Code of Maine Rules › 14 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 193 - OFFICE OF ADULT MENTAL HEALTH › Chapter 2 - RULES GOVERNING ESSENTIAL STANDARDS AND BASIC PRINCIPLES REQUIRED OF CERTAIN ASSERTIVE COMMUNITY TREATMENT TEAMS FOR PARTICIPATION IN THE PROGRESSIVE TREATMENT PROGRAM › Appendix 193-2-A - ACT Fidelity Scale

Current through 2024-29, July 17, 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
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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