Or. Admin. R. 309-019-0242

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

Section 309-019-0242 - ACT Program Operational Standards

(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.

Or. Admin. R. 309-019-0242

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

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