1. Assertive community treatment webinar
Week 3: Admission Criteria/Identifying Consumers/Discharge Criteria

2. Where is everyone currently in the process of onboarding staff?
Any big concerns/obstacles?
Updates

3. Understanding the level of care
Minimum of Level 1 Outpatient per ASAM Criteria, though will likely start with Level 2 in terms of contact with team members
What does that mean in regard to risk level?
Might be a candidate for group sessions, but unlikely.

4. Eligibility criteria
Individuals who have severe mental illness and co-occurring substance use disorders who are most at-risk of
Psychiatric crisis and hospitalization
Involvement in the criminal justice system
Housing instability/chronic homelessness

5. Eligibility Criteria Typical diagnoses include: Schizophrenia
Schizoaffective Disorder
Major Depression w/ psychotic features
Bipolar Disorder w/ psychotic features

6. Eligibility criteria
Consistent inability to perform practical daily tasks needed to function in the community:
Maintaining personal hygiene
Meeting nutritional needs
Caring for personal business affairs
Obtaining medical, legal, and housing services; and
Recognizing and avoiding common dangers for hazards to one’s self and one’s possessions.

7. Eligibility Criteria
Persistent or recurrent failure to perform daily living tasks, except with significant support from others
Consistent inability to maintain employment at a self-sustaining level or carry out homemaker roles
Inability to maintain a safe living situation (e.g. repeated evictions or loss of housing)

8. Those who receive prioritization include those who:
Have engaged in high acute psychiatric hospitalization (e.g., two or more admissions per year) or psychiatric emergency services;
Persistent or recurrent severe mental health symptoms (e.g., affective, psychotic, suicidal);
Coexisting substance-use disorder of significant duration (e.g., greater than 6 months);
High risk or a recent history of being involved in the criminal justice system;
In substandard housing, homeless, or at imminent risk of becoming homeless;
Living in an inpatient facility or supervised community residence but assessed to be capable of living independently with assistance of intensive services; and
Inability to participate in traditional office-based services.

9. Establishing rapport
The team will identify a point of contact for the new client.
Someone who has met with the client and seems to have the beginnings of a good relationship with the individual
Slowly introduce new team members
Helps determine appropriateness for the program
Next 30 days is set for assessment and treatment planning – that dictates the contact moving forward.

10. Unresponsive to team member – must be a clear, documented good-faith effort to engage the client
Danger to team members
Deemed capable of success in less-structured/traditional program
Refusal to take medications cannot be a reason for admission denial
Who is inappropriate?

11. Building a client base
Limit number of admissions to 4-6 individuals per month
Admissions into ACT can be very intensive: transdisciplinary assessment, treatment planning, psychiatric stabilization, as well as addressing all unmet needs.
Maximum number of participants.
Rural – 8:1 Ratio clients when fully staffed (excluding psych)
Urban – 10:1 Ratio clients when fully staffed (excluding psych)
Admission decision must be made within 7 business days of receipt of the initial referral

12. Referral system Who do you anticipate being community stakeholders?
Where do you anticipate your referrals coming from?
What community relationships with MH providers do you feel would be beneficial to foster?
The referral process will be discussed in greater detail in Session 5
Referral system

13. Discharge criteria
Discharges from ACT occur when the participant and staff mutually agree to the termination of services.
<5% of clients are expected to graduate annually

14. Specific to NAC 458 / Division Criteria, Discharge occurs when:
Participants demonstrate, over a minimum period of one year, the ability to function in major role areas (i.e., work, social, self-care).
Participants move outside of the ACT team geographic area of responsibility. In such a case, the team is responsible for arranging for a transfer of services to an appropriate provider and will maintain contact with the participant until the transfer is established.
Participants decline or refuse services and request a discharge, despite the team’s repeated efforts to engage. For those with a history of harm to self or others alternative treatment should be arranged.

15. Specific to NAC 458 / Division Criteria, Discharge occurs when:
Deceased.
Long-term hospitalization or incarceration for three months or longer. Provisions will be made for these individuals to reengage in services upon their release.
Inability to locate the participant for a minimum of 3 months.
Refusal to take medication is not a sufficient reason for discharge.

16. Questions comments concerns