DAR File No. 43214

Human Services, Substance Abuse and Mental Health

Rule R523-18

Mobile Crisis Outreach Teams Certification Standards

Notice of Proposed Rule

(New Rule)

DAR File No.: 43214
Filed: 09/14/2018 03:20:35 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

This rule is enacted for the purpose of promoting the availability of comprehensive behavioral health crisis services throughout the state by: a) creating standards of certification, care, and practice for statewide mental health crisis response system using the Mobile Crisis Outreach Team (MCOT) model of care, and b) outlining the responsibilities of MCOTs including interaction with civil commitment.

Summary of the rule or change:

This new rule includes: a) definitions for uncommon/industry specific terms used in this rule; b) general provisions and philosophical principles are established and defined; c) minimum standards of care are established and defined for all MCOTs seeking State Certification; d) minimum personnel configuration and certification process are established; e) oversight activities by the Division of Substance Abuse and Mental Health (DSAMH) are established and defined; and f) a revocation of certification and agency recourse are established.

Statutory or constitutional authorization for this rule:

• Subsection 62A-15-116(4)
• Section 62A-15-1402

Anticipated cost or savings to:

the state budget:

The Department of Human Services (DHS)/DSAMH was allocated $2,595,000 to administer this program that includes: the expansion of mental health crisis services i.e. contracting for statewide crisis response teams through five providers, hiring a program administrator, and any additional administrative cost. Contracting for a Central Emergency Mental Health Crisis Line: DHS/DSAMH will be contracting with the five Local Mental Health Authorities to develop a statewide system of crisis response teams that will provide the direct services needed to maintain a comprehensive Mental Health Crisis Management System. Each contracted team will be compensated $500,000 per annum. This cost includes development of the crisis response teams, maintenance of fidelity to the MCOT model that has been adopted as the service delivery model, and all overhead and administrative costs. Cost of Administrative Oversite: DHS/DSAMH has hired a Program Administrator I to oversee and coordinate efforts to develop a statewide crisis response system, and the salary for this position is a cost of $95,668 including benefits and fringe.

local governments:

The legislation that necessitates this rule added $2,500,000 to the DHS/DSMAH budget to fund five MCOTs that will be distributed throughout the state. These funds are to be awarded to county governments and their Local Mental Health Authorities to help offset the costs associated with the development and maintenance of these teams. Each awardee will receive $500,000, with a minimum of a 20% match in county funds; thus each county receiving a contract for MCOT services will be require to provide a minimum of $100,000 in matching funds based on the aforementioned requirement. Other costs associated with this rule are tied to the cost of having employees certify as crisis workers with DSAMH, which is a staffing requirement for these teams. These costs could include time, productivity, and financial components. Time cost include whatever accounting process is developed to track all crisis employees and the status of their certification. Productivity costs include the lost opportunities of providing services to a caseload for at least 40 hours every 2 years. Financial costs include per diem and salaries paid to employees who are required to certify as crisis workers and the billable hours that are not provided by an employee that is going through the Crisis Worker certification process.

small businesses:

It is anticipated that no small businesses will participate in the certification or development of a crisis line as described in this rule. This rule mostly affects local governments, employees of local governments, and possibly businesses contracted with local governments to provide substance use and/or mental health treatment services (none of which are small businesses at this time).

persons other than small businesses, businesses, or local governmental entities:

There are no costs in this rule associated with other persons.

Compliance costs for affected persons:

There are compliance costs associated to local governments in this new rule. These costs are not imposed on any local governments that choose not to participate in developing a state certified MCOT. Some of these costs can be estimated, such as the $100,000 match required by statute, but others are not estimable, such as startup onetime cost i.e. setup and development of the MCOT, and cost associated with maintaining an eligible team of employees that are Certified Crisis Workers.

Comments by the department head on the fiscal impact the rule may have on businesses:

After conducting a thorough analysis, it was determined that this proposed rule will not result in a fiscal impact to businesses.

