Behavioral Health Services

ENHANCED SERVICES

Monarch’s Enhanced Services are designed to improve the range of mental health, substance use disorder and developmental disabilities care for those with chronic and complicated disabilities as defined by the state of North Carolina.

Below you will find detailed descriptions of the person-centered support that we offer, eligibility criteria and the stories of people who are experiencing a better quality of life as a result of these programs.

Assertive Community Treatment Team (ACTT)

An Assertive Community Treatment Team (ACTT) consists of a community-based group of medical, behavioral health and rehabilitation professionals who use a team approach to meet the needs of an individual with severe and persistent mental illness.

An ACTT provides person-centered services addressing the breadth of an individual’s needs, helping him or her achieve their personal goals. Thus, a fundamental charge of ACTT is to be the first-line (and generally sole provider) of all the services that an individual receiving ACTT needs.

Eligibility Criteria

ACTT shall document written admission criteria that reflect the following requirements, which ALL must be met for a beneficiary to be deemed eligible for ACTT services:

  • Beneficiaries (ages 18 and over) with severe and persistent mental illness; priority is given to people with schizophrenia, other psychotic disorders (e.g. schizoaffective disorder) and bipolar disorder because these illnesses more often cause long-term psychiatric disability. Beneficiaries with other psychiatric illnesses are eligible dependent on the level of the long-term disability.  Individuals with a primary diagnosis of a substance use disorder or intellectual/developmental disabilities are not the intended beneficiary group.
  • The beneficiary has significant functional impairment as demonstrated by at least ONE of the following conditions:
    • Significant difficulty consistently performing the range of routine tasks required for basic adult functioning in the community (for example, caring for personal business affairs; obtaining medical, legal, and housing services; recognizing and avoiding common dangers or hazards to self and possessions; meeting nutritional needs; attending to personal hygiene) or persistent or recurrent difficulty performing daily living tasks except with significant support or assistance from others such as friends, family, or relatives;
    • Significant difficulty maintaining consistent employment at a self-sustaining level or significant difficulty consistently carrying out the head-of-household responsibilities (such as meal preparation, household tasks, budgeting, or child-care tasks and responsibilities); or
    • Significant difficulty maintaining a safe living situation (for example, repeated evictions or loss of housing or utilities).
  • The beneficiary has ONE OR MORE of the following problems, which are indicators of continuous high-service needs:
    • High use of acute psychiatric hospital (2 or more admissions during the past 12 months) or psychiatric emergency services;
    • Intractable (persistent or recurrent) severe psychiatric symptoms (affective, psychotic, suicidal, etc.);
    • Coexisting mental health and substance use disorders of significant duration (more than 6 months);
    • High risk or recent history of criminal justice involvement (such as arrest, incarceration, probation);
    • Significant difficulty meeting basic survival needs, residing in substandard housing, homelessness, or imminent risk of homelessness;
    • Residing in an inpatient or supervised community residence, but clinically assessed to be able to live in a more independent living situation if intensive services are provided; or requiring a residential or institutional placement if more intensive services are not available; or
    • Difficulty effectively using traditional office-based outpatient services.
  • There are no indications that available alternative interventions would be equally or more effective based on North Carolina community practice standards and within the LME-MCO service array.

Service Areas

Cleveland County
Davidson County
Forsyth County
Gaston County
Guilford County
Lincoln County
Mecklenburg County
Stanly County

Community Support Team (CST)

Community Support Team (CST) services consist of community-based mental health and substance abuse rehabilitation services and necessary supports provided through a team approach to assist adults in achieving rehabilitative and recovery goals. It is intended for individuals with mental illness, substance abuse disorders, or both who have complex and extensive treatment needs. CST is designed to reduce presenting psychiatric or substance abuse and is available 24/7.

