Mclean Hospital

Program of Assertive Community Treatment (PACT)

At McLean Hospital, we understand that care doesn’t end when someone leaves the hospital.

Our Program of Assertive Community Treatment (PACT) brings clinicians into individuals’ homes and local communities. This allows us to best meet the ongoing needs of people with psychotic disorders such as schizophrenia, bipolar disorder, and psychosis.

As a “hospital without walls,” PACT strives to provide customized, person-centered care for individuals at any stage of the rehabilitation process. The program is structured to make sure people receive the help they need, when they need it, and for as long as they need it.

For information or to make a referral, please call 617.855.2674.

PACT’s community-based team offers services to help patients transition between levels of care or to avoid the need for hospitalization. Our clinicians address symptoms and assist with therapy and medication management.

We place equal emphasis on building and growing aspects of an individual’s life that are important to recovery. This can include community integration and independent living skills.

PACT is best suited to adults 18 years and older who:

  • Have bipolar disorder, schizophrenia, or other related diagnoses—with or without coexisting conditions like substance use disorders
  • Are at risk for repeated hospitalization or in need of recovery supports
  • Seek person-centered treatment that is flexible and adaptable to one’s goals and needs
  • Struggle with staying on track with their treatment or need help with skills for day-to-day living, including vocational and social skills
  • Need individualized care and access to a compassionate mobile treatment team
  • Want help taking steps to achieve their goals

In order for PACT to be effective, an initial desire for change is necessary from the patient and their family. Patients also must be willing to allow the PACT team into their home and/or community.

At PACT, we do not define our patients by their illness. Instead, we recognize that everyone can create a meaningful life. We meet people where they are, both mentally and physically. By helping individuals get the right support, we empower each patient so they are an active participant in their care and in their life.

Doctors and researchers have long understood that people receive extensive care while they’re in the hospital. However, patients don’t always get that care after release from the hospital. This often results in another hospital stay.

Programs like PACT bridge gaps in care. They have been successful at reducing the number, frequency, and length of hospital admissions. Studies show that people who have used similar programs spend less time out of work, earn more money, and have more fulfilling social lives. Services like PACT can also reduce caregiver burnout by adding resources to patients’ support systems.

PACT
PACT meets patients where they are, both mentally and physically

Individuals may need help for only a month, or they may need longer-term, more comprehensive assistance. Though the minimum length of participation in this self-pay program is one month, PACT is flexible in order to meet the needs of the patient.

Participants in PACT benefit from the program’s low patient-to-staff ratios, a high frequency of contact between the patient and clinicians, direct service from the PACT team, outreach in the community, and access to a medication prescriber.

PACT in the News

Watch program director Chloe Pedalino, LICSW, on the first episode of the Food for Thought Mental Health Podcast.

Read more about McLean’s newest clinical program in the article “Hospital Without Walls for Individuals With Chronic Mental Illness.”

PACT is supported by philanthropy. Read more about Monica Luke and the PACT program in the article “New PACT Team Offers Support 24/7.”

Treatment Approach

PACT is designed to support those at risk for repeated hospitalizations. We provide the clinical services a person needs to keep up with their treatment and the independent living skills they need to navigate day-to-day life.

The PACT Model

PACT patients get support where it’s needed most. This most often means meetings with the PACT team are in the home or community setting.

For those who experience a lot of symptoms, have trouble organizing themselves to get out and around, or find going to the hospital is overwhelming, we can meet with the patient where they are comfortable.

PACT uses open dialogue/dialogic practice and emphasizes a flexible, person-centered approach. We focus on shared decision-making and peer support. Contact with PACT staff takes a variety of forms, including texting, phone, and in-person visits.

Our clinicians take a team approach. Multiple providers with different specialties care for a patient. Our team also includes a provider with lived experience of their own mental health diagnosis.

This team approach also allows us to ensure continuity of care. A patient works with various PACT team members at any given time. Over time, a patient will get to know several members of the team and feel comfortable working with each.

Our care is flexible, which means that members of the team fit their schedules around the needs of the patient. They don’t have to wait until their next appointment. If a patient has a problem today, they can get help today.

“[The PACT staff] are always accessible. They believe in me. They are observant. They see me beyond my illness. Because of PACT’s indispensable support, I now live more independently with some additional care.”– Program of Assertive Community Treatment patient

The treatment team bases frequency of meetings on the individual’s needs. The team discusses each patient’s progress and reassesses their treatment approach daily. This allows for a constant readjustment of services to grow with the patient’s rehabilitation.

Our services are designed for easy and rapid access to the PACT team. This allows us to manage symptoms proactively, intervene in a crisis, and prevent further decompensation.

Our experienced treatment team collaborates with other services and resources—at McLean and in the individual’s community—to ensure patients get the care and support they need.

Support and Services

PACT provides comprehensive and ongoing clinical support, assessment, rehabilitation assistance, and general help with daily life. We help with all aspects of treatment, including medications, crisis intervention, peer support, and more.

With a focus on rehabilitation, an individual can work with the PACT team to develop or enhance skills to benefit work or personal life. Rehabilitation is achieved by not only treating symptoms but by also building up one’s life outside of traditional mental health treatment.

The PACT team works with patients to help identify and achieve goals for ongoing recovery and independent living. Goals can include establishing routine and structure, developing new interests, and becoming connected to one’s community. We assist individuals in determining and obtaining what is meaningful in their life, whether it be volunteering, pursuing an education, or employment.

