental health issues, problems with tracking patients, family interference, and fear of discharge from the program. Challenges related to the work environment were identified as poor pay for mental health staff, increasing paper work, professional boundaries, and balancing work demand and personal experiences. Recommendations to address challenges included open communication, interdisciplinary meetings to improve coordination of resources, increased support for family participation, and community support for mental health services. This project adds to the knowledge on ACT programs and will assist organizations planning or delivering ACT services in channeling resources to areas recommended by ACT clinicians. Recommended organizational changes will provide a positive social change to improve care of individuals with mental health challenges in the community.

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Nursing Commons