Eligibility Criteria

Must meet ALL off the following criteria:

  • There is a documented, significant impairment in at least two of the life domains (emotional, social, safety, housing, medical or health, educational, vocational and legal). This impairment is related to the beneficiary’s diagnosis and impedes the beneficiary’s use of the skills necessary for independent functioning in the community
  • There is a mental health or substance use disorder diagnosis as defined by the DSM-5, or any subsequent editions of this reference material, other than a sole diagnosis of intellectual and developmental disability.
  • For beneficiaries with a primary substance use disorder diagnosis, the American Society for Addiction Medicine Criteria is met.
  • Four or more of the following conditions related to the diagnosis are present:
    • High use of acute psychiatric hospitals or crisis/emergency services, including but not limited to mobile crisis management, in-clinic or crisis residential (2 or more admissions in a year), extended hospital stay (30 days within the past year), or psychiatric emergency services
    • History of difficulty using traditional services (missing office appointments, difficulty maintaining medication schedules, etc.)
    • Intermittently medication refractory (not achieving full response to medication or sustained reduction of symptoms) or difficulty maintaining compliance with taking medication
    • Co-occurring diagnoses of a substance use disorder (ASAM—any level of care) and mental illness
    • Legal issues (conditional release for non-violent offense; history of failures to show in court, etc.) related to the beneficiary’s mental or substance use disorder diagnosis
    • Homeless or at high risk of homelessness due to residential instability resulting from beneficiary’s mental health or substance use disorder diagnosis
    • Clinical evidence of suicidal gestures, persistent ideation, or both in past 3 months
    • Ongoing inappropriate public behavior in the community within the last 3 months
    • Within the past 6 months, physical aggression, intense verbal aggression, or both toward self or others (due to symptoms associated with diagnosis) sufficient to create functional problems in the home, community, school, job, etc.
    • A less intense level of care has been tried and found to be ineffective for the clinical needs of the beneficiary
  • There is no evidence to support that alternative interventions would be equally or more effective, based on North Carolina community practice standards (for example, American Society for Addiction Medicine, American Psychiatry Association) is available.

Service Areas

Cleveland County
Gaston County
Lincoln County

In-Home Therapy Service (IHTS)

This service provides therapy and case management when a child or young adult is at risk of out-of-home placement. It is a stepup from outpatient care due to case management needs. We help manage a child’s behavior and assist and empower families in developing problem-solving skills and accessing community resources. Our staff will work with the entire family at their home to provide therapy, in addition to case management when the child progresses and steps down to outpatient. This is designed as a six-month program to work on case management needs to ensure the child stays in their home environment.

Eligibility Criteria

The individual is working age (18+) and:

  • Has a primary diagnosis of a serious mental illness (SMI) that includes severe and persistent mental illness (SPMI) and co-occurring disorders. This may include a primary substance use disorder diagnosis.
  • Experiences difficulties in at least two or more of the following areas:
    • In or at risk of placement in a congregate setting or difficulty maintaining safe living situations, including homelessness.
    • Co-occurring mental health and substance use disorders.
    • High risk of crisis diversion, intervention, including hospital transitions.
    • Difficulty effectively using traditional office-based outpatient services.
    • Difficulty with daily living, communication, interpersonal skills, self-care, self-direction.
    • High risk or recent history (within the past 12 months) of criminal justice involvement (such as arrest, incarceration or probation).

Locations

Davidson County
Rowan County
Cabarrus County
Stanly County
Mecklenburg County
Union County

Individual Placement And Support – Supported Employment (IPS-SE)

Individual Placement and Support – Supported Employment (IPS-SE) is a person-centered, behavioral health service with a focus on employment, that provides assistance in choosing, acquiring, and maintaining competitive paid employment in the community for individuals 18 years old and older for whom employment has not been achieved, has been interrupted or intermittent.

