Section
3.8 Outreach, Engagement, Re-engagement, Closure, and Re-enrollment
3.8.1
Introduction
3.8.2 References
3.8.3 Scope
3.8.4 Did you know…?
3.8.5 Objectives
3.8.6 Procedures
3.8.6-A: Outreach
3.8.6-B: Engagement
3.8.6-C: Re-engagement
3.8.5-D: Disenrollment of a person enrolled
in the behavioral health system
3.8.6-E: Re-enrollment of a person previously
enrolled in the behavioral health system
3.8.1 Introduction
The activities described within this section are an essential element
of clinical practice. Outreach to vulnerable populations, establishing
an inviting and non-threatening clinical environment, and re-establishing
contact with persons who have become temporarily disconnected from
services are critical to the success of any therapeutic relationship.
This section
addresses five critical activities that behavioral health providers
must incorporate when delivering services within Arizona’s
public behavioral health system:
- Expectations
for outreach activities directed to persons who are at risk for
the development or emergence of behavioral health disorders;
- Expectations
for the engagement of persons seeking or receiving behavioral
health services;
- Procedures
to re-engage enrolled persons who have withdrawn from participation
in the treatment process;
- Conditions
necessary to disenroll a person from the behavioral health system;
and
- Expectations
for re-enrolling persons who are attempting to re-enter the behavioral
health system.
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3.8.2
References
-
A.R.S.
Title 36, Chapter 5
-
R9-21-302
-
AHCCCS/ADHS Contract
-
ADHS/RBHA
Contract
-
ADHS/Gila
River Health Care Corporation Intergovernmental Agreement
- ADHS/Pascua
Yaqui Behavioral Health Program Intergovernmental Agreement
-
Section 3.4, Co-payments
-
Section 3.9, Intake,
Assessment and Service Planning
-
Section 3.10,
SMI Eligibility Determination
-
Section 3.11, General
and Informed Consent to Treatment
-
Section 3.17,
Transition of Persons
-
Section 3.18,
Pre-Petition Screening, Court Ordered Evaluation and Court Ordered
Treatment
-
Section 3.22, Out-of-State
Placements for Children and Young Adults
-
Section 4.1, Disclosure
of Behavioral Health Information
-
Section 4.3, Coordination
of Care with AHCCCS Health Plans and Primary Care Providers
-
Section 7.5,
Enrollment, Disenrollment and Other Data Submission
-
Substance Abuse Prevention and Treatment Performance Partnership
Block Grant
-
Providing
Services to Children in Detention Technical Assistance Document
3.8.3 Scope
To Whom Does This Apply?
- All Title
XIX and Title XXI eligible persons;
- All persons
determined to have a serious mental illness; and
- All other
persons, based on available funding, according to Section 3.21,
Service Prioritization for Non-Title XIX/XI Funding.
3.8.4
Did you know…?
Most of behavioral health conditions are not “cured”
in the manner that many acute physical health care concerns may
be resolved. Behavioral health needs and symptoms wax and wane over
time, and more often than not, recur or intensify as life stressors
increase. As such, behavioral health services should be considered
from a “disease management” perspective rather than
a narrowed perspective where care may be discontinued as soon as
signs of illness are no longer observed. Ongoing supportive services
that strengthen resiliency, promote skill development against future
environmental assaults, and encourage and maintain natural supports
should be continued beyond the resolution of immediate symptoms.
Premature disenrollment from the behavioral health system is neither
efficient nor clinically sound.
3.8.5
Objectives
The objective of this section is to describe requirements for behavioral
health providers to:
- Actively
engage all persons seeking or receiving behavioral health services
to the maximum extent, to re-engage persons who withdraw from
treatment, to disenroll persons who are no longer receiving services,
when appropriate, and to re-enroll persons who have been disenrolled
from the behavioral health system for less than six months; and
- Inform behavioral
health providers about various outreach activities that are performed
by T/RBHAs and communicate information about the availability
and accessibility of behavioral health services to individuals
and the community at large.
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3.8.6
Procedures
3.8.6-A:
Outreach
Overview of Outreach Activities
The behavioral health system must provide outreach activities to
inform the public of the benefits and availability of behavioral
health services and how to access them. T/RBHAs must disseminate
information to the general public, other human service providers,
school administrators and teachers and other interested parties
regarding the behavioral health services that are available to eligible
persons.