We work with individuals to learn skills, such as how to manage money, use public transportation, shop for groceries, or coordinate medical appointments. PACT helps with obtaining support services and benefits, such as financial and educational services and legal aid.

PACT also provides services such as social skills coaching, symptom education, family support and education, ADL coaching, coping skills development, community integration assistance, and 24/7 crisis on-call access.

PACT doesn’t include traditional individual therapy. Instead, the PACT model goes beyond the walls of office-based therapy to work with people directly in the community. This allows us to overcome any potential barriers to treatment. In select cases, we may meet with someone in an office setting, though this is often not the treatment recommendation. If deemed clinically appropriate, the team may suggest referral to an office-based therapist external to the PACT team.

Patient speaks with clinician outside
The PACT team is accessible 24/7 for crisis intervention

Maintaining a relationship with an outside therapist can be beneficial for many patients, though this is not required. For most patients, we recommend medication management through the PACT team’s medication prescriber, our nurse practitioner. This allows for more flexible, more responsive, and more integrated care.

Daily in-home medication administration is not a part of the program. The team can assist with connecting patients with various home health care services as needed. These services are not part of PACT and may be private pay or insurance based.

Family involvement is up to the patient. However, it is highly recommended, as we believe that mental health affects the entire family system. Family can be an integral part of one’s treatment and sustained recovery. With permission of the patient, we include family members in treatment to the extent that it is clinically appropriate.

We strongly encourage families to take part in their own education by attending family educational and support sessions offered by McLean Hospital and NAMI.

Admission & Cost

Admission

The Program of Assertive Community Treatment (PACT) is a community-based treatment program. It is ideal for adults with chronic mental health diagnoses—such as schizophrenia, bipolar disorder, psychosis, and other related disorders—who would benefit from access to a comprehensive treatment team and crisis on-call services offered in the individual’s home or local community.

Potential patients must have a desire to change, be ready to set and meet at least one goal, and be willing to let the PACT team into their home or community.

We generally accept patients whose communities are within a 20-minute drive from McLean’s Belmont campus. Those beyond this radius are considered on a case-by-case basis.

For further information or to make a referral, please contact:

Chloe Pedalino, LICSW, Program Director
Phone: 617.855.2674
Email: cpedalino@partners.org

We evaluate individuals prior to admission to ensure the program is a good fit, which includes meeting a specific set of criteria. Potential program participants or referring clinicians should fill out and return the PACT Referral Form. If you need assistance with the admission process, please contact the program using the information provided above.

Cost

PACT is a self-pay program. The rate is $1,500 per month, which covers all services provided by the PACT team. Services provided by other McLean Hospital programs or by programs in an individual’s community are not included in this fee. Non-program services may be covered by health insurance.

Treatment Team

Program Leadership

Chloe Pedalino, LICSWChloe Pedalino, LICSW, Program Director

Ms. Pedalino is also the director of Collaboration and Community Liaison for the Psychotic Disorders Division at McLean Hospital. A co-founder of the Psychotic Disorders Mentorship Program (PDMP), she previously worked as a clinical social worker at McLean’s Schizophrenia and Bipolar Disorder Inpatient Program, where she served as a lead clinical social worker.


Taylor Buckley, LCSWTaylor Buckley, LCSW, Assistant Program Director

Ms. Buckley has experience in cognitive behavior therapy (CBT) techniques and open dialogue practice. She was recipient of a Partners In Excellence Award for Innovation and Leadership in 2018.


Joseph Stoklosa, MDJoseph Stoklosa, MD, Clinical Director, Psychotic Disorders Division

Dr. Stoklosa is also the assistant program director for the MGH/McLean Adult Psychiatry Residency Training Program and is an instructor in psychiatry at Harvard Medical School. He is actively involved in educational research and founded the Clinician Educator Program for the MGH/McLean residency program. Dr. Stoklosa also developed the Schizophrenia and Bipolar Disorder Inpatient Program’s clinical care model, which is focused on improving the use of evidence-based treatment.


Staff and Associates

Our staff includes experienced and well-trained social workers, psychiatric nurse practitioners, a peer counselor, and more. They have extensive background in the treatment of chronic and persistent mental illness such as schizophrenia and bipolar disorder. Staff have experience working with patients from diverse cultural and socioeconomic backgrounds from across the country and around the world.

PACT is a community-based program within McLean’s Psychotic Disorders Division, under the leadership of Dost Öngür, MD, PhD.

FAQ

Where is PACT located?

The PACT program is based at McLean’s Belmont, Massachusetts, campus. However, PACT is a community-based program, and care and services are delivered in the individual’s home or community, as appropriate.

Who benefits most from PACT?

PACT is designed to help adults with psychotic disorders such as schizophrenia, bipolar disorder, psychosis, and other related disorders. The program is aimed at individuals who need assistance to stay on track with their treatment or need help with skills for day-to-day living, including vocational and rehabilitation skills.

Is family involved in treatment?

Family involvement is up to the individual. Family can be an integral part of one’s treatment and sustained recovery. With permission of the patient, we include family members in treatment to the extent that it is clinically appropriate.

Is aftercare planning a part of the program?

The treatment team works closely with the individual as well as with family, significant friends, and outside providers to develop a personalized aftercare plan. Recommendations by staff are made based upon clinical needs, progress made during treatment, and long-term treatment goals.