Eligibility Criteria

The individual is working age (18+) and:

  • Has a primary diagnosis of a serious mental illness (SMI) that includes severe and persistent mental illness (SPMI) and co-occurring disorders. This may include a primary substance use disorder diagnosis.
  • Experiences difficulties in at least two or more of the following areas:
    • In or at risk of placement in a congregate setting or difficulty maintaining safe living situations, including homelessness.
    • Co-occurring mental health and substance use disorders.
    • High risk of crisis diversion, intervention, including hospital transitions.
    • Difficulty effectively using traditional office-based outpatient services.
    • Difficulty with daily living, communication, interpersonal skills, self-care, self-direction.
    • High risk or recent history (within the past 12 months) of criminal justice involvement (such as arrest, incarceration or probation).
  • Expresses the desire to work and has an established pattern of unemployment, underemployment or sporadic employment and requires assistance in obtaining or maintaining employment in addition to what is typically available from the employer because of functional limitations as described above, and behaviors associated with the individual’s diagnosis.

Locations

Forsyth County
Stanly County
Wake County
Robeson County
Guilford County
Gaston County (includes service to Lincoln and Cleveland counties)
Nash County

Intensive In-Home Service (IIHS)

When a family feels they have come to a point of crisis with a child experiencing mental health problems, Monarch will go to them to create an environment for success through the Intensive In-Home Service (IIHS). We help manage a child’s behavior and assist and empower families in developing problem-solving skills and accessing community resources. Our staff is available around the clock to work with the entire family at their home. We will do whatever it takes to prevent out-of-home placement for a child with a mental health diagnosis. This is designed as a six-month program to work on case management and therapy needs to ensure the child stays in their home environment.

Eligibility Criteria

A beneficiary (ages 3-20) is eligible for this service when all the following criteria are met:

  • There is a mental health/substance use disorder diagnosis (as defined by the DSM-IV-TR or its successors), other than a sole diagnosis of intellectual and developmental disability.
  • Based on the current comprehensive clinical assessment, this service was indicated and outpatient treatment services were considered or previously attempted, but were found to be inappropriate or not effective.
  • The youth has current or past history of symptoms or behaviors indicating the need for a crisis intervention as evidenced by suicidal/homicidal ideation, physical aggression toward others, self-injurious behavior, serious risk-taking behavior (running away, sexual aggression, sexually reactive behavior, or substance use).
  • The youth’s symptoms and behaviors are unmanageable at home, school, or in other community settings due to the deterioration of his or her mental health or substance abuse condition, requiring intensive, coordinated clinical interventions.
  • The youth is at imminent risk of out-of-home placement based on the child or adolescent’s current mental health or substance abuse clinical symptomatology, or is currently in an out of-home placement and a return home is imminent.
  • There is no evidence to support that alternative interventions would be equally or more effective, based on North Carolina community practice standards (Best Practice Guidelines of the American Academy of Child and Adolescent Psychiatry, American Psychiatric Association, American Society of Addiction Medicine).

Service Areas

Cabarrus County
Cleveland County
Davidson County
Forsyth County
Lincoln County
Mecklenburg County
Rowan County
Stanly County
Union County

Psychosocial Rehabilitation (PSR)

For some, recovery from mental illness is a long and especially challenging road. For adults with Severe and Persistent Mental Illness (SPMI), Monarch provides Psychosocial Rehabilitation (PSR). PSR utilizes evidence-based practices to empower individuals with the skills they need to serve as active members of their community. PSR staff members work with people in a group setting where positive peer support is part of the healing initiative. Group sessions are designed to increase self-confidence, maintain mental stability, develop employment opportunities, and seek out increased community interaction.

Eligibility Criteria

The beneficiary is eligible for this service when ALL of the following apply:

  • A mental health diagnosis
  • Level of Care Criteria
  • The beneficiary has impaired role functioning that adversely affects at least two of the following:
    • Employment
    • Management of financial affairs
    • Ability to procure needed public support services
    • Appropriateness of social behavior, or
    • Activities of daily living
  • The beneficiary’s level of functioning may indicate a need for psychosocial rehabilitation if the beneficiary has unmet needs related to recovery and regaining the skills and experience needed to maintain personal care, meal preparation, housing, or to access social, vocational and recreational opportunities in the community.

* PSR cannot be provided during the same authorization period with the following services: partial hospitalization and ACTT.

Service Areas

Forsyth County
Harnett County
Lee County
Richmond County