What kinds
of outreach activities are T/RBHAs typically involved with?
Outreach activities conducted by the T/RBHAs may include, but are
not limited to:
- Participation
in local health fairs or health promotion activities;
- Involvement
with local school districts;
- Routine
contact with AHCCCS Health Plan behavioral health coordinators
and/or primary care providers;
- Development
of homeless outreach programs;
- Publication
and distribution of informational materials;
- Liaison
activities with local and county jails and county detention facilities;
- Routine
interaction with agencies that have contact with substance abusing
pregnant women/teenagers;
- Development
and implementation of outreach programs that identify persons
with co-morbid medical and behavioral health disorders and those
who have been determined to have a serious mental illness within
the T/RBHA’s geographic service area, including persons
who reside in jails, homeless shelters, county detention facilities
or other settings; and
- Provision
of information to mental health advocacy organizations.
In addition
to the above, the Gila River RBHA targets outreach to the following
tribal agencies and providers serving members of the Gila River
Indian Community:
- Tribal Social
Services (TSS);
- Department
of Human Services (formerly Alcohol and Drug Program);
- Gila River
Health Care Corporation Behavioral Health Clinic;
- Gila River
Police, Fire and EMS; and
- Primary
medical providers through Indian Health Services (IHS).
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3.8.6-B:
Engagement
- T/RBHAs
or their subcontracted providers must actively engage the following
in the treatment planning process:
- The
person;
- The
person’s family/significant others, if applicable and
amenable to the person; and
- Other
agencies/providers as applicable.
- Behavioral
health providers should:
- Provide
a courteous, welcoming environment that provides persons with
the opportunity to explore, identify and achieve their personal
goals.
- Engage
persons in an empathic, hopeful and welcoming manner during
all contacts.
- Provide
culturally relevant care that addresses and respects language,
customs, and values and is responsive to the person’s
unique family, culture, traditions, strengths, age and gender.
- Be aware
of and seek to gain an understanding of persons with different
disorders and characteristics.
- Display
sensitivity to, and respect for, various cultural influences
and backgrounds (e.g., ethnic, racial, gender, sexual orientation
and socio-economic class).
- Establish
an empathic service relationship in which the person experiences
the hope of recovery and is considered to have the potential
to achieve recovery while developing hopeful and realistic
expectations.
- Demonstrate
the ability to welcome persons, the person’s family
members, others involved in the person’s treatment and
other service providers as collaborators in the treatment
planning and implementation process.
- Demonstrate
the desire and willingness to include the person’s viewpoint
and to regularly validate the daily courage needed to recover
from persistent and relapsing disorders.
- Assist
in establishing and maintaining the person’s motivation
for recovery.
- Provide
information on available services and assist the person and
the person’s family (and the entire clinical team) in
identifying services that help toward meeting the person’s
goals.
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3.8.6-C:
Re-engagement
Behavioral health providers must attempt to re-engage enrolled persons
who have withdrawn from participation in the treatment process prior
to the successful completion of treatment, refused services or failed
to appear for a scheduled service. The behavioral health provider
must attempt to re-engage the person by:
- Contacting
the person or the person’s legal guardian by telephone,
at times when the person may reasonably be expected to be available
(e.g., after work or school);
- Contacting
the person or the person’s legal guardian face-to-face,
if telephone contact is insufficient to determine acuity and risk;
and
- Sending
a letter requesting contact, if all attempts at personal contact
are unsuccessful, except when a letter is contraindicated due
to safety concerns (e.g., domestic violence) or confidentiality
issues.
If the above
activities are unsuccessful, the behavioral health provider must
make further attempts to re-engage persons determined to have a
serious mental illness, children, pregnant substance abusing women/teenagers,
or any person determined to be at risk of relapse, decompensation,
deterioration or a potential harm to self or others by:
- Contacting
family members, neighbors, law enforcement, other state agencies
or others who may have information on the person’s location
and condition to the extent allowed by state and federal confidentiality
laws (see Section
4.1, Disclosure of Behavioral Health Information);
- Initiating
the pre-petition screening or petition for treatment process described
in Section 3.18, Pre-petition Screening, Court-Ordered Evaluation
and Court-Ordered Treatment, if the person appears to meet clinical
standards as a danger to self, danger to others, persistently
or acutely disabled or gravely disabled. Due to tribal sovereignty,
Section 3.18 does not apply to Tribal RBHAs. Gila River RBHA providers
should contact the RBHA for assistance in facilitating court ordered
treatment pursuant to the Gila River Mental Health Ordinance (GR-06-96).
