Assertive Community Treatment Fidelity Scale

Transcription

1 H1 - H2 - H3 - H4 - H5 - H6 - Assertive Community Treatment Fidelity Scale & COMPOSITION SMALL CASELOAD: Persons served/clinician ratio of 10:1. TEAM APPROACH: Provider group functions as team rather than as individual practitioners; clinicians know and work with all persons served. PROGRAM MEETING: meets frequently to plan and review services for each person served. PRACTICING TEAM LEADER: Supervisor of front line clinicians provides direct CONTINUITY OF STAFFING: maintains same staffing over time. STAFF CAPACITY: operates at full staffing to persons PROVIDER GATHERS served/clinician IN ADVANCE OF or fewer REVIEW, interviews 50 persons served/clinician or more. Fewer than 10% persons have faceto-face contact with > 1 staff member in 2 weeks. serviceplanning for each person served usually occurs once/month or less frequently. Supervisor provides no Greater than 80% turnover in 2 years. has operated at less than 50% of staffing in past 12 months % % %. 90% or more persons have face-to-face contact with > 1 staff member in 2 weeks. At least twice/month but less often than once/week. At least once/week but less often than twice/week. Supervisor Supervisor provides services provides services on rare routinely as occasions as backup, or less backup. than 25% of the time % turnover in 2 years % turnover in 2 years. At least twice/week but less often than 4 times/week. Supervisor normally provides services between 25% and 50% time % turnover in 2 years. meets at least 4 days/week and reviews each person served each time, even if only briefly. Supervisor provides services at least 50% time. Less than 20% turnover in 2 years. Clinical Record Reviews Meeting Minutes Other, Clinical Record Reviews PROVIDER GATHERS IN ADVANCE OF REVIEW, interviews 50-64% 65-79% 80-94% has operated at 95% or more of full, PROVIDER staffing in past 12 GATHERS IN ADVANCE months. OF REVIEW

2 H7 H8 H9 H10 & COMPOSITION PSYCHIATRIST ON STAFF: for 60 There is a psychiatrist on staff individuals has 2 that works on the ACT team a hours or less of minimum of 10 hrs/week for psychiatric time an average census of 60. NURSE ON STAFF: There is at least one full-time nurse assigned to work with 60 SUBSTANCE ABUSE SPECIALIST ON STAFF: At least one of the ACT staff members of the 60 person team shall have special training and certification in treatment and/or treating persons with co-occurring mental health and disorders. VOCATIONAL SPECIALIST ON STAFF: At least one of the ACT staff members of the 60 person team shall have special training in rehabilitation counseling, including vocational, work readiness and educational support for 60 for 60 for 60 for 60 individuals has individuals has individuals has individuals has 3-4 hours of 5-6 hours of 7-9 hours of 10 hours of psychiatric time psychiatric time psychiatric time psychiatric time for 60 clients for 60 persons has less than.25 FTE. has less than.25 FTE S/A expertise per 60 has less than.25 FTE vocational expertise per 60 for 60 persons has FTE. for 60 persons has FTE. has.26 - has FTE S/A.75 FTE S/A expertise per 60 expertise per 60 has.26 - has FTE.75 FTE vocational vocational expertise per 60 expertise per 60 for 60 persons has FTE. has FTE S/A per 60 has FTE vocational expertise per 60 One full-time nurse (or more) on a team with 60 One FTE or more with 1 year S/A training or supervised S/A experience per 60 person team. One FTE or more with 1 year voc. rehab. training or supervised VR experience per 60 person team.

3 H11 & COMPOSITION PROGRAM SIZE: is of sufficient absolute size to consistently provide the necessary staffing diversity and coverage. has fewer than 1.5 FTE staff FTE FTE FTE has at least 6 FTE staff ORGANIZATIONAL BOUNDARIES EXPLICIT ADMISSION has no CRITERIA: has set criteria and clearly identified mission to admits persons serve a particular population with no regard to and has and uses measurable eligibility. and operationally defined criteria to screen out inappropriate referrals. O1 - O2 - O3 - INTAKE RATE: takes persons in at a low rate to maintain a stable service environment. This is based on a ratio of 10 for every 1 FTE staff FULL RESPONSIBILITY FOR TREATMENT SERVICES: In addition to case management, program directly provides psychiatric services, counseling / psychotherapy, housing support, substance abuse treatment, employment / rehabilitative Highest monthly intake rate in the last 6 months = greater than 15 persons/month. provides no more than case management has a generally defined mission but the admission process is dominated by organizational convenience persons per month provides one of five additional services and refers externally for others. The program makes an effort to seek and select a defined set of persons but accepts most referrals. 10 to 12 persons per month provides two of five additional services and refers externally for others. typically actively seeks and screens referrals carefully but occasionally bows to organizational pressure. 7 to 9 persons per month provides three or four of five additional services and refers externally for others. The program actively recruits a defined population and all persons receiving services meet explicit admission criteria. Highest monthly intake rate in the last 6 months no greater than 6 persons/month. provides all five of these additional services to clients Data run completed by Collaborative prior to fidelity review - # authorized by month for past 6 months,

4 RESPONSIBILITY FOR CRISIS SERVICES: has 24-hour responsibility for covering psychiatric crises. O4 - O5 - O6 - O7 - RESPONSIBILITY FOR HOSPITAL ADMISSIONS: is involved in RESPONSIBILITY FOR HOSPITAL DISCHARGE PLANNING: is involved in planning for discharges. TIME-UNLIMITED SERVICES (GRADUATION RATE): rarely closes persons to ACT but remains the point of contact for all as needed. Emergency is service has available by provides 24-hour programgenerated telephone, coverage predominantly in protocol for consulting role.. has no responsibility for handling crises after hours. has involvement in fewer than 5% decisions to ize. has involvement in fewer than 5% of discharges. More than 90% of are expected to be discharged within 1 year. involved in 5% - 34% of 5% - 34% of and. From 38-90% of are expected to be discharged within 1 year. involved in 35% - 64% of 35-64% of and. From 18-37% of are expected to be discharged within 1 year. provides emergency service backup; e.g., program is called, makes decision about need for direct program involvement. involved in 65% - 94% of 65-94% of and. From 5-17% of are expected to be discharged within 1 year. involved in 95% or more 95% or more of and. All persons are served on a timeunlimited basis, with fewer than 5% expected to graduate annually. Policies

5 S1- S2 - S3 - S4 - NATURE OF SERVICES COMMUNITY-BASED SERVICES: works to monitor status, develop community living skills in the community rather than the office. NO DROPOUT POLICY: retains a high percentage of its persons served. ASSERTIVE ENGAGEMENT MECHANISMS: As part of assuring engagement, program uses street outreach, as well as legal mechanisms (e.g., probation/parole, OP commitment) as indicated and as available. INTENSITY OF SERVICE: High total amount of service time as needed. FREQUENCY OF CONTACT: At least 4 contacts per week in the 4 weeks preceding review % % %. 80% of total contacts in community (offsite). Less than 20% of contacts in community (offsite). Less than 50% of of the caseload is retained over a 12- month period. passive in recruitment and re-engagement; almost never uses street outreach legal mechanisms. Average of less than 15 min/week or less of face-toface contact per individual. There are weeks within the past 4 weeks where no contact is made 50-64% % %. 95% or more of the caseload is retained over a 12-month period makes initial attempts to engage but generally focuses efforts on most motivated individuals minutes / week. attempts outreach and uses legal mechanisms only as convenient minutes / week. There is at least There is at least one contact per two contacts per week week consistently consistently for for the past 4 the past 4 weeks. weeks. usually has plan for engagement and uses most of the mechanisms that are available minutes / week. There are at least three contacts per week consistently for the past 4 weeks. demonstrates consistently wellthought-out strategies and uses street outreach and legal mechanisms whenever appropriate. Average of 2 hours/week or more of face-toface contact per individual. There are at least four contacts per week consistently for the past four weeks. Data run completed by Collaborative prior to fidelity review., Discharged/Total number of Persons Served Interview S5

6 S6 - S7 - S8 - NATURE OF SERVICES WORK WITH INFORMAL SUPPORT SYSTEM: With or without individual present, program provides support and skills for persons's support network: family, landlords, employers. INDIVIDUALIZED SUBSTANCE ABUSE TREATMENT: One or more members of the program provide direct treatment and treatment to persons disorders. DUAL DISORDER TREATMENT GROUPS: uses group modalities as a treatment strategy for people diagnosed with disorders..5-1 contact with 1-2 contacts with 2-3 contacts with Four or more support system support system in support system in contacts with in the community the community the community support system in per month per per month per per month per the community individual. individual. individual. per month per individual. Less than.5 contact with support system in the community per month per individual. No direct, individualized treatment is provided by the team. Fewer than 5% of the persons disorders attend at least one treatment group meeting during a month. The team variably addresses SA concerns with person; no formal, individualized SA treatment provided. While the team integrates some treatment into regular contact with person, they provide no formal, individualized SA treatment. Some formal individualized SA treatment is offered; persons disorders spend less than 24 minutes/week in such treatment. 5-19% 20-34% 35-49% 50% or more of the persons disorders attend at least one treatment group meeting during a month. Persons disorders spend, on average, 24 minutes / week or more in formal treatment.

7 S9 - S10 - NATURE OF SERVICES DUAL DISORDERS (DD) MODEL: uses a stage-wise treatment model that is non-confrontational, follows behavioral principles, considers interactions of mental illness and substance abuse, and has gradual expectations of abstinence. ROLE OF PERSONS IN RECOVERY ON TREATMENT TEAM: Persons in recovery are involved as members of the team providing direct uses uses uses fully primarily mixed model: e.g., primarily DD based in DD traditional model: DD principles in model: e.g., DD treatment e.g., refers to AA; treatment plans; principles in principles, with uses inpatient refers persons to treatment plans; treatment detox & persuasion persuasion and provided by rehabilitation; groups; uses active treatment program staff. recognizes need ization for groups; rarely for persuasion of rehab.; refers to ize for persons in denial AA, NA. rehab. nor detox or who don't fit except for AA. medical necessity; refers out some s/a fully based on traditional model: confrontation; mandated abstinence; higher power, etc. Persons in recovery have no involvement in service provision in relation to the program. Persons in Persons in recovery fill specific service roles with respect to program (e.g., self-help). recovery work part-time in casemanagement roles with reduced responsibilities. treatment. Persons in recovery work fulltime in case management roles with reduced responsibilities. Persons in recovery are employed fulltime as clinicians (e.g., case managers) with full professional status.