Ann Williamson, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Office of Administrative Rules, or at:

Human Services
Substance Abuse and Mental Health
195 N 1950 W
SALT LAKE CITY, UT 84116

Direct questions regarding this rule to:

• Thomas Dunford at the above address, by phone at 801-538-4181, by FAX at 801-538-4696, or by Internet E-mail at tdunford@utah.gov

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

10/31/2018

This rule may become effective on:

11/07/2018

Authorized by:

Doug Thomas, Director

Appendix 1: Regulatory Impact Summary Table*

Fiscal Costs	FY 2019	FY 2020	FY 2021
State Government	$2,596,668	$2,596,668	$2,596,668
Local Government	$100,000	$100,000	$100,000
Small Businesses	$0	$0	$0
Non-Small Businesses	$0	$0	$0
Other Person	$0	$0	$0
Total Fiscal Costs:	$2,696,668	$2,696,668	$2,696,668
Fiscal Benefits	$0	$0	$0
State Government	$0	$0	$0
Local Government	$0	$0	$0
Small Businesses	$0	$0	$0
Non-Small Businesses	$0	$0	$0
Other Persons	$0	$0	$0
Total Fiscal Benefits:	$0	$0	$0
Net Fiscal Benefits:	$(2,696,668)	$(2,696,668)	$(2,696,668)

 

*This table only includes fiscal impacts that could be measured. If there are inestimable fiscal impacts, they will not be included in this table. Inestimable impacts for State Government, Local Government, Small Businesses and Other Persons are described in the narrative. Inestimable impacts for Non-Small Businesses are described in Appendix 2.

 

Appendix 2: Regulatory Impact to Non-Small Businesses

There are no estimable or inestimable costs or benefits to non-small businesses in this rule. The statute and funding associated with this rule only effect state and local government agencies and budgets, and those cost have been described in the attached new rule analysis.

 

 

R523. Human Services, Substance Abuse and Mental Health.

R523-18. Mobile Crisis Outreach Teams Certification Standards.

R523-18-1. Authority.

(1) This rule establishes guidelines, procedures and standards for the establishment of statewide Mobile Crisis Outreach Teams (MCOT) as directed in Subsections 62A-15-116(4) and 62A-15-1402.

 

R523-18-2. Purpose.

(1) This rule is enacted for the purpose of promoting the availability of comprehensive behavioral health crisis services throughout the state, by:

(a) creating standards of certification, care and practice for statewide mental health crisis response system using the MCOT model of care, and

(b) outlining the responsibilities of MCOTs including interaction with civil commitment.

 

R523-18-3. Definitions.

(1) "Assessment" means a formal and continuous process of collection and evaluating information about an individual to ascertain whether or not a patient is functioning at a healthy psychological, social, or developmental level and aids in service planning, treatment and referral. Assessments establish justification for interventions, services and referrals.

(2) "Certified Crisis Worker" means an individual who meets the standards of certification that the Substance Abuse and Mental Health (division) sets, in accordance with Subsection R523-17-4.

(3) "Crisis Stabilization" means direct mental health care to non-hospitalized individuals experiencing an acute crisis of a psychiatric nature that may jeopardize their current community living situation, or put them at risk of psychiatric hospitalization by:

(a) providing emotional support and safety, and

(b) mobilizing community resources, the individuals support system, family members, and others for ongoing maintenance, and rehabilitation.

(4) "Designated Examiner" is defined in Subsection 62A-15-602(5).

(5) "Emergency medical service personnel" means an individual who provides emergency medical services to a patient and is required to be licensed under Section 26-8a-302, which includes:

(a) paramedics,

(b) medical directors of a licensed emergency medical service provider,

(c) emergency medical service instructors,

(d) and other categories established by the committee.

(6) "MCOT certification" means the certification created in Section R523-18-5.

(7) "MCOT personnel" means a licensed mental health therapist as defined in Subsection 58-60-102(5) and a certified crisis worker.

(8) "Mental Health Crisis" means any intense behavioral, emotional, or psychiatric situation perceived to be a crisis by the individual or family experiencing the crisis, or others who closely observe the individual where:.

(a) the crisis manifests itself by symptoms of sufficient severity that a prudent layperson who possesses an average knowledge of mental health issues could reasonably expect the absence of immediate attention or intervention to result in:

(i) serious jeopardy to the individual's health or well-being, or

(b) a danger to others, or

(c) significantly reduced levels of functioning in primary activities of daily living, including interfering with the ability to go to school, work, and engage in meaningful relationships.

(9) "Mental health crisis services" means mental health services and on-site interventions that a person renders to an individual suffering from a mental health crisis. This includes the provision of:

(a) safety and care plans,

(b) stabilization services that are offered for a minimum of 60 days, and

(c) referrals to other community resources.

(10) "Mobile Crisis Outreach Team" means a mobile team of medical and MCOT personnel that provide mental health crisis services and, based on the individual circumstances of each case, coordinates with local law enforcement, emergency medical service personnel, and other appropriate state or local resources. Medical professionals may serve in a response or oversight role on the team.

