C.M.R. 14, 193, ch. 2, app 193-2-A
Current through 2024-46, November 13, 2024
| Human resources: Structure and composition | |||||||
| Criterion | Ratings / Anchors | ||||||
| 1 | 2 | 3 | 4 | 5 | Min. Score | ||
| H1 | Small caseload: Consumer/provider ratio = 10:1 | 50 consumer's/ team member or more | 35 - 49 | 21 - 34 | 11 - 20 | 10 consumer's/ team member or fewer | 5 |
| H2 | Team approach: Provider group functions as team rather than as individual ACT team members; ACT team members know and work with all consumers | Less than 10% consumer's with multiple team face-to-face contacts in reporting 2-week period | 10 - 36% | 37 - 63% | 64 - 89% | 90% or more consumer's have face-to-face contact with >1 staff member in 2 weeks | 3 |
| H3 | Program meeting: Meets often to plan and review services for each consumer | Service-planning for each consumer usually 1x/month or less | At least 2x/month but less often than 1x/week | At least 1x/week but less than 2x/week | At least 2x/week but less than 4x/week | Meets at least 4 days/week and reviews each consumer each time, even if only briefly | 3 |
| H4 | Practicing ACT leader: Supervisor of Frontline ACT team members provides direct services | Supervisor provides no services | Supervisor provides services on rare occasions as backup | Supervisor provides services routinely as backup or less than 25% of the time | Supervisor normally provides services between 25% and 50% time | Supervisor provides services at least 50% time | 4 |
| H5 | Continuity of staffing: Keeps same staffing over time | Greater than 80% turnover in 2 years | 60 - 80% turnover in 2 years | 40 - 59% turnover in 2 years | 20 - 39% turnover in 2 years | Less than 20% turnover in 2 years | 3 |
| H6 | Staff capacity: Operates at full staffing | Operated at less than 50% staffing in past 12 months | 50 - 64% | 65 - 79% | 80 - 94% | Operated at 95% or more of full staffing in past 12 months | 3 |
| H7 | Psychiatrist on team: At least 1 full-time psychiatrist for 100 consumer's works with program | Less than .10 FTE regular psychiatrist for 100 consumer's | .10 - .39 FTE for 100 consumer's | .40 - .69 FTE for 100 consumer's | .70 - .99 FTE for 100 consumer's | At least 1 full-time psychiatrist assigned directly to 100-consumer program | 5 |
| H8 | Nurse on team: At least 2 full-time nurses assigned for a 100-consumer program | Less than .20 FTE regular nurse for 100 consumer's | .20 - .79 FTE for 100 consumer's | .80 - 1.39 FTE for 100 consumer's | 1.40 - 1.99 FTE for 100 consumer's | 2 full-time nurses or more are members for 100-consumer program | 5 |
| H9 | Substance abuse specialist on team: A 100-consumer program with at least 2 staff members with 1 year of training or clinical experience in substance abuse treatment | Less than .20 FTE S/A expertise for 100 consumer's | .20 - .79 FTE for 100 consumer's | .80 - 1.39 FTE for 100 consumer's | 1.40 - 1.99 FTE for 100 consumer's | 2 FTEs or more with 1 year S/A training or supervised S/A experience | 3 |
| H10 | Vocational specialist on team: At least 2 team members with 1 year training/experience in vocational rehabilitation and support | Less than .20 FTE vocational expertise for 100 consumer's | .20 - .79 FTE for 100 consumer's | .80 - 1.39 FTE for 100 consumer's | 1.40 - 1.99 FTE for 100 consumer's | 2 FTEs or more with 1 year voc. Rehab. Training or supervised VR experience | 4 |
| H11 | Program size: Of sufficient absolute size to consistently provide necessary staffing diversity and coverage | Less than 2.5 FTE staff | 2.5 - 4.9 FTE | 5.0 - 7.4 FTE | 7.5 - 9.9 | At least 10 FTE staff | 3 |
| Organizational boundaries | |||||||
| Criterion | Ratings / Anchors | ||||||
| 1 | 2 | 3 | 4 | 5 | Min Score | ||
| O1 | Explicit admission criteria: Has clearly identified mission to serve a particular population. Has and uses measurable and operationally defined criteria to screen out inappropriate referrals. | Has no set criteria and takes all types of cases as determined outside the program | Has a generally defined mission but admission process dominated by organizational convenience | Tries to seek and select a defined set of consumer's but accepts most referrals | Typically actively seeks and screens referrals carefully but occasionally bows to organizational pressure | Actively recruits a defined population and all cases comply with explicit admission criteria | 4 |
| O2 | Intake rate: Takes consumer's in at a low rate to maintain a stable service environment | Highest monthly intake rate in the last 6 months = greater than 15 consumer's /month | 13 - 15 | 10 - 12 | 7 - 9 | Highest monthly intake rate in the last 6 months no greater than 6 consumer's/month | 3 |
| O3 | Full responsibility for treatment services: In addition to case management, directly provides psychiatric services, counseling/ psychotherapy, housing support, substance abuse treatment, employment and rehabilitative services | Provides no more than case management services | Provides 1 of 5 additional services and refers externally for others | Provides 2 of 5 additional services and refers externally for others | Provides 3 or 4 of 5 additional services and refers externally for others | Provides all 5 services to consumer's | 4 |
| O4 | Responsibility for crisis services: Has 24-hour responsibility for covering psychiatric crises | Has no responsibility for handling crises after hours | Emergency service has program-generated protocol for program consumer's | Is available by phone, mostly in consulting role | Provides emergency service backup; e.g., program is called, makes decision about need for direct program involvement | Provides 24-hour coverage | 3 |
| O5 | Responsibility for hospital admissions: Is involved in hospital admissions | Is involved in fewer than 5% decisions to hospitalize | ACT team is involved in 5% - 34% of admissions | ACT team is involved in 35% - 64% of admissions | ACT team is involved in 65% - 94% of admissions | ACT team is involved in 95% or more admissions | 3 |
