Current through Register Vol. 63, No. 9, September 1, 2024
(1) All ACT teams shall be available seven
days a week, 24 hours a day by direct phone link and regularly accessible to
individuals who work or are involved in other scheduled vocational or
rehabilitative services during non-traditional hours.2ACT teams will need to
utilize equitable split staff assignment from multiple ACT program staff to
achieve this coverage and:
(a) Operate
continuous 24/7 crisis coverage that includes direct after-hours on-call system
with staff experienced in the program and skilled in crisis intervention
procedures.
(b) The ACT team shall
have the capacity to triage crisis calls and respond accordingly, either in
person or by telephone depending on the participants needs in the moment of
crisis event.
(c) To ensure ACT
Participants have direct access to the ACT Team; the provider shall utilize a
single crisis phone line system that will include procedures of notifying the
identified ACT Program staff who is on-call. This staff member can evaluate,
and triage appropriate response needed by ACT Program per (2)(a) of this rule
set.
(d) ACT program staff shall
document any crisis dispatches or calls they attend to within the participant's
chart,
(e) If the ACT staff respond
to a call and need additional supports, they may coordinate with other Mental
Health community programs and/or Law Enforcement as per clinical judgement to
ensure the crisis is properly handled for the individual in need. Collaboration
and resourcing out for additional supports while responding to crisis will not
count against fidelity as long as it is properly documented why additional
supports were needed.
(2) Service Intensity:
(a) The ACT team shall have the capacity to
provide the frequency and duration of staff-to-participant Face to Face
contacts required by each Individual Recovery Plan and their immediate needs
per the model and fidelity tools;
(b) The ACT team shall have the capacity to
increase and decrease Face to Face contacts based upon daily assessment of the
individual's clinical need with a goal of maximizing independence;
(c) The team shall have the capacity to
provide multiple contacts to participants in high need and a rapid response to
early signs of relapse;
(d) Natural
supports and Informal Support System contacts as defined in OAR
309-019-0225 will be utilized as
part of the treatment goal.
(e) The
ACT team Psychiatrist and the Psychiatric Nurse Practitioner (PNP) shall have
scheduling flexibility to accommodate individual needs. If the individual will
not come to meet the Psychiatrist or the PNP at the ACT office, the
Psychiatrist or PNP shall provide services as clinically indicated for that
participant in the community. Secure telepsychiatry may be used when clinically
indicated;
(f) The ACT team shall
have the capacity to provide services via group modalities that are Face to
Face as defined 309-019-0225(13).
(3) The ACT Team shall ensure that
services are designed to meet participants needs in a culturally,
linguistically and are developmentally appropriate. This includes collaboration
and/or MOU's with local Tribal Communities or other diverse community partners
within the ACT program's service area that would benefit participants treatment
goals.
(4) Staffing Guidelines for
ACT teams:
(a) ACT team individual to
clinical staff ratio may not exceed 10:1; if there is a vacancy longer than 30
calendar days that impacts this ratio, the program must communicate this to
Division Approved Reviewer to discuss possibility of submitting a Variance to
The Division per 309-019-0240(9)
and seek Technical Assistance and support on filling that core position to
ensure quality of evidence-based services.
(b) A single ACT program will not serve more
than 120 participants.
(c) ACT
Program must hire the appropriate staff to meet the minimum 1:10 staff ratio to
individuals served.
(d) Programs
may not create multiple teams unless the program is at or above the 120
individuals served;
(e) There is an
identified geographical service area and/or specialized targeted population
that is person centered for additional team.
(f) A Small ACT Team per OAR
309-019-0225(29)
is recommended to have no more than 10
staff
(g) A Mid-Size ACT Team per
OAR 309-019-0225(24)
is recommended to have no more than 12 staff
(h) A Large ACT Team per OAR
309-019-0225(21)
is recommended to have no more than 14
staff.
(5) No individual
ACT staff member shall be assigned less than .20 FTE for their role on the team
unless filling the role of psychiatrist or PNP. The ACT team psychiatrist or
PNP may not be assigned less than .10 FTE.
(6) ACT team staffing is multi-disciplinary.
The core minimum staffing for an ACT team includes:
(a) A team leader position that shall be
occupied by only one individual per team. The team leader is a QMHP level
clinician qualified to provide direct supervision to all ACT staff except the
psychiatric care provider and nurse.
(b) Psychiatric Care Provider (Psychiatrist
or PNP) FTE is recommended by the number of individuals served by the ACT team
based on The Division Approved Fidelity Scale.
