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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.
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.
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.
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 symptoms or substance abuse and is available 24/7. A new emphasis has been placed on training the CST on how to assess an individual’s potential housing needs and how to provide assistance with those needs, if applicable.
Must meet ALL off the following criteria:
- The beneficiary has a mental health or substance use disorder (SUD) diagnosis as defined by the DMS-5, or any subsequent editions of this reference material, other than a sole diagnosis of intellectual and development disability
- There is documented, significant impairment in at least two of the life domains (emotional, 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
- For a beneficiary with a primary substance use disorder diagnosis, the American Society for Addiction Medicine Criteria Level I or higher level is met
- The beneficiary is capable of developing skills to manage symptoms, make behavioral changes and respond favorably to therapeutic interventions; and there is no evidence to support that alternative interventions would be more effective, based on North Carolina community practice standards; and,
- Two or more of the following conditions related to the diagnosis are present:
- The beneficiary requires active rehabilitation and support services to achieve the restoration of functioning and community integration and valued life roles in social, employment, daily living, personal wellness, educational or housing domains
- Deterioration in functioning in the absence of community-based services and supports would lead to hospitalization, other long-term treatment setting or congregate care, such as adult care or assisted living
- The beneficiary’s own resources and support systems are not adequate to provide the level of support needed to live safely in the community
- One or more admissions in an acute psychiatric hospital or use of crisis or emergency services per calendar year, or a hospital stay more than 30 calendar days within the past calendar year
- Pending discharge (less than 30 calendar days) from an adult care home, acute psychiatric hospital, emergency department or other crisis setting
- Traditional behavioral health services alone, are not clinically appropriate to prevent the beneficiary’s condition from deterioration (such as missing an office appointment or difficulty maintaining medication schedules)
- Legal issues related to the beneficiary’s mental or substance use disorder diagnosis
- Homeless or at high risk of homelessness due to residential instability resulting from the beneficiary’s mental health or substance use disorder diagnosis or has difficulty sustaining a safe stable living environment; or,
- Clinical evidence of suicidal gestures, persistent ideation or both in the past three months.
This service provides therapy and case management when a child or young adult is at risk of out-of-home placement. It is a step up 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.
The individual age 3 to 21 and:
- 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.
- Based on the current comprehensive clinical assessment, this service was indicated and traditional office-based outpatient treatment services were considered or previously attempted, but were found to be inappropriate or not effective.
- The clinical assessment identifies the need for linkage and/or coordination with other service systems or community resources to prevent family disruption or need for more intensive levels of care.
- The child, adolescent or young adult’s symptoms and behaviors at home, school, or in other community settings due to the beneficiary’s mental health or substance use disorder condition, are moderate to severe in nature and require intensive, coordinated clinical interventions.
- Evidence of problems in at least 2 major life domains, which are significantly affecting the child, adolescent or young adult’s behavioral health needs, as evidenced by at least 2 of the following:
- housing (problems with safety/stability)
- physical health care linkage or access needs
- involvement with one or more of the following:
- Department of Social services (involvement due to allegations of abuse, neglect, etc. or involvement for prevention based on identification of at risk factor for potential removal of children from the home; safety concerns identified; reports that were unsubstantiated, but some concerns still identified or consumers in custody working towards family reunification)
- Department of Juvenile Justice or other legal system (individuals actively on probation, on diversion contracts, being discharged from jail or youth detention or identified as at risk for involvement due to criminal activities)
- Exceptional Children’s Program (actively involved with IEP, 504 plan, or alternative school setting; individuals identified as in need of these school services that are not yet actively in place; individuals that may be able to be maintained in traditional settings with some additional support and coordination, such as behavior plans or early intervention)
- The child, adolescent or young adult does not present with an imminent risk of BOTH out of home placement based on MH/SA diagnosis AND does not have a history of multiple crisis events within the last 6 months.
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 16 years old and older for whom employment has not been achieved, has been interrupted or intermittent.
The individual is working age (16+) 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.
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.
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).
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.
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:
- 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.
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