Assertive community treatment webinar Week 3: Admission Criteria/Identifying Consumers/Discharge Criteria

Where is everyone currently in the process of onboarding staff? Any big concerns/obstacles? Updates

Understanding the level of care Minimum of Level 1 Outpatient per ASAM Criteria, though will likely start with Level 2 in terms of contact with team members What does that mean in regard to risk level? Might be a candidate for group sessions, but unlikely.

Eligibility criteria Individuals who have severe mental illness and co-occurring substance use disorders who are most at-risk of Psychiatric crisis and hospitalization Involvement in the criminal justice system Housing instability/chronic homelessness

Eligibility Criteria Typical diagnoses include: Schizophrenia Schizoaffective Disorder Major Depression w/ psychotic features Bipolar Disorder w/ psychotic features

Eligibility criteria Consistent inability to perform practical daily tasks needed to function in the community: Maintaining personal hygiene Meeting nutritional needs Caring for personal business affairs Obtaining medical, legal, and housing services; and Recognizing and avoiding common dangers for hazards to one’s self and one’s possessions.

Eligibility Criteria Persistent or recurrent failure to perform daily living tasks, except with significant support from others Consistent inability to maintain employment at a self-sustaining level or carry out homemaker roles Inability to maintain a safe living situation (e.g. repeated evictions or loss of housing)

Those who receive prioritization include those who: Have engaged in high acute psychiatric hospitalization (e.g., two or more admissions per year) or psychiatric emergency services; Persistent or recurrent severe mental health symptoms (e.g., affective, psychotic, suicidal); Coexisting substance-use disorder of significant duration (e.g., greater than 6 months); High risk or a recent history of being involved in the criminal justice system; In substandard housing, homeless, or at imminent risk of becoming homeless; Living in an inpatient facility or supervised community residence but assessed to be capable of living independently with assistance of intensive services; and Inability to participate in traditional office-based services.

Establishing rapport The team will identify a point of contact for the new client. Someone who has met with the client and seems to have the beginnings of a good relationship with the individual Slowly introduce new team members Helps determine appropriateness for the program Next 30 days is set for assessment and treatment planning – that dictates the contact moving forward.

Unresponsive to team member – must be a clear, documented good-faith effort to engage the client Danger to team members Deemed capable of success in less-structured/traditional program Refusal to take medications cannot be a reason for admission denial Who is inappropriate?

Building a client base Limit number of admissions to 4-6 individuals per month Admissions into ACT can be very intensive: transdisciplinary assessment, treatment planning, psychiatric stabilization, as well as addressing all unmet needs. Maximum number of participants. Rural – 8:1 Ratio. 42-50 clients when fully staffed (excluding psych) Urban – 10:1 Ratio. 80-100 clients when fully staffed (excluding psych) Admission decision must be made within 7 business days of receipt of the initial referral

Referral system Who do you anticipate being community stakeholders? Where do you anticipate your referrals coming from? What community relationships with MH providers do you feel would be beneficial to foster? The referral process will be discussed in greater detail in Session 5 Referral system

Discharge criteria Discharges from ACT occur when the participant and staff mutually agree to the termination of services. <5% of clients are expected to graduate annually

Specific to NAC 458 / Division Criteria, Discharge occurs when: Participants demonstrate, over a minimum period of one year, the ability to function in major role areas (i.e., work, social, self-care). Participants move outside of the ACT team geographic area of responsibility. In such a case, the team is responsible for arranging for a transfer of services to an appropriate provider and will maintain contact with the participant until the transfer is established. Participants decline or refuse services and request a discharge, despite the team’s repeated efforts to engage. For those with a history of harm to self or others alternative treatment should be arranged.

Specific to NAC 458 / Division Criteria, Discharge occurs when: Deceased. Long-term hospitalization or incarceration for three months or longer. Provisions will be made for these individuals to reengage in services upon their release. Inability to locate the participant for a minimum of 3 months. Refusal to take medication is not a sufficient reason for discharge.

Questions comments concerns