Missouri Code of State Regulations
Title 9 - DEPARTMENT OF MENTAL HEALTH
Division 30 - Certification Standards
Chapter 4 - Mental Health Programs
Section 9 CSR 30-4.195 - Access Crisis Intervention (ACI) Programs

(A) Access Crisis Intervention (ACI)-crisis intervention/referral services provided twenty-four (24) hours per day, seven (7) days per week by telephone hotline or face-to-face mobile response at the location of the crisis or at another location in the community;

(B) Administrative agent-an agency and its approved designee(s) authorized by the Division of Behavioral Health (DBH) as an entry and exit point into the state mental health service delivery system for a geographic service area defined by the department;

(C) Advocate-individual who assists those receiving department-funded services with treatment planning, care issues, and the complaint/grievance and resolution process;

(D) Community outreach/education plan-a plan outlining how individuals receiving services and their family members/natural supports, advocates, state agencies, law enforcement and others in the community will become familiar with the local Access Crisis Intervention System;

(E) Community Psychiatric Rehabilitation Program-a specialized program that provides or arranges for, at a minimum, the following core services: eligibility determination, initial comprehensive assessment, annual assessment, treatment planning, crisis intervention and resolution, medication services, physician/professional consultation services, medication administration, community support, metabolic syndrome screening (for individuals receiving antipsychotic medication), and psychosocial rehabilitation in a nonresidential setting for individuals with serious mental illness or serious emotional disturbances;

(F) Community support-as defined in 9 CSR 30-4.047;

(G) Crisis Intervention Team (CIT)-law enforcement officers with specialized training for response to behavioral health crises;

(H) Individual served-anyone receiving department-funded services directly from an organization/agency;

(I) Internal agency protocol-a specific method indicating how the agency plans to respond to guidelines set forth by the department;

(J) Mobile crisis response-specialized staff available twenty-four (24) hours per day, seven (7) days per week to assess and intervene face-to-face with individuals where the crisis is occurring or another secure location in the community;

(K) Qualified Mental Health Professional (QMHP)-as defined in 9 CSR 10-7.140;

(L) Risk assessment-the process of assessing dangerousness to self or others;

(M) Residential crisis services-a service used for persons who are at high risk for hospitalization or who are being diverted from hospitalization and can include specific crisis stabilization units, group homes, residential, apartments, motels/hotels, and foster home type settings;

(N) Specialized program-programs operated by an agency that provide specific services to designated eligible individuals enrolled in that program;

(O) Telephone hotline services -a published, centralized, twenty-four (24) hours per day, seven (7) days per week staffed toll-free telephone number to provide direct means of crisis assessment and triage for individuals in crisis, their families/natural supports, and agencies needing assistance; and

(P) Withdrawal management/detoxification-support provided to persons served during withdrawal from alcohol and/or other drugs.

(A) A treatment plan is not required for individuals receiving only telephone hotline or mobile outreach through the ACI program. Evidence of coordination between the ACI staff and the treating staff for individuals currently receiving department-funded services, or those who are in the process of being admitted to a CPR program, must be documented in the individual record.

(B) At a minimum, programs funded for ACI must keep the following records for telephone hotline services when possible to obtain from caller:

(C) ACI programs must have a method for retaining hotline data in compliance with 9 CSR 10-7.030.

(D) When a call is received on behalf of another individual who is in crisis, the caller and the individual in crisis must both be identified as recipients of the crisis intervention services provided by the ACI program. For data collection purposes, the identified service recipient is the individual in crisis.

(E) At a minimum, agencies providing ACI services must keep the following records for mobile outreach services when the individual agrees to provide identifying information:

(F) The agency must document when the individual does not provide identifying information.

(G) Agencies providing ACI services must submit data reports and documentation to the department in accordance with the department's standardized form and protocol.

(H) Agencies providing ACI services must meet the documentation and confidentiality requirements as defined in 9 CSR 10-7.030.

(A) Each administrative agent must provide or arrange for the delivery of ACI services.

(B) ACI programs must operate or arrange for a twenty-four- (24-) hour per day, seven (7) day per week telephone hotline. Each pro-gram shall have a written description of the telephone hotline system including the following:

(C) Each administrative agent must have a designated agency staff person or persons on call to the ACI system twenty-four (24) hours per day, seven (7) days per week.

(D) If the individual served, advocate, family member/natural support requests to speak with a staff member from a specialized program including, but not limited to, the CPR program's community support specialist and the ACI clinical staff have determined this action is clinically necessary, the ACI hotline staff shall contact the appropriate designated agency staff person.