- All attempts
to re-engage persons who have withdrawn from treatment, refused
services or failed to appear for a scheduled service must be documented
in the comprehensive clinical record.
Follow-up
after special events
Behavioral health providers must also conduct follow-up activities
to maintain engagement within the following timeframes for persons:
- Discharged
from inpatient services within a timeframe based upon the person’s
clinical needs; ideally within 7 days, but no later than 30 days;
- Involved
in a behavioral health crisis within timeframes based upon the
person’s clinical needs, but no later than 7 days;
- Refusing
prescribed psychotropic medications within timeframes based upon
the person’s clinical needs and individual history; and
- Released
from local and county jails within 72 hours.
Additionally,
for persons to be released from Level I care, behavioral health
providers must help establish priority prescribing clinician appointments
within 7 days of the person’s release to ensure client stabilization,
medication adherence, and to avoid re-hospitalization.
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3.8.5-D:
Disenrollment of a person enrolled in the behavioral health system
Under certain circumstances, it may be appropriate or necessary
to disenroll a person from services. Disenrollment can occur due
to administrative or clinical factors involving the enrolled person.
Clinical
Factors
- Treatment
Completed:
Persons must be disenrolled upon completion of treatment. Prior
to disenrolling a person following the completion of treatment,
the behavioral health provider and the person or the person’s
legal guardian must mutually agree that behavioral health services
are no longer needed.
- Further Treatment
Declined:
A person must be disenrolled from services if the person or the
person’s legal guardian makes a decision to refuse ongoing
behavioral health services. Prior to disenrolling a person for
declining further treatment, the behavioral health provider must
ensure the following:
- All
applicable re-engagement activities described in subsection
3.8.6-C. have been conducted; and
- The
person does not meet clinical standards for initiating the
pre-petition screening or petition for treatment process described
in Section 3.18, Pre-petition Screening, Court Ordered Evaluation
and Court Ordered Treatment.
- Lack
of Contact:
A person may be disenrolled if the T/RBHA or behavioral health
provider is unable to locate or make contact with the person
after ensuring that all applicable re-engagement activities
described in subsection 3.8.6-C. have been conducted.
Administrative
Factors
- Eligibility/entitlement
information changes including:
- Loss
of Title XIX/XXI eligibility, if other funding is not available
to continue services; and
- Persons
who become or are enrolled as elderly or physically disabled
(EPD) under the Arizona Long Term Care System (ALTCS) must
be disenrolled from the T/RBHA after ensuring appropriate
coordination and continuity of care with the ALTCS program
contractor. (Not applicable for developmentally delayed ALTCS
members (ALTCS/DD) whose behavioral health treatment is provided
through the T/RBHA system.) An ALTCS/EPD eligible person may
remain enrolled with the T/RBHA as Non-Title XIX if the person
has been determined to have a serious mental illness (SMI)
and will continue to receive Non-Title XIX covered SMI services
through the T/RBHA.
- Behavioral
health providers may disenroll Non-Title XIX/XXI eligible persons
for non-payment of assessed co-payments per Section
3.4, Co-payments, under the following conditions:
- The
person is not eligible as a person determined to have a serious
mental illness per Section
3.10, SMI Eligibility Determination; and
- After
attempting reasonable options to resolve the situation, including
informal discussions with the person.
- Out-of-State
Relocations
- A person
who relocates out-of-state must be disenrolled. This does
not apply to persons placed out-of-state by the T/RBHA or
Arizona Department of Economic Security/ Division of Children,
Youth, and Families (DES/DCYF) for purposes of providing behavioral
health treatment (see Section
3.22, Out-of-State Placements for Children and Young Adults).
- Inter-T/RBHA
Transfers
- A person
who relocates to another geographic service area and requires
ongoing behavioral health services must be disenrolled and
services must be transitioned per Section
3.17, Transition of Persons.
