Or. Admin. R. 309-019-0225

Current through Register Vol. 63, No. 6, June 1, 2024

Section 309-019-0225 - Assertive Community Treatment (ACT) Definitions

(1) In addition to the definitions in OAR 309-019-0105, when used and not otherwise defined in OAR 309-019-0225 through OAR 309-019-0255, the following terms shall have the meaning given in this section.

(2) "24/7 Crisis Coverage" means there is one identified phone line for ACT participants to contact if they are experiencing a mental health crisis 24 hours a day, 7 days a week, 365 days a year:

(a) The ACT Teams will have direct access to this phone line and a procedure in place to receive information about the caller. ACT Teams must be readily available to assist with de-escalation strategies. This could include dispatching out to the individual in need;

(b) The ACT Team is required to document all crisis coverage calls as part of this service delivery.

(3) "Assertive Community Treatment" or "ACT" means an intensive and highly integrated approach that is an evidence-based practice. Objective is to improve outcomes for people with severe mental illness. It is designed to be a team model concept. Program operations are held to a fidelity standard based on Division Approved Fidelity Scale.

(4) "Community-Based" means services and supports that must be provided in a participant's home and/or surrounding community. This can include but not limited to virtual telehealth, or wherever within the community the participant feels most comfortable. This is person-centered and will be tailored to the participants discretion.

(5) "Competency" or "Competencies" means six months of work related experience or one year of equivalent training and/or education in the specialty area and demonstration of the specific skills or knowledge.

(6) "Competitive Integrated Employment" means full-time or part time work with the following criteria:

(a) At minimum wage or higher;

(b) At a rate that is not less than the customary rate paid by the employer for the same or similar work performed by other employees who are not individuals with disabilities;

(c) With eligibility for the level of benefits provided to other employees and position is open to the public to ensure competitiveness;

(d) Internships that are open to anyone. . This includes work-study opportunities with colleges and or trade schools;

(e) Seasonal employment as long as it is consistent with that industry of work;

(f) Self-Employment if income is reported to the government and taxes could be filed if income generated met those requirements.

(g) Employment from temporary agencies that other community members use is counted if that agency and/or industry typically hires from the temporary services.

(7) "Comprehensive Assessment" means the organized process of gathering and analyzing current and past information with each individual and any other informal support deemed relevant to create a treatment plan with the following:

(a) Mental and functional status;

(b) Effectiveness of past treatment;

(c) Current treatment, rehabilitation, and support needs to achieve person-centered goals and support recovery; and

(d) The range of individual strengths (e.g., knowledge gained from dealing with adversity, personal or professional roles, talents, personal traits) that may act as resources to the participant and the recovery plan in pursuing goals. The results of the information gathered, and analysis are used to:

(A) Establish immediate and long-term service needs with each ACT Participant;

(B) Set goals and develop the first person directed recovery plan with each ACT participant; and,

(C) Optimize benefits that can be derived from existing strengths and resources of the participant, family, and natural support network in the community.

(8) "Co-Occurring Disorders (COD) Services" means integrated assessment and treatment for participants who have co-occurring mental health and substance use condition.

(9) "Division" means the Health Systems Division of the Oregon Health Authority, or its designee.

(10) "Division Approved Reviewer" means the Division's contracted entity that is responsible for conducting ACT fidelity reviews, training, and technical assistance to support new and existing ACT programs statewide.

(11) "Employment Specialist" means the staff identified on the ACT Team to provide Employment Support Services but is part of the ACT Program. This staff member provides Vocational Services per (32) of this rule set and is typically supervised by Team Lead within the ACT program, unless they are part of a separate evidence-based program and just assigned to the ACT Team.

(12) "Face to Face" means that a personal interaction where communication between at least two-person(s) can be had either in-person or virtually through telehealth services where there is a secured HIPAA approved live streaming audio and video per OAR 410-120-1990 rule set. Virtual Telehealth meetings for Face-to-Face fidelity measurement purposes will be a last resort option if in-person is not safely available or feasible.

(13) "Fidelity" means the ACT Program is providing services that are faithful to the evidence-based practice model and obtains a satisfactory score from the Division Approved Reviewer

(14) "Fidelity Tool" means the documents used to score and evaluate programs fidelity based on the Division approved fidelity scale.

(15) "Fixed Point of Responsibility" means the ACT program provides virtually all needed services, rather than sending participants to different programs. If the ACT program cannot provide a service, the program will accommodate to ensure that the service is provided.

(16) "Full-Time Equivalent" or "FTE" means for ACT fidelity purposes, it is way to calculate the needed time for a staff member's duties to be dedicated to the ACT program, with a measurement based on a 40-hour work week regardless of program job description FTE status. The consistency of 40 hours is part of the evidence-based practice and ensures equitable scoring for all programs.

