Current through Register Vol. 56, No. 18, September 16, 2024
(a)
This section delineates the services, which PACT teams must provide to eligible
consumers and also sets requirements for service coordination among PACT teams
and other service providers.
(b) In
order to help the consumer cope with and gain mastery over symptoms, overcome
barriers, achieve wellness and recovery in the context of daily living, the
PACT team shall be available to provide symptom assessment, management, and
supportive counseling. These services shall include, but not necessarily be
limited to:
1. Ongoing assessment of the
consumer's mental illness symptoms, behaviors, and concerns (that is, the
consumer's unique experience with the mental illness), and the consumer's
response to treatment;
2. Ongoing
assessment of the consumer's response to treatment, including the team's
strategies for engaging the consumer in PACT services;
3. Education of the consumer regarding his or
her illness and the effects and side effects of prescribed
medications;
4. Symptom management
efforts directed to helping each consumer identify the symptoms and occurrence
patterns of his or her mental illness and develop methods (internal,
behavioral, or adaptive) to help lessen their effects;
5. Provision, both on a planned and "as
needed" basis, of such psychological support as is necessary to help consumers
accomplish their recovery goals and to cope with the stresses of day-to-day
living;
6. For any interested
consumer, an evidence-based program, such as an Illness Management and Recovery
Program, which involves regular sessions between PACT team staff and the
consumer, aimed at assisting the consumer to identify and pursue personally
meaningful recovery goals and is founded upon a core set of interventions that,
at a minimum, include: psycho-education, social skills training,
cognitive-behavioral techniques, motivational interviewing, and relapse
prevention planning;
7. Education
of and, where applicable, assistance to the consumer regarding psychiatric
advance directives (in accordance with N.J.A.C. 10:37); and
8. Education of and, where applicable,
assistance to the consumer regarding Wellness Recovery Action Plans (WRAP),
and/or other crisis planning tools.
(c) The PACT team shall be available to
provide crisis assessment and intervention 24 hours per day, seven days per
week, including telephone and face-to-face contact. These services may be
provided in conjunction with the catchment area's designated screener or
emergency services.
1. Response to crisis
shall be rapid and flexible.
2. If
screening center services, extended crisis evaluation beds, crisis housing,
short-term-care and voluntary and involuntary inpatient units are necessary,
then PACT staff shall fully collaborate in treatment. PACT shall provide
support to the maximum extent possible, including accompanying the consumer to
the local screening center or psychiatric emergency service and remaining with
the consumer during the assessment process.
(d) The PACT team shall provide services in
the areas of medication prescription, administration, monitoring, and
documentation.
1. The PACT team psychiatrist
shall:
i. Assess each consumer's stated
concerns, mental illness symptoms, and behavior and prescribe appropriate
medication;
ii. Regularly review
and document the consumer's stated concerns, mental illness symptoms, as well
as his or her response to prescribed medication treatment;
iii. Monitor, treat, and document any
medication side effects; and
iv.
Participate in outreach contacts as needed.
2. In accordance with applicable law, PACT
provider agencies shall establish medication policies and procedures, which
identify processes to:
i. Record physician's
orders;
ii. Order
medications;
iii. Arrange for all
consumer medications to be organized through the team and integrated into staff
daily and weekly schedules;
iv.
Provide security for medications (that is, daily supplies, long-term injectable
and longer-term supplies) and set aside a private, designated area for set up
of medications; and
v. Administer
medications to program consumers; train other team members regarding medication
education, medication delivery, observation of self-administration of
medication, and medication monitoring; and regularly assess other team members'
competency in this area.
3. All PACT team staff shall assess the
consumer's stated concerns, mental illness symptoms, and behavior in response
to medication and shall monitor for medication side-effects during the
provision of observed self-administration and during ongoing face-to-face
contacts.
4. Regarding PACT
enrollees residing in Department of Health licensed residential health care
facilities (RHCFs), pursuant to
8:43-10.1(a), the
RHCF is responsible for providing resident supervision and/or assistance during
self-administration of medications and for documenting any observed instance
where medications are not taken.
i. After
obtaining the consumer's consent, PACT team staff shall collaborate with
appropriate RHCF staff to ensure that PACT consumers are receiving prescribed
medications. This shall include mutual sharing of information regarding PACT
consumers' mental illness symptoms and behavior in response to medication and
medication side effects. After obtaining the consumer's consent, a PACT team
member shall meet in person with the RHCF operator and/or staff at least once
per month to discuss the status of each PACT consumer residing in the RHCF and
shall document the results of these meetings in the consumer's PACT
record.
ii. PACT team staff shall
also regularly advise the RHCF nurse(s) as to which medications are being
prescribed and ordered by the PACT psychiatrist, communicate to the RHCF staff
about PACT consumers' treatment plans, for example, goals, objectives, and
interventions, and provide medication education for PACT consumers.
iii. For those RHCFs which are not
"registered generators" under the applicable law (see, for example,
7:26-3A.8) and thus are unable to
dispose of syringes and cannot administer injectable medications, PACT nurses
shall administer injectable psychotropic medications, maintain a record of
these injections in the consumer's PACT record, and communicate to the RHCF
that such injections have been given.
5. Where a PACT enrollee resides in a
boarding home ("BH") licensed by the Department of Community Affairs, the PACT
team, after obtaining the consumer's consent, shall collaborate with
appropriate BH staff to ensure that the consumer is receiving prescribed
medications.
i. Collaboration shall include
mutual sharing of information regarding PACT consumers' mental illness symptoms
and behavior in response to medication and medication side-effects as permitted
in 5:27-10.5.
ii. The PACT team shall regularly review the
BH's records of residents who are PACT consumers as permitted in
5:27-8.1(c).
iii. The PACT team shall also provide regular
communication to BH staff about PACT consumers' treatment plans, for example,
goals, objectives, and interventions; and provide medication education. A PACT
team member shall meet in person at least once per month with the BH staff
and/or operator to discuss the status of each resident who is a PACT consumer
and shall record the results of these meetings in the consumer's PACT
record.
iv. Where mutually agreed
upon between the PACT team and the BH operator, the PACT team may supervise the
observed self-administration of medication. A PACT team member shall meet in
person at least once per month with the BH staff and/or operator to review
medication provision to each PACT consumer resident and shall record the
results of these meetings in the consumer's PACT record.
(e) The PACT team shall provide
whatever direct assistance is reasonable and necessary to ensure that the
consumer obtains the basic necessities of daily life, including, but not
limited to:
1. Safe, clean, affordable
housing;
2. Food and
clothing;
3. Medical and dental
services;
4. Appropriate financial
support, which may include supplemental security income, social security
disability insurance, general relief, and money management services.
i. The PA shall ensure that PACT team members
are able to have on-hand, in their possession, during regular working hours,
and when appropriate, during on-call hours, an adequate amount of petty cash
with which to make emergency purchases of food, shelter, clothing,
prescriptions, transportation, or other items and services as needed for PACT
consumers.
ii. The PA shall ensure
that PACT team members have efficient, rapid access to larger sums of client
assistance funds for security deposits, purchases of furniture, and other items
needed by PACT consumers.
iii. The
team or another party may serve as "representative payee" for some consumers'
SSI/SSD benefits, provided that the consumer's case record includes written
justification for such an arrangement and the approval of an administrator
outside of the PACT team.
iv. PACT
may utilize client assistance funds to assist consumers with short-term loans
or grants, as necessary.
v.
Provider agencies are obligated to attempt to procure entitlement benefits on
behalf of consumers, including, but not limited to, Medicaid/NJ FamilyCare,
housing and other public assistance;
5. Social services;
6. Transportation; and
7. Legal advocacy and
representation.
(f) The
PACT team shall provide training and instruction, including individual support,
problem-solving, skill development, modeling, and supervision, in home and
community settings to teach the consumer to:
1. Carry out personal hygiene
tasks;
2. Perform household chores,
including housekeeping, cooking, laundry, and shopping;
3. Develop or improve money management
skills;
4. Use community
transportation; and
5. Locate,
finance, and maintain safe, clean, affordable housing.
(g) The PACT team shall develop and support
the consumer's participation in recreational and social activities and
relationships. The highest priority shall be given to supporting and helping
individual consumers establish positive social relationships and activities in
normative community settings. Such services shall include, but not be limited
to, assisting consumers in:
1. Developing
social skills, and where needed, the skills to develop meaningful personal
relationships;
2. Planning
appropriate and productive use of leisure time including familiarizing
consumers with available social and recreational opportunities and increasing
their use of these activities;
3.
Interacting with landlords, neighbors, and others effectively and
appropriately;
4. Developing
assertiveness and self-esteem; and
5. Use of existing self-help centers,
self-help groups and other social, church and recreational clubs to combat the
isolation and withdrawal experienced by many persons coping with severe and
persistent mental illness.
(h) The PACT team shall provide highly
individualized dual disorder services for enrollees who have co-occurring
mental health and substance abuse disorders. Interventions may be offered via
individual and group modalities. Enrollees who do not benefit from (for
example, do not or cannot attend) group treatments must be offered individual
services. Interventions must take into account each consumer's stage of
treatment and will assist consumers in:
1.
Identifying substance use effects and patterns;
2. Recognizing the interactive effects of
substance use, psychiatric symptoms, and psychotropic medications;
3. Developing motivation for decreasing
substance use;
4. Developing coping
skills and alternatives to minimize substance use;
5. Relapse prevention planning;
6. Attending appropriate recovery or
self-help meetings; and
7.
Acquiring information about the use of alcohol, tobacco, prescribed
medications, and other drugs of abuse, and the impact that chemicals have on
the ability to function in major life areas.
(i) The PACT team shall provide information
about eating disorders, gambling, overspending, and sexual and other
addictions, as appropriate.
(j) The
PACT team shall make appropriate referrals and linkages to addiction services
that are beyond the scope of PACT services to individuals with co-occurring
mental health and substance abuse disorders.
(k) The PACT team shall act to minimize
consumer involvement with the criminal justice system, with services to
include, but not limited to:
1. Helping the
consumer identify precipitants to the consumer's criminal
involvement;
2. Providing necessary
treatment, support, and education to help eliminate any unlawful activities or
criminal involvement that may be a consequence of the consumer's mental
illness; and
3. Collaborating with
police, court personnel, and jail/prison officials to ensure appropriate use of
legal and mental health services.
(l) The PACT team shall
provide rehabilitation and support to assist consumers to find and maintain
employment. Services to be provided shall include, but not be limited to:
1. Assessment of job-related interests and
abilities based on a complete education and work history.
i. This assessment shall include a thorough
evaluation of the consumer's strengths.
ii. This assessment shall consider the effect
of the consumer's mental illness on employment, with identification of specific
behaviors that interfere with the consumer's work performance and development
of interventions to address such behaviors.
iii. Assessment of consumer's employment
needs is on-going during the course of the consumer's enrollment with
PACT;
2. Assistance with
each consumer's individual needs with regard to job-seeking skills, on-the-job
assessment, and support, so that consumers will acquire and maintain
appropriate job and social skills necessary to get and keep
employment;
3. Job
development;
4. Individual
supportive counseling to assist the consumer to identify and cope with the
symptoms of mental illness that may interfere with his or her work
performance;
5. On-the-job or
work-related crisis intervention; and
6. Work-related supportive services, such as
assistance with grooming and personal hygiene, securing appropriate clothing,
wake-up calls, and transportation.
(m) The PACT team shall provide support to
the consumer's family and other members of the consumer's social network to
help them manage the symptoms and related consequences of the consumer's
illness, reduce the level of family and social stress associated with the
illness, and achieve wellness. PACT shall assist them and the consumer to
relate in a positive and supportive manner through such means as:
1. Education about the consumer's illness and
the role of the family in the therapeutic process;
2. Education about wellness and recovery
principles, advance directives for mental health care (N.J.A.C. 10:32), and
Wellness and Recovery Action Plans (WRAPs);
3. Supportive counseling;
4. Intervention to resolve
conflict;
5. Referral, as
appropriate, of the family to therapy, self-help and other family support
services;
6. Provision, as
appropriate, of the consumer's other support systems with education and
information about serious mental illnesses and PACT treatment;
7. Education about co-morbidity and the
importance of maintaining primary health care and healthy lifestyle habits;
and
8. Where necessary, and in
accordance with
10:37J-2.6(b)6
the PACT team shall engage in ongoing efforts to obtain the consumer's consent
to disclose to family members confidential information related to a consumer's
mental health treatment.
(n) The PA shall coordinate services with
other community mental health and non-mental health providers, as well as other
medical professionals, and shall provide the following functions for all
consumers served:
1. Development of formal and
informal affiliations with appropriate mental health, health care, addictions,
and other human service providers, and inpatient units;
2. Involvement of other pertinent agencies,
the consumer's family, and members of the consumer's social network in the
coordination of the assessment, and in the development, implementation and
revision of recovery plans;
3.
Advocacy for and assistance to consumers to obtain needed benefits and services
such as supplemental security income, housing subsidies, food stamps, medical
assistance, and legal services;
4.
Coordination of meetings of the consumer's service providers in the
community;
5. Maintenance of
ongoing communication with all other agencies serving the consumer including
hospitals, rehabilitation services and housing providers;
6. Maintenance of working relationships with
other community services, such as education, law enforcement and social
services;
7. Coordination with
existing community agencies to develop needed community support resources
including housing, employment options and income assistance; and
8. Maintenance of a clinical treatment
relationship with the consumer on a continuing basis whether the consumer is in
the hospital, in the community, involved with other agencies or the criminal
justice system.
(o) Methods for service
coordination and communication between PA's and other service providers serving
the same consumers shall be developed and implemented consistent with
confidentiality rules in
10:37-6.79.
(p) In the event that the PACT team
determines that a PACT consumer requires referral to more specialized services
to any DMHAS-funded program other than PACT, the PACT team shall first request
and obtain approval from the appropriate DMHAS Regional Office. Referrals to
extra-PACT services for Medicaid-eligible consumers shall be subject to the
reimbursement conditions delineated in the State Medicaid PACT rules
(10:76-2.4) .
(q) The following are among the mechanisms
that may be utilized to monitor provision of the services in this section:
1. A review of documentation in the clinical
file of program consumers;
2. A
review of documentation in agency/program records;
3. Observation of PACT team staff members
performing the functions of their roles;
4. Observation of the PACT team during daily
meetings;
5. An interview with PACT
program staff;
6. An interview with
program consumers; or
7. An
interview with family members of consumers.
