Ind. Admin. Code tit. 440, r. 11-3-3 – Operational standards

Sec. 3. (a) Each ACT team shall meet the operational standards in this section.

(b) All individuals admitted to the ACT team must meet the admission criteria in section 4 of this rule.

(c) At least eighty percent (80%) of the individuals must have a 295-296 Axis I diagnosis as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, published by the American Psychiatric Association, 2000. This document is incorporated by reference and is available from the publisher, the American Psychiatric Association, 1400 K Street NW, Washington, D.C. 20005. It is also available for review and inspection at the Division of Mental Health and Addiction, Indiana Family and Social Services Administration, IGCS Room W353, 402 West Washington Street, Indianapolis, IN 46204.

(d) An ACT team shall not admit more than five (5) individuals per month.

(e) The ACT team shall operate at least eight (8) hours per day from Monday through Friday.

(f) On weekends and holidays, an ACT team shall provide at least two (2) hours of direct service per day, subject to the following:

(1) On weekends and holidays, if a team member has scheduled a face-to-face contact with an individual or the individual's family, and if the individual or individual's family fails to attend or to appear for the appointment, the attempt at contact will be counted toward the two (2) hours of direct service required in this subsection.
(2) An inability to contact an individual by telephone will not be counted toward meeting the requirement for two (2) hours of direct service per day on a weekend or holiday.

(g) Subject to subsections (e) and (f), at least one (1) team member shall be on call at all other hours.

(h) ACT team staff and individuals must have face-to-face contact on an average of at least three (3) times per week. For any time period being calculated, the total number of weekly face-to-face contacts with all individuals divided by the total number of ACT individuals will equal an average of three (3) or more face-to-face contacts per individual.

(i) Individuals must have face-to-face contact for an average of at least two (2) hours per week per individual. For any time period being calculated, the total number of weekly face-to-face contact hours for all individuals divided by the total number of all ACT individuals will equal an average of two (2) or more hours of contact per individual.

(j) At least seventy-five percent (75%) of all team contacts with individuals during a one (1) month period shall occur out of the ACT team office.

(k) An average of at least ninety percent (90%) of individuals during a one (1) month period shall have contact with three (3) or more team members per month.

(l) For a minimum of six (6) months, the team shall attempt at least two (2) face-to-face contacts out of the office per month with individuals who choose not to participate in ACT.

(m) During any twelve (12) month period, at least eighty percent (80%) of acute inpatient admissions for individuals being served by an ACT team shall be planned jointly with the ACT team.

(n) During any twelve (12) month period, at least ninety percent (90%) of acute inpatient discharges for individuals that were being served by an ACT team prior to hospitalization shall be planned jointly with the ACT team.

(o) Excluding planned graduations, at least eighty percent (80%) of the caseload shall be retained over a twelve (12) month period.

(p) The ACT team shall offer services to all individuals on a time unlimited basis.

(q) Fewer than twenty percent (20%) of individuals will transition to less intensive services annually, excluding individuals who drop out of ACT.

(r) A member of the ACT team shall contact or attempt to contact each individual not less than once every two (2) weeks.

(s) A team shall not serve more than one hundred twenty (120) individuals at a time.

(t) Daily team meetings shall be held each business day and shall meet the following requirements:

(1) Team members assigned to be on duty shall attend each daily team meeting.
(2) The psychiatrist or the AHCP must attend at least two (2) daily ACT team meetings per week.
(3) All team members present for a daily meeting shall record their presence in writing by providing the following information:
1. (A) Name.
2. (B) Credentials.
3. (C) Date.
4. (D) Signature.
(4) The team leader or designee shall document the absence of any team member from the daily meeting.
(5) Team members, except the psychiatrist or the team leader, may participate in a daily team meeting from a remote location through the use of telephone or interactive computer audio-video systems, except as follows:
1. (A) Not more than one (1) staff member may use remote participation during each daily meeting.
2. (B) The same staff member may not use remote participation more than twice in the same week.
(6) The remote participation of any team member shall be:
1. (A) recorded on the attendance record by the team leader or designee; and
2. (B) identified in writing as participation from a remote location.
(7) Remote participation must allow for live, active participation by audio or visual means among the team members at the meeting site and the remote staff person.
(8) At each daily meeting, the status of all individuals shall be reviewed and a brief behavioral statement shall be recorded in the daily log.
(9) The daily staff schedule shall be written during the daily team meeting.
(10) A team shall:
1. (A) have record retention policies; and
2. (B) retain documentation of all activities conducted in the daily team meeting in accordance with those policies.

(u) All team member contacts with individuals must be documented in the individual's clinical record, which shall be easily accessible to the entire team.

(v) The team shall provide crisis services twenty-four (24) hours per day and seven (7) days per week. Crisis services must comply with the requirements of 440 IAC 9-2-2 and must also comply with the following:

(1) A team member shall be available by telephone or face-to-face with backup by:
1. (A) the team leader; and
2. (B) either a psychiatrist or an AHCP.
(2) The team shall have an active, ongoing collaboration with emergency services providers.

(w) If any of the following positions are vacant, the CMHC must provide alternative staffing for the duration of the vacancy:

(1) Team leader.
(2) Registered nurse.
(3) Psychiatrist.

(x) A staff position on the team shall not remain vacant for more than sixty (60) calendar days. If a staff position is vacant for more than sixty (60) days, the CMHC shall notify the division in writing.

(y) The team must have a written plan that details how positions are covered when team members are absent.

(Division of Mental Health and Addiction; 440 IAC 11-3-3; filed Feb 9, 2011, 10:24 a.m.: 20110309-IR-440090875FRA; readopted filed Jun 19, 2017, 10:11 a.m.: 20170719-IR-440170221RFA; readopted filed May 10, 2023, 2:25 p.m.: 20230607-IR- 440230142RFA)