| O6 | Responsibility for hospital discharge planning: Is involved in planning for hospital discharges | Is involved in fewer than 5% of hospital discharges | 5% - 34% of program consumer discharges planned jointly with program | 35% - 64% of program consumer discharges planned jointly with program | 65 - 94% of program consumer discharges planned jointly with program | 95% or more discharges planned jointly with program | 3 |
| O7 | Time-unlimited services (graduation rate): Rarely closes cases but remains the point of contact for all consumer's as needed | More than 90% of consumer's are expected to be discharged within 1 year | From 38 - 90% of consumer's expected to be discharged within 1 year | From 18 - 37% of consumer's expected to be discharged within 1 year | From 5 - 17% of consumer's expected to be discharged within 1 year | All consumer's served on a time-unlimited basis, with fewer than 5% expected to graduate annually | 3 |
| Nature of services | |||||||
| Criterion | Ratings / Anchors | ||||||
| 1 | 2 | 3 | 4 | 5 | Min Score | ||
| S1 | Community-based services: Works to monitor status, develop community living skills in community rather than in office | Less than 20% of face-to-face contacts in community | 20 - 39% | 40 - 59% | 60 - 79% | 80% of total face-to-face contacts in community | 3 |
| S2 | No dropout policy: Retains high percentage of consumer's | Less than 50% of caseload retained over 12-month period | 50 - 64% | 65 - 79% | 80 - 94% | 95% or more of caseload is retained over a 12-month period | 3 |
| S3 | Assertive engagement mechanisms: As part of ensuring engagement, uses street outreach and legal mechanisms (probation/parole, OP commitment) as indicated and as available | Passive in recruitment and re-engagement; almost never uses street outreach legal mechanisms | Makes initial attempts to engage but generally focuses on most motivated consumer's | Tries outreach and uses legal mechanisms only as convenient | Usually has plan for engagement and uses most mechanisms available | Demonstrates consistently well-thought-out strategies and uses street outreach and legal mechanisms whenever appropriate | 3 |
| S4 | Intensity of service: High total amount of service time, as needed | Average 15 minutes/ week or less of face-to-face contact for each consumer | 15 - 49 minutes/ week | 50 - 84 minutes/week | 85 - 119 minutes/week | Average 2 hours/week or more of face-to-face contact for each consumer | 3 |
| S5 | Frequency of contact: High number of service contacts, as needed | Average less than 1 face-to-face contact/ week or fewer for each consumer | 1 - 2x/week | 2 - 3x/week | 3 - 4x/week | Average 4 or more face-to-face contacts/week for each consumer | 3 |
| S6 | Work with informal support system: With or without consumer present, provides support and skills for consumer's support network: family, landlords, employers | Less than .5 contact/ month for each consumer with support system | .5 - 1 contact/ month for each consumer with support system in the community | 1 - 2 contact/month for each consumer with support system in the community | 2 - 3 contacts/month for consumer with support system in the community | 4 or more contacts/month for each consumer with support system in the community | 3 |
| S7 | Individualized substance abuse treatment: 1 or more team members provides direct treatment and substance abuse treatment for consumer's with substance-use disorders | No direct, individualized substance abuse treatment provided | Team variably addresses SA concerns with consumer's; provides no formal, individualized SA treatment | While team integrates some substance abuse treatment into regular consumer contact, no formal, individualized SA treatment | Some formal individualized SA treatment offered; consumer's with substance-use disorders spend less than 24 minutes/week in such treatment | consumer's with substance-use disorders average 24 minutes/week or more in formal substance abuse treatment | 3 |
| S8 | Co-Occurring disorder treatment groups: Uses group modalities as treatment strategy for consumer's with substance-use disorders | Fewer than 5% of consumer's with substance-use disorders attend at least 1 substance abuse treatment group meeting a month | 5 - 19% | 20 - 34% | 35 - 49% | 50% or more of consumer's with substance-use disorders attend at least 1 substance abuse treatment group meeting/month | 3 |
| S9 | Dual Disorders (DD) Model: Uses a non-confrontational, stage-wise treatment model, follows behavioral principles, considers interactions of mental illness and substance abuse, and has gradual expectations of abstinence | Fully based on traditional model: confrontation; mandated abstinence; higher power, etc. | Uses primarily traditional model: e.g., refers to AA; uses inpatient detox & rehab; recognizes need to persuade consumer's in denial or who don't fit AA | Uses mixed model: e.g., DD principles in treatment plans; refers consumer's to persuasion groups; uses hospitalization for rehab.; refers to AA, NA | Uses primarily DD model: e.g., DD principles in treatment plans; persuasion and active treatment groups; rarely hospitalizes for rehab. or detox except for medical necessity; refers out some SA treatment | Fully based in DD treatment principles, with treatment provided by ACT staff members | 3 |
| S10 | Role of consumer's on team: consumer's involved as team members providing direct services | consumer's not involved in providing service | consumer's fill consumer-specific service roles (e.g., self-help) | consumer's work part-time in case-management roles with reduced responsibilities | consumer's work full-time in case management roles with reduced responsibilities | consumer's employed full-time as ACT team members (e.g., case managers) with full professional status | 3 |
| Department of Health and Human Services Adult Mental Health Services 32 Blossom Lane, Marquardt Building, 2nd Floor # 11 State House Station Augusta, Maine 04333-0011 Tel: (207) 287-4243 Fax: (207) 287-1022; TTY: 1-800-606-0215 |
C.M.R. 14, 193, ch. 2, app 193-2-A