PURPOSE: This rule sets forth standards and regulations for Access Crisis Intervention Programs.

1. (1) The Access Crisis Intervention (ACI) program is designed to be provided by administrative agents with certified outpatient programs.
2. (2) The terms defined in section 630.005, RSMo are used in this rule.

3. (3) Unless the context clearly requires otherwise, the following terms as used in this rule shall mean—

   1. (A) Access Crisis Intervention (ACI)—crisis intervention/referral services provided by telephone or face-to-face at the location of the crisis or at another location in the community;
   2. (B) Administrative agent—an agency and its approved designee(s) authorized by the Division of Comprehensive Psychiatric Services (CPS) as an entry and exit point into state mental health service delivery system for a geographic service area defined by the division;
   3. (C) Alcohol and drug detoxification services—services providing detoxification which is the process of withdrawing a person from alcohol, other drugs or both in a safe, humane, and effective manner;
   4. (D) Community outreach/education plan— a plan outlining how families, consumers, consumer advocates, state agencies, law enforcement and others in the community will become familiar with the local Access Crisis Intervention System;
   5. (E) Community Psychiatric Rehabilitation Program—a specialized program that provides or arranges for, at a minimum, the following core services: intake and annual evaluations, crisis intervention and resolution, medication services, physician consultation services, medication administration, community support and psychosocial rehabilitation in a nonresidential setting for individuals with serious mental illness in conjunction with standards set forth in 9 CSR 30-4.031–9 CSR 30-4.047;
   6. (F) Community support—as defined in 9 CSR 30-4.043(2)(F)–(G);
   7. (G) Consumer—a person who receives mental health services or ACI services, regardless of source of payment. Parents and/or legal custodians/guardians of children and youth are primