MN Youth ACT Foundations, Statute & Process Martha J. Aby MBA, MSW, LICSW Martha.J.Aby@state.mn.us
Agenda Foundations of Assertive Community Treatment MN Youth ACT Statute MN Youth ACT Development Process
Assertive Community Treatment History of ACT Developed during the early 1970s during deinstitutionalization Model developed at the Mendota Mental Health Institute in Madison, Wisconsin Thought of as a hospital with out walls Services available in vivo to clients when they need them not when the office is open Goal was to help transition people from hospital living to community living
Assertive Community Treatment The defining characteristics of ACT include: a clear focus on those participants (clients) who require the most help from the service delivery system; an explicit mission to promote the participants' independence, rehabilitation, and recovery, and in so doing to prevent homelessness and unnecessary hospitalization; an emphasis on home visits and other in vivo (out of the office) interventions, eliminating the need to transfer newly learned skills from an artificial rehabilitation or treatment setting to the "real world"; [2]
Assertive Community Treatment a participant-to-staff ratio that is low enough to allow the ACT "core services team" to perform virtually all of the necessary rehabilitation, treatment, and community support tasks themselves in a coordinated and efficient manner unlike traditional case managers, who broker or "farm out" most of the work to other professionals;
Assertive Community Treatment a "total team approach" in which all of the staff work with all of the participants, under the supervision of a qualified mental health professional who serves as the team's leader; an interdisciplinary assessment and service planning process that typically involves a psychiatrist and one or more nurses, social workers, substance abuse specialists, vocational rehabilitation specialists, occupational therapists, and certified peer specialists (individuals who have had personal, successful experience with the recovery process);
Assertive Community Treatment a willingness on the part of the team to take ultimate professional responsibility for the participants' wellbeing in all areas of community functioning, including most especially the "nitty-gritty" aspects of everyday life; a conscious effort to help people avoid crisis situations in the first place or, if that proves impossible, to intervene at any time of the day or night to keep crises from turning into unnecessary hospitalizations; and
Assertive Community Treatment a promise to work with people on a timeunlimited basis, as long as they continue to demonstrate the need for this unusually intensive and integrated form of professional help. Information from Wikipedia: http://en.wikipedia.org/wiki/assertive_community_treatment#see_also
ACT vs. Case Management Assertive Community Treatment Low client ratio: 10 to 1 staff Most services provided in the community--not office based Caseloads shared across team 24 hour availability Services provided by team not brokered out Time unlimited services Case Management Role: assessment, planning, linking to services, and monitoring Referring to services not performing them Client ratio: 30 to 1 staff member Individual case loads
Adult ACT Standards ACT Fidelity Scale Minnesota ACT Standards
MN Youth ACT Minnesota Statutes 256B.0947 Intensive Rehabilitative Mental Health Services Defined Client Population: Youth ages 16, 17, 18, 19, & 20 Diagnosis of Serious Mental Illness or Co- Occurring Mental Illness and Substance Abuse Addiction
MN Youth ACT Minnesota Statutes 256B.0947 Intensive Rehabilitative Mental Health Services Level of Care Determination for Intensive Integrated Intervention without 24- hour medical monitoring Functional Impairment and history of difficulty in functioning safely in community, school, home or job
MN Youth ACT Minnesota Statutes 256B.0947 Intensive Rehabilitative Mental Health Services Likely to need services from the Adult Mental Health system in next 2 years Has a Diagnostic Assessment that documents Intensive Nonresidential mental health services are medically necessary
MN Youth ACT Required Service Components Individual, family and group psychotherapy Individual, family and group skills training Crisis assistance Medication management Mental health case management Medication education Care coordination Psychoeducation of and consultation and coordination with the client s family and/or immediate nonfamilial support Clinical consultation to employer or school Crisis intervention and stabilization services
MN Youth ACT Required Service Components Assessment of client s treatment progress and effectiveness Transition services Integrated Dual Disorders treatment Housing access support
MN Youth ACT Core Team: Independently Licensed Mental Health Professional (Team Leader) Advanced-Practice Registered Nurse with certification in psychiatric or mental health care or a Board-Certified Child and Adolescent Psychiatrist Licensed Alcohol and Drug Counselor who is also trained in mental health interventions Peer Specialist
MN Youth ACT Core Team May Also Include: Additional mental health professionals Vocational specialist Educational specialist Child and adolescent psychiatrist as a consultant Mental health practitioner Mental health case manager Housing access specialist
MN Youth ACT Treatment Team Ad Hoc members: Mental health professional treating the client prior to placement with the team Client s current substance abuse counselor, if applicable Lead member of the client s IEP team or school based mental health provider Representative from client s health care home or primary care clinic Client s probation agent Client s current vocational or employment counselor
MN Youth ACT Service Standards in MN Statutes 256B.0947: Team treatment not individual treatment model Services must be available at times that meet client needs Functional assessment completed within 10 days of intake and updated every 3 months ITP for each client Treatment team will engage family and significant others within parameters of HIPAA Interventions to promote positive interpersonal relationships
MN Youth ACT Medical Assistance Payment and Rate Setting: Daily encounter rate Payment will be to 1 entity for each client Regional cost-based rates considering: Cost for similar services in the health care trade area Actual costs Intensity and frequency of services Degree that clients will receive other services Costs of other services
MN Youth ACT Development Process Rate Setting Methodology Performance Measures and Evaluation Process Develop Administrative and Clinical Contract Standards Add to State Plan Amendment Provider Enrollment
MN Youth ACT Questions? Comments? Contact Information: Martha J. Aby 651/431-4860 Martha.J.Aby@state.mn.us