(E) The ACI hotline staff shall remain in contact with the caller until a successful hand-off contact between caller and designated agency staff person has occurred.

(F) Once contact between the caller and agency staff has occurred, the designated agency staff person shall respond to the caller and/or secure the appropriate requested specialized program personnel involved.

(G) The designated agency staff person shall remain in contact with the caller until a successful hand-off or contact between specialized program personnel and caller has occurred.

(H) Each administrative agent must have a written internal agency protocol in place for how the designated agency staff person will be able to contact staff from specialized programs that require twenty-four (24) hours per day, seven (7) days per week crisis intervention as a component of their service menu.

(I) If ACI staff does not follow the procedure listed in subsection (H) of this section, there must be a written protocol for contacting the ACI supervisor and the specialized program supervisor within twenty-four (24) hours to review the immediate action taken and then reviewed for a performance improvement process within forty-eight (48) hours.

(J) ACI programs must have a written description for resource and referral to the following services:

(K) ACI programs must operate a twenty-four- (24-) hour per day, seven (7) day per week mobile response system. Each program shall have a written description of the mobile response system including the following:

(L) ACI programs shall provide mobile response to known and unknown individuals twenty-four (24) hours per day, seven (7) days per week at the location of the crisis or another secure community location.

(M) Mobile response shall not be provided exclusively in emergency rooms, jails, or mental health facilities.

(N) When a call is referred to mobile response, a phone-only response is appropriate if the clinical needs of the person who is in crisis can be addressed over the phone and/or the crisis has been deescalated.

(O) Each agency providing ACI services must have safety mechanisms in place for mobile response. These may include, but are not limited to:

(P) In crisis situations in which law enforcement need to be contacted by the ACI staff, the ACI staff must make the initial contact and remain involved until the crisis is resolved, by phone or with the mobile response team.

(Q) If the caller is not satisfied, the grievance procedure must be followed as defined in 9 CSR 10-7.020(7).

(A) Each administrative agent must develop a community outreach/education plan that includes details of how the following groups will become familiar with the ACI system:

(B) The community outreach/education plan must include the various action steps that will be taken in educating the community as to how to access the ACI system through written material and other means of communication.

(C) The community outreach/education plan must indicate how the components will be accomplished on an ongoing basis.

(D) Agencies providing ACI services must, be able to demonstrate their community awareness and education activities, at least annually, in a report or other format specified by the department which may include, but is not limited to, number of hotline calls, walk-ins, media outreach, and outreach/educational efforts with schools, law enforcement, or other entities in the community.

(E) The telephone number for ACI must be published in local telephone books distributed in each service area and be prominently displayed on agency websites and social media pages.

(F) If the level of crisis services provided by an agency is significantly below the state average or other established benchmarks, this circumstance must be addressed in the performance improvement plan.

(G) Agencies providing ACI services must promptly respond to requests from local institutions of higher education to assist in developing appropriate crisis response systems on college campuses.

(A) Staff providing telephone hotline services must have a bachelor's degree with three (3) years of behavioral health and crisis intervention experience or a master's degree with one (1) year of behavioral health and crisis intervention experience.

(B) For mobile response, the mobile crisis team shall have at least one (1) QMHP to provide face-to-face crisis intervention for each mobile response.

(C) Each administrative agent shall designate a coordinator for ACI services who must be a QMHP.

(D) The agency shall have written documentation that clinical supervision is provided on a scheduled basis including, but not limited to: meeting minutes, supervision logs, or peer review processes.

(E) For administrative agents that subcontract for hotline services this standard applies. Administrative agents shall have designated staff on call to the ACI system twenty-four (24) hours per day, seven (7) days per week for specialized programs. This designated staff person or persons shall have received crisis intervention training and have experience in responding to crisis situations with individuals and families.

(F) Each agency shall have an ACI Training Plan. The training plan shall include individuals served, families/natural supports, and advocates in the development and implementation of the plan.

(G) Staff providing ACI services shall complete the designated ACI training required by the department at least annually that includes, but is not limited to, the following core competencies as defined by the department:

(H) ACI staff shall have a working familiarity with the core competencies prior to providing crisis intervention services.

(I) New ACI staff shall be trained and document the demonstration of the core competencies within the first six (6) months of employment.

(J) The administrative agent shall describe how the core competencies will be incorporated into the ACI staff training program on an ongoing basis.

(K) Each agency shall provide a written plan of how it will measure the competencies of the ACI staff. The plan must include at least two (2) measurable outcomes including, but not limited to:

(L) New ACI staff must receive clinical supervision and job-shadow the supervisor or experienced crisis workers for a minimum of forty (40) hours prior to providing crisis services.