(c) The Nurse FTE is recommended by the
number of individuals served by the ACT team based on The Division Approved
Fidelity Scale;
(d) The Program
Administrative Assistant FTE is not counted in the clinical staff
ratio.
(7) ACT team
minimum staffing shall include clinical staff with the following FTE and
specialized competencies:
(a) The Substance
Use Specialist FTE is recommended by the number of individuals served by the
ACT team based on The Division Approved Fidelity Scale. A Substance Use
Specialist specialized competencies shall include:
(A) Substance Use assessment and substance
use diagnosis;
(B) Principles of
Integrated Dual Disorder Treatment and practices of harm reduction;
(C) Knowledge and application of motivational
interviewing strategies.
(b) The Employment Specialist FTE is dictated
by the number of individuals served by the ACT team based on The Division
Approved Fidelity Scale. An Employment Specialist specialized competencies
shall include:
(A) Competence in the
Vocational Services;
(i) Complete a Vocational
assessment for any participant that communicates interest in
employment;
(ii) Job exploration
and matching to individual's interest and strengths and ensure all employment
possibilities explored are Competitive and Integrated Employment.
(iii) Skills development related to choosing,
securing, and maintaining employment.
(c) The ACT Program can utilize a Certified
Peer Support Specialist or Peer Wellness Specialist as described in OAR
410-180-0300 to 0380 and defined
in OAR 309-019-0105(81)
and 309-019-0105(84).
A registry of certified Peer Support Specialist Specialists and Peer Wellness
Specialists may be found at the Office of Equity and Inclusion's Traditional
Health Worker's website.
(8) ACT Team Staffing Core Competencies:
(a) Upon hiring, all clinical staff on an ACT
team shall have experience in providing direct services related to the
treatment and recovery of individuals with a serious and persistent mental
illness. Staff shall be selected consistent with the ACT core operating
principles and values. Clinical staff shall have demonstrated competencies in
clinical documentation and engagement interventions ;
(b) All staff shall demonstrate basic core
competencies in designated areas of practice, including the Assertive Community
Treatment core principles, integrated mental health and substance abuse
treatment, supported employment, psycho-education, and wellness
self-management;
(9) The
ACT team shall conduct organizational staff meetings: The Division recommends
at least four times per week. These meetings shall be conducted per
evidence-based practice.
(a) The ACT team
shall maintain in writing:
(A) A roster of the
participants served in the program; and
(B) For each participant, a brief
documentation of any treatment or service contacts that have occurred during
the last 24 hours and a concise, behavioral description of the individual's
status that day.
(b)
During the organizational staff meeting, the ACT team shall plan for emergency
and crisis situations and add service contacts to the daily staff assignment
schedule.
(10) The ACT
team shall conduct treatment planning meetings under the supervision of the
team leader that include the input from the Psychiatrist or PNP. These
treatment planning meetings shall occur at least annually or as needed per the
participants progression in the program. The Division recommends more frequent
meetings on new admissions. The ACT Participants presence is needed to ensure
the identified treatment plan is an approved pathway for the individual and
attainable
(a) Convene at regularly scheduled
times per a written schedule set by the team leader;
(b) Occur and be scheduled when the majority
of the team members can attend, including the psychiatrist or psychiatric nurse
practitioner, team leader, and all members of the treatment team including any
Peer Support Specialists;
(c)
Require individual staff members to present and systematically review and
integrate an individual's information into a holistic analysis and prioritize
problems.
(11) A
Comprehensive Assessment and Individualized Treatment Plan is completed upon
each individual's admission to the ACT program
(12) Service Note Content:
(a) More than one intervention, activity, or
goal may be reported in one service note, if applicable;
(b) ACT team staff shall complete a service
note for each contact or intervention provided to an individual. Each service
note shall include all the following:
(A)
Individual's name;
(B) Medicaid
identification number or client identification number;
(C) Date of service provision;
(D) Name of service provided;
(E) Type of contact;
(F) Place of service;
(G) Purpose of the contact as it relates to
the goals on the individual's treatment plan;
(H) Description of the intervention provided
if one occurred.
(I) Amount of time
spent performing the intervention;
(J) Assessment of the effectiveness of the
intervention and the individual's progress towards the individual's
goal;
(K) Signature and credentials
and/or job title of the staff member who provided the service.
Table referenced is not included in rule text.
Click here for PDF copy of
table
Statutory/Other Authority: ORS
413.042
Statutes/Other Implemented: ORS
430.630