(17) "Hospital Discharge Planning" means the ACT Program will collaborate with Oregon State Hospital (OSH) or any other acute care psychiatric hospital for care coordination and discharge planning, developed and implemented through a person-centered planning process in which the participant has a primary role and is based on principles of self-determination.

(18) "Informal Support System" means a person(s) (often another professinal) outside of ACT program that supports the participant, such as, landlord, shelter staff, employer, or other key person(s) identified by the participant or ACT staff.

(19) "Individualized Treatment Plan" means a document that all staff have direct access to and shall include the "Comprehensive Assessment" as defined in (10) of this rule set along with:

(a) Person centered goals;

(b) Person centered preferences and/or culturally specific community partners that ACT Participant may currently or plans to engage with for benefited purposes of their recovery plan.

(20) "Large ACT Team" means an ACT team serving between 80 to 120 individuals.

(21) "Life Skills Training" means training that helps individuals develop skills and access resources needed to increase their capacity to be successful and satisfied in the living, working, learning, and social environments of their choice.

(22) "Medication Management" means the prescribing, administering, and reviewing of medications and their side effects, including both pharmacological management as well as supports and training to the individual. For the purposes of ACT, Medication Management is a collaborative effort between the individual receiving services and the prescribing psychiatrist or psychiatric nurse practitioner with the ACT treatment program.

(23) "Mid-Size Act Team" means an ACT team serving between 41 and 79 individuals.

(24) "Natural Supports" means personal associations and relationships typically developed in the community that enhance the quality and security of life for individuals. This includes but not limited to family relationships, friendships reflecting the diversity of the neighborhood and the community, association with fellow students or coworkers in regular classrooms, and associations developed though participation in clubs, organizations, and other civic activities.

(25) "Psychiatry Services" means the prescribing and administering and reviewing of medications and their side effects, including both pharmacological management as well as supports and training to the individual. Psychiatry services shall be provided by a psychiatrist, or a psychiatric nurse practitioner licensed by the Oregon Medical Board.

(26) "Serious and Persistent Mental Illness (SPMI)" means for the ACT program, the diagnostic eligibility from current DSM criteria for at least one of the following conditions, as a primary diagnosis for an adult 18 years of age or older:

(a) Schizophrenia and other psychotic disorders;

(b) Major depressive disorder;

(c) Bipolar disorder;

(d) Anxiety disorders limited to Obsessive Compulsive Disorder (OCD) and Post Traumatic Stress Disorder (PTSD)and;

(e) Schizotypal personality disorder.

(27) "Single Point of Contact (SPOC)" means the entity that is not directly the certified ACT Program and designated to orchestrate and track referrals. This coordination of services and supports is in collaboration with the Coordinated Care Organizations (CCO), and/or the certified ACT Program.

(28) "Small ACT Team" means an ACT team serving between 10 to 40 individuals.

(29) "Symptom Management" means to prevent or treat as early as possible the symptoms of a disease, side effects caused by treatment of a disease, and psychological, social, and spiritual problems related to a disease or its treatment.

(30) "Telehealth" means services that are delivered using secure HIPAA compliant audio and video communication. All allowable accommodations will be made for any individuals with any hearing, visual or physical impairments or disabilities who agree to utilize services in this manner. per OAR 410-120-1990 rule set

(31) "Telepsychiatry" means the application of telemedicine to the specialty field of psychiatry. The term describes the delivery of psychiatric assessment and care through telecommunications technology, usually videoconferencing.

(32) "Time-unlimited Services" means services that are provided not on the basis of predetermined timelines but if they are medically appropriate.

(33) "Vocational Services" means employment support services that leads to Competitive Integrated employment as defined in 309-019-0225(7)(a)-(g).

(34) "Young Adult" means an individual who is 18 years to 25 years old at time of service

Or. Admin. R. 309-019-0225

MHS 11-2016(Temp), f. 6-29-16, cert. ef. 7-1-16 thru 12-27-16; MHS 18-2016, f. 11-28-16, cert. ef. 11/30/2016; MHS 26-2016(Temp), f. 12-27-16, cert. ef. 12-28-16 thru 6-23-17; MHS 1-2017(Temp), f. 1-17-17, cert. ef. 1-18-17 thru 7-16-17; MHS 6-2017, f. & cert. ef. 6/23/2017; MHS 10-2017(Temp), f. 9-15-17, cert. ef. 9-15-17 thru 3-13-18; MHS 4-2018, amend filed 02/27/2018, effective 3/1/2018; BHS 44-2023, amend filed 12/22/2023, effective 1/1/2024

Statutory/Other Authority: ORS 413.042

Statutes/Other Implemented: ORS 430.630