Section 440IAC11-3-1. Staff positions and requirements for ACT teams serving 50 or fewer individuals

   (a) An ACT team serving fifty (50) or fewer individuals shall have qualified individuals to fill the staff positions and perform the functions in this section.

  (b) Each team serving fifty (50) or fewer individuals must be composed of the required psychiatrist or AHCP and at least the following full-time core staff:

(1) A team leader.

(2) A registered nurse.

(3) A substance abuse specialist.

(4) A vocational specialist.

(5) Two (2) OBHPs; or one (1) OBHP and one (1) recovery specialist.

  (c) An ACT team shall have psychiatrists who shall meet the following requirements:

(1) An ACT team serving up to fifty (50) individuals shall have at least sixteen (16) hours of psychiatric coverage each week, which may consist of not more than two (2) psychiatrists and one (1) AHCP. The AHCP may fulfill the role of the psychiatrist or psychiatrists for up to fifty percent (50%) of the required psychiatrists' time.

(2) An ACT team psychiatrist shall meet with and evaluate each individual served by the team at least one (1) time every six (6) months. This function of the team psychiatrist shall not be performed by the AHCP.

(3) Each month, the ACT team psychiatrist shall review at least ten percent (10%) of the case load of the AHCP on the team.

(4) The CMHC must demonstrate active participation of the psychiatrist or psychiatrists as members of the ACT team.

(5) The responsibilities of the team psychiatrist or psychiatrists and the AHCP shall include, but not be limited to, the following:

(A) Supervision of the psychiatric treatment of all individuals, including the following:

(i) Performing psychiatric assessments.

(ii) Providing individuals with necessary psychopharmacologic treatment.

(iii) At least a monthly assessment of the individual's response to medications, provided, however, that more frequent assessment may be required if an individual is in crisis.

(B) Attending a combined total of at least seventy percent (70%) of treatment planning meetings.

(C) Active collaboration with all registered nurses and licensed practical nurses.

(D) Supervision of the medication management system.

  (d) An ACT team shall have a team leader who must meet the following requirements:

(1) The team leader shall:

(A) be assigned full time to the team;

(B) be a QBHP; and

(C) have at least two (2) years previous supervisory experience.

(2) The responsibilities of the team leader include, but are not limited to, the following:

(A) Providing the direct supervision of team members in compliance with the policies of the CMHC.

(B) Functioning as a practicing clinician with contact with individuals for at least five (5) hours per week.

  (e) An ACT team shall have nurses who meet the following requirements:

(1) An ACT team serving fifty (50) or fewer individuals shall have at least one (1) full-time registered nurse.

(2) A registered nurse shall have at least six (6) months of experience working with persons with mental illness before serving on an ACT team.

(3) A registered nurse shall perform the following critical roles:

(A) In collaboration with the psychiatrist or AHCP, a registered nurse shall:

(i) manage the medication system; and

(ii) administer and document medication treatment.

(B) Conduct health assessments of individuals within the scope of practice of a registered nurse.

(C) Coordinate services with other health providers.

(D) Provide training to other ACT team members to assist them in monitoring psychiatric symptoms and medication side effects.

(4) A licensed practical nurse serving on the ACT team shall have at least six (6) months of experience working with persons with mental illness.

(5) A licensed practical nurse shall have the following responsibilities:

(A) In collaboration with the psychiatrist, registered nurse, or AHCP, a licensed practical nurse shall:

(i) manage the medication system; and

(ii) administer and document the administration of medication.

(B) Coordinate services with other health providers.

  (f) An ACT team shall have at least one (1) full-time substance abuse specialist who meets the following requirements:

(1) The substance abuse specialist shall have one (1) of the following:

(A) A license under:

(i) IC 25-23.6-10.5-1 as an addiction counselor; or

(ii) IC 25-23.6-10.5-2 as a clinical addiction counselor.

(B) A credential in addictions counseling from a credentialing body approved by the division.

(C) Two (2) years of experience as a substance abuse counselor in a substance abuse program and be actively working toward licensure under clause (A) or an approved credential under clause (B).

(2) The substance abuse specialist shall have the following responsibilities:

(A) Taking the lead in substance abuse assessment, planning, and treatment for all individuals.

(B) Providing treatment specifically indicated for individuals with mental illness and substance abuse issues for all individuals.

(C) Providing training to other ACT team members to assist them in:

(i) identifying substance abuse issues; and

(ii) monitoring the progress of individuals in treatment.

  (g) An ACT team shall have at least one (1) full-time vocational specialist who meets the following requirements:

(1) A vocational specialist works with a supported employment program operated by a CMHC under a contract with the office of vocational rehabilitation services.

(2) A vocational specialist shall have the following responsibilities:

(A) Providing to individuals a full range of supported employment services including, but not limited to, the following:

(i) Vocational assessment and planning.

(ii) Job development.

(iii) Job placement.

(iv) Job support.

(v) Career counseling.

(vi) Employment follow-along.

(vii) Maintaining a liaison with vocational rehabilitation counselors.

(B) Providing training to other ACT team members regarding the range of supported employment services.

  (h) An ACT team shall have at least one (1) full-time team member who meets the following requirements:

(1) The team member performs general community support tasks listed in section 5(b) through 5(g) of this rule.

(2) The team member is qualified as an OBHP under this article and must:

(A) hold an associate's or bachelor's degree;

(B) have six (6) months of behavioral health experience; and

(C) meet minimum competency standards set forth by the:

(i) CMHC;

(ii) supervising licensed professional or the QBHP.

  (i) An ACT team may have a recovery specialist who meets the following requirements:

(1) A recovery specialist holds a recovery specialist certificate issued or approved by the division.

(2) A recovery specialist:

(A) shall be a fully integrated member of the team; and

(B) must participate in the clinical responsibilities and functions of the team in providing direct services to individuals.

(3) A recovery specialist must be counted when calculating the case ratio.

(Division of Mental Health and Addiction; 440 IAC 11-3-1; filed Feb 9, 2011, 10:24 a.m.: 20110309-IR-440090875FRA)