- Arizona Department
of Corrections Confinements
A person age 18 or older must be disenrolled upon acknowledgement
that the person has been placed in the long-term control and custody
of a correctional facility.
- Children
Held at County Detention Facilities
- A child
who was enrolled in a T/RBHA prior to detainment in a county
detention facility will remain enrolled as long as the child
remains Title XIX/XXI eligible. T/RBHAs and/or their subcontracted
providers must check the AHCCCS Pre-paid Medical Management
Information System (PMMIS) to ensure Title XIX/XXI eligibility
prior to the delivery of each behavioral health service to
a child who is held in a county detention facility.
- Deceased
Persons
- A person
must be disenrolled from the T/RBHA following acknowledgement
that the person is deceased, effective on the date of the
death.
Crisis Episodes
For persons who are enrolled as a result of a crisis episode, disenrollment
may occur if the following conditions have been met:
- The behavioral
health provider conducts all applicable re-engagement activities
described in subsection 3.8.6-C. and such attempts are unsuccessful;
or
- The behavioral
health provider and the person or the person’s legal guardian
mutually agree that ongoing behavioral health services are not
needed.
One Time
Consultations
For persons who are enrolled for the purpose of a one time consultation
as described in Section
4.3, Coordination of Care with AHCCCS Health Plans and Primary Care
Providers, the person may be disenrolled if the behavioral
health provider and the person or the person’s legal guardian
mutually agree that ongoing behavioral health services are not needed.
Data Submission
Behavioral health providers must follow all applicable data submission
procedures as described in Section 7.5, Enrollment, Disenrollment
and Other Data Submission following a decision to disenroll a person
from the behavioral health system.
Providers within
the Gila River RBHA network are not responsible for the submission
of 834-enrollment and disenrollment data transactions. The Gila
River RBHA completes all such transactions and submits data directly
to ADHS.
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3.8.6-E:
Re-enrollment of a person previously enrolled in the behavioral
health system
Some persons who are disenrolled may need to re-enter the behavioral
health system. The process used to re-enroll a person is based on
the length of time that a person has been disenrolled from the behavioral
health system.
Re-enrollment
process for persons
disenrolled for less than 6 months |
Re-enrollment
process for persons
disenrolled for 6 months or longer |
| If
the person has not received a behavioral health assessment
in the past 6 months, conduct a new behavioral health assessment
consistent with Section
3.9, Intake, Assessment and Service Planning,
and revise the person’s service plan as needed.
If the
person has received a behavioral health assessment in the
last six months and there has not been a significant change
in the person’s behavioral health condition, T/RBHAs
or behavioral health providers may utilize the most current
assessment. Review the most recent service plan (developed
within the last six months) with the person, and if needed,
coordinate the development of a revised service plan with
the person’s clinical team (see Section
3.9, Intake, Assessment and Service Planning). |
Conduct
a new intake, behavioral health assessment and service plan
consistent with Section
3.9, Intake, Assessment and Service Planning. |
| Continue
the person’s SMI status if the person was previously determined
to have a serious mental illness (see Section
3.10, SMI Eligibility Determination). |
Continue
the person’s SMI status if the person was previously determined
to have a serious mental illness (see Section
3.10, SMI Eligibility Determination). |
| If
the re-enrollment occurs at a different T/RBHA or provider,
obtain new general and informed consent to treatment (see Section
3.11, General and Informed Consent to Treatment). |
Obtain
new general and informed consent to treatment, as applicable
(see Section
3.11, General and Informed Consent to Treatment). |
| If
the re-enrollment occurs at a different T/RBHA or provider,
obtain new authorizations to disclose confidential information,
as applicable (see Section
4.1, Disclosure of Behavioral Health Information). |
Obtain
new authorizations to disclose confidential information, as
applicable (see Section
4.1, Disclosure of Behavioral Health Information). |
| Submit
new demographic and enrollment data (see
Section 7.5, Enrollment, Disenrollment and Other Data Submission). |
Submit
new demographic and enrollment data (see
Section 7.5, Enrollment, Disenrollment and Other Data Submission). |
3.8
Outreach, Engagement, Re-engagement, Closure and Re-enrollment
Last Revised: 02/10/2005
Effective Date: 08/01/2005
|
