Rochester Forensic Assertive Community Treatment (R-FACT)

Rochester Forensic Assertive Community Treatment (R-FACT) is an outpatient treatment program to reduce recidivism and promote recovery among justice-involved adults with a serious mental illness. The program is an adaptation of assertive community treatment (ACT), developed to prevent psychiatric hospitalization and promote housing stability. However, ACT alone has not been shown to reduce recidivism. R-FACT adapts the ACT model by targeting criminogenic risk factors, utilizing legal authority to promote engagement, and emphasizing mental health and criminal justice collaboration to promote effective problem solving. These elements distinguish R-FACT from ACT and from other FACT-type interventions. By targeting the drivers of crime and emphasizing shared problem solving, R-FACT represents a criminiologically-informed hybrid that combines practices from the fields of mental health and community corrections.

R-FACT consists of four components, including 1) high-fidelity assertive community treatment provided by a team of criminal justice–savvy staff, 2) identification and targeting of criminogenic risk factors, 3) use of legal authority to promote engagement in necessary interventions (i.e., legal leverage), and 4) mental health/criminal justice collaboration to promote effective problem solving. In the R-FACT model, legal leverage can be provided by a judge, a probation officer, or a parole officer, depending on the collaborating criminal justice agency. 

Lamberti et al. (2017) conducted a randomized control trial in which 70 offenders with a diagnosis of severe mental illness who were recruited and participated in the study between February 10, 2011, and May 14, 2014 were randomly assigned to R-FACT or enhanced treatment as usual. A single judge provided judicial oversight, which for the treatment group included weekly meetings between R-FACT clinicians, the judge and representatives from the public defender and district attorney offices to discuss problems and agree upon intervention strategies prior to any court appearances. Weekly court appearances were initially required, and the frequency of subsequent meetings was determined by the judge in collaboration with a clinical team liaison and attorneys. Evaluation data were collected at baseline and after a one-year intervention period. All participants (treatment and control) entered the study under a conditional discharge status, whereby their pre-enrollment sentences were suspended pending successful compliance with legal stipulations that included accepting mental health treatment and avoiding further criminal activity.

Findings showed that compared to control, at posttest offenders in the treatment group had significantly fewer convictions for new crimes and spent significantly fewer days in jail. In terms of risk and protective factors, offenders in R-FACT treatment were also engaged in outpatient treatment for significantly longer periods of time, and they spent significantly fewer days in the hospital, on average.

Citation:
Lamberti, J. S. (2017). Understanding and preventing criminal recidivism among adults with psychotic disorders. Psychiatric Services58, 773-781.

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Return to Blueprints Bulletin Issue 8. December 2018.