(11) "Mental Health Officer" means an individual who is designated by a Local Mental Health Authority as qualified by training and experience in the recognition and identification of mental illness.

(12) "Mental Health Therapist" means an individual licensed in Utah under the mental health professional practice act as defined in Subsection 58-60-102(5).

(13) "Peer Support Specialist (PSS)" means an individual who meet the requirements outlined in R523-5.

(14) "Family Resource Facilitator (FRF)" means an individual who meets the requirements outlined in R523-6.

 

R523-18-4. General Provisions.

(1) MCOT services are based on the following principles:

(a) cultural competence,

(b) strong community relationships,

(c) the use of peer supports,

(d) the use of evidence based practices,

(e) building on existing foundations with an eye towards innovation,

(f) utilization of an integrated system of care,

(g) outreach to students through school-based clinics,

(h) trauma informed care,

(i) de-escalation,

(j) access to supports and services is timely,

(k) services are provided in the least restrictive manner possible,

(l) crisis is defined by the individual or family,

(m) treatment plans are strengths-based, and

(n) helping the individual and family to regain a sense of control and safety is a priority.

(2) MCOTs must be capable of serving in the context of a crisis as outlined below:

(a) children, adolescents, adults and older adults,

(b) individuals with co-occurring conditions including:

(i) mental health conditions,

(ii) substance use disorders,

(iii) medical needs,

(iv) intellectual/developmental disabilities,

(v) physical disabilities,

(vi) traumatic brain injuries; and/or,

(vii) dementia and related neurological conditions.

(c) individuals demonstrating aggressive behavior,

(d) individuals who are uninsured or unable to pay for services, and

(e) individuals who may lack Utah residency or legal immigration status.

(3) MCOTS shall encourage each modality of service within the Crisis Response System to incorporate peer support into the services they provide, when clinically appropriate.

 

R523-18-5. Minimum Guidelines and Standards of Care.

(1) Mobile crisis services provide a timely in-person response to a crisis in the community. Mobile crisis services shall collaborate with local and statewide crisis line services, and any additional crisis response services, including the stabilization and mobile response services if available.

(2) When a MCOT is dispatched from the statewide crisis line, the statewide crisis line staff shall provide whenever possible the:

(a) the name of individual in crisis,

(b) their date of birth,

(c) the presenting problem as demonstrated through the individual's current behaviors),

(d) the location of the individual needing services,

(e) any history of violence and/or substance use,

(f) the presence of any weapons and/or dogs in the house, and

(g) the need for a coordination plan to include police assistance, and/or family's willingness to helping coordinate services while accounting for all relevant safety and security issues, so the MCOT can provide a timely face to face response.

(3) When law enforcement requests response from a MCOT, and is staying on scene, it is important to provide as rapid as a response as possible which may mean, responding to the crisis with limited information.

(4) A MCOT must have the capacity to:

(a) intervene wherever the crisis occurs,

(b) serve individuals unknown to the system,

(c) coordinate multiple simultaneous requests for services and,

(d) work closely with police, EMS, Fire, dispatch, crisis hotlines, schools, hospital emergency departments, and other related agencies.

(5) A MCOT must operate 24 hours per day, 7 days per week, and 365 days per year in providing community-based crisis intervention, screening, assessment, and referrals to appropriate resources.

(6) In screening the individual in crisis, the MCOT must collect at least the following information:

(a) identifying information,

(b) the chief complaint/presenting problem,

(c) acute medical concerns and chronic health conditions, and

(d) current healthcare providers.

(7) The MCOT must administer an ongoing assessment, if clinically indicated by the initial screening, that shall include:

(a) any imminent danger to the individual in crisis through potentially lethal means of harm to one's self or others.

(b) risk for suicide using the Columbia Suicide Severity Rating Scale (C-SSRS)or another empirically validated instrument,

(c) the individual's emotional status and imminent psychosocial needs,

(d) individual strengths and available coping mechanisms,

(e) resources that can increase service participation and success, and

(f) the most appropriate and least restrictive service alternative for the individual, and the referral mechanisms and procedures to access services.

(8) Following the assessment, if there is risk for harm to self or others, the MCOT shall engage the person to establish a crisis response plan using:

(a) Crisis Response Planning (CRP),

(b) Stanley Brown Safety Plan, or

(c) another evidenced based safety plan/crisis prevention practice.

(9) If clinically indicated access ER or other crisis receiving facility to address ongoing safety concerns and for further evaluation.

(10) A MCOT must be staffed by skilled and licensed mental health professionals.

(11) A MCOT must understand the emergency civil commitment process as described in Section 62A-15-629, and one of the members must be either a Designated Examiner or Mental Health Officer to facilitate civil commitment should that be the indicated course of action for the safety of the individual, family or the community.

(12) A MCOT will preferably utilize Certified Peer Support Specialists and Family Resource Facilitators, in conjunction with a Mental Health Therapist when deploying for mobile crisis outreach.

(13) A MCOT shall respond to individuals in the community who are in crisis with the goal of resolving the crisis in the least restrictive manner and setting, including:

(a) reducing inpatient treatment admissions and Emergency Department visits if appropriate,

(b) increasing jail diversions, and

(c) reducing law enforcement involvement while maintaining public safety.

(14) A MCOT shall collaborate with stakeholders involved in the crisis service delivery system and partner to resolve service delivery concerns.

(15) MCOT providers shall have a published plan in place that outlines triage policies and coordination of crisis response services with community stakeholders.

(a) The plan shall address community collaboration with the following partners at minimum:

(i) Local Mental Health and Substance Abuse Authorities,

(ii) SMR providers,

(iii) local law enforcement,

(iv) fire departments,

(v) dispatch,

(vi) hospital emergency departments,

(vii) schools,

(viii) EMS,

(ix) Department of Human Services agencies, and

(x) other social service partners, including health plans and other crisis services in the local community.

(16) The MCOT provider shall enter into MOU's with each Local Mental Health and Substance Abuse Authority operating a crisis line in their region, and the Statewide Crisis Line. The MOU shall include the following elements at a minimum:

(a) data sharing process between Statewide Crisis Line, Local Authority and MCOT provider including data on number of callers from region MCOT serves,

(b) mobile deployments from the Statewide Crisis Line,

(c) a clear procedure for coordination between the Statewide Crisis Line and MCOT provider, for deploying MCOT services for individuals in need of MCOT services who have called into the Statewide Crisis Line,

(d) data and a process for warm hand offs between Statewide Crisis Line, MCOT, and Local Authorities to support individuals in ongoing services; and

(e) procedures for case consultation on services, high utilizers, and collaboration.

 

R523-18-6. MCOT Personnel and Team Certification.

(1) The Following requirements shall be met in order for an agency to receive a certification of their MCOT:

(a) personnel shall consist of a minimum of two members, one of which shall be a:

(i) Mental Health Therapist who is a Certified Crisis Worker, and is either a:

(A) Designated Examiner, or

(B) a Mental Health Officer.

(b) The second member shall be a Certified Crisis Worker, who is preferably a Certified Peer Support Specialist or a Family Resource Facilitator.

(c) All teams shall have access to a Designated Examiner and a medical professional for consultation during the MCOT response.

(2) Agencies shall apply for participation and funding in MCOT activities through a Request For Proposal process that requires:

(a) submitting a plan that describes service delivery and team make-up,

(b) submitting a plan for meeting minimum guidelines and standards of care as outlined in this rule, and

(c) evidence that the statutory match requirement of 20% will be met.

(3) The division shall provide certification to applicant agencies after review of the submitted materials demonstrate that the plan of care and team make up meet the guidelines set forth in this rule.

 

R523-18-7. Division Oversight of Programs.

(1) The division may enter and survey the physical facility, program operations, and review curriculum and interview staff of a certified MCOT agency, to determine compliance with this rule or any applicable contract to provide such services.

(2) Participating organizations including Local Authorities and the Statewide Crisis Line shall, allow representatives from the division and from the local authorities as authorized by the division to monitor services. Such visits may be announced or unannounced.

 

R523-18-8. Revocation of Certification.

(1) MCOT shall maintain its certification by meeting the guidelines set forth in this rule.

(2) The Division shall review all complaints related to an MCOT that is not meeting the guidelines set forth in this rule.

(3) The Division shall refuse to certify, suspend, revoke, or renew a certification to any MCOT that is found to have a substantiated complaint.

(4) An MCOT that has been served a Notice of Agency Action that the certification has been suspended, revoked, or will not be renewed may request a Request for Review to the Division Director or designee within 30 days of receipt of notice.

(5) The Division Director or designee will review the findings of the Notice of Agency Action and shall determine to uphold, amend or revise the action of denial or revocation of the certification.

(6) The MCOT certification shall be posted and available upon request.

 

KEY: mobile crisis outreach team, MCOT standards, statewide crisis response standards

Date of Enactment or Last Substantive Amendment: 2018

Authorizing, and Implemented or Interpreted Law: 62A-15-116(4), 62A-15-1402