Or. Admin. R. 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 the daytime hours. ACT teams may utilize split staff assignment schedules to achieve coverage.
(2) ACT teams are primarily responsible for crisis response and for after-hour calls related to individuals they serve. The ACT team shall operate continuous and direct after-hours on-call system with staff experienced in the program and skilled in crisis intervention procedures. The ACT team shall have the capacity to respond rapidly to emergencies, both in person and by telephone. To ensure direct access to the ACT team, individuals shall be given a phone list with the responsible ACT staff to contact after hours.
(3) Service Intensity:
(a) The ACT team shall have the capacity to provide the frequency and duration of staff-to-individual contact required by each individual's service plan and their immediate needs;
(b) The ACT team shall provide a minimum of 40 percent of all services in-community as demonstrated by the average in-community encounters reviewed in case record reviews;
(c) The ACT team shall have the capacity to increase and decrease contacts based upon daily assessment of the individual's clinical need with a goal of maximizing independence;
(d) The team shall have the capacity to provide multiple contacts to individuals in high need and a rapid response to early signs of relapse;
(e) The team shall have the capacity to provide support and skills development services to individuals' natural supports and collateral contacts;
(f) Natural supports and collateral contacts may include family, friends, landlords, or employers, consistent with the service plan. Natural supports and collateral contacts are typically not supports that are paid for services;
(g) 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 individual in the community. Secure telepsychiatry may be used when clinically indicated;
(h) The ACT team shall have the capacity to provide services via group modalities as clinically appropriate, including but not limited to individuals with substance abuse disorders and for family psychoeducation and wellness self-management services.
(4) An ACT team shall have sufficient staffing to meet the varying needs of individuals. As an all-inclusive treatment program, a variety of expertise shall be represented on the team. Staffing shall be clearly defined and dedicated to the operation of the team.
(5) Staffing Guidelines for ACT teams:
(a) A single ACT team may not serve more than 120 individuals unless:
(A) It is expanding for the expressed purpose of splitting into two ACT teams within a 12-month period; and
(B) It hires the appropriate staff to meet the required 1:10 staff ratio to individuals served.
(b) ACT team individual to clinical staff ratio may not exceed 10:1;
(c) ACT team staff shall be composed of individual staff members in which a portion or all of their job responsibilities are defined as providing ACT services;
(d) Other than for coverage when a staff member has a leave of absence, ACT teams may not rotate staff members into the ACT team that are not specifically assigned to the team as part of their position's job responsibilities.
(6) 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.
(7) Maximum ACT team staffing requirements: ACT teams may not exceed the following upper staffing limits:
(a) No more than eight individual staff members per small ACT team;
(b) No more than 12 individual staff members per mid-size ACT team;
(c) No more than 18 individual staff members per large ACT team.
(8) 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. The team leader is a QMHP level clinician qualified to provide direct supervision to all ACT staff except the psychiatric care provider and nurse. Pursuant to the table in OAR 309-019-0242(13), the Team Leader FTE is dictated by the number of individuals served by the ACT team;
(b) Pursuant to the table in OAR 309-019-0242(11), Psychiatric Care Provider (Psychiatrist or PNP) FTE is dictated by the number of individuals served by the ACT team;
(c) Pursuant to the table in OAR 309-019-0242(11), the Nurse FTE is dictated by the number of individuals served by the ACT team;
(d) The Program Administrative Assistant FTE is not counted in the clinical staff ratio.
(9) ACT team minimum staffing shall include clinical staff with the following FTE and specialized competencies:
(a) Pursuant to the table in OAR 309-019-0242(11), the Substance Abuse Specialist FTE is dictated by the number of individuals served by the ACT team. A Substance Abuse Specialist specialized competencies shall include:
(A) Substance abuse assessment and substance abuse diagnosis;
(B) Principles and practices of harm reduction;
(C) Knowledge and application of motivational interviewing strategies.
(b) Pursuant to the table in OAR 309-019-0242(11), the Employment Specialist FTE is dictated by the number of individuals served by the ACT team. An Employment Specialist specialized competencies shall include:
(A) Competence in the IPS Supported Employment fidelity model;
(B) Vocational assessment;
(C) Job exploration and matching to individual's interest and strengths;
(D) Skills development related to choosing, securing, and maintaining employment.
(c) Pursuant to the table in OAR 309-019-0242(11), the Peer Support and Wellness Specialist FTE is dictated by the number of individuals served by the ACT team;
(d) See 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.
(10) 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 motivational interviewing;
(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;
(c) All staff shall receive ACT 101 training from the Division approved reviewer prior to receiving the Division provisional certification; and
(d) All professional ACT team staff shall obtain the appropriate licensure to provide services in Oregon for their respective area of specialization.
(11) ACT Team Size Staff (FTE) to Individual Ratio Table.
(12) The ACT team shall conduct daily organizational staff meetings at least four days per week and regularly scheduled times per a schedule established by the team leader. These meetings shall be conducted in accordance with the following procedures:
(a) The ACT team shall maintain in writing:
(A) A roster of the individuals served in the program; and
(B) For each individual, 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) The daily organizational staff meeting includes a review of the treatment contacts that occurred the day before and provides a systematic means for the team to assess the day-to-day progress and status of all clients;
(c) During the daily organizational staff meeting, the ACT team shall also revise treatment plans as needed, plan for emergency and crisis situations, and add service contacts to the daily staff assignment schedule per the revised treatment plans.
(13) The ACT team shall conduct treatment planning meetings under the supervision of the team leader and the Psychiatrist or PNP. These treatment planning meetings shall:
(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;
(c) Require individual staff members to present and systematically review and integrate an individual's information into a holistic analysis and prioritize problems; and
(d) Occur with sufficient frequency and duration to make it possible for all staff to:
(A) Be familiar with each individual and their goals and aspirations;
(B) Participate in the ongoing assessment and reformulation of problems;
(C) Problem-solve treatment strategies and rehabilitation options;
(D) Participate with the individual and the treatment team in the development and the revision of the treatment plan; and
(E) Fully understand the treatment plan rationale in order to carry out each individual's plan.
(14) ACT Assessment and Individualized Treatment Planning:
(a) An initial assessment and treatment plan is completed upon each individual's admission to the ACT program; and
(b) Individualized treatment plans for ACT team-served individuals shall be updated at least every six months.
(15) 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 of 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. Documentation of the intervention shall accurately reflect substance abuse related treatment for the duration of time indicated;
(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 or job title of the staff member who provided the service; and
(L) Each service note page shall be identified with the beneficiary's name and client identification number.
(c) Documentation of discharge or transition to lower levels of care shall include all of the following:
(A) The reasons for discharge or transition as stated by both the individual and the ACT team;
(B) The individual's biopsychosocial status at discharge or transition;
(C) A written final evaluation summary of the individual's progress toward the goals set forth in the person-centered treatment plan;
(D) A plan for follow-up treatment developed in conjunction with the individual; and
(E) The signatures of the individual, the team leader, and the psychiatrist or PNP.

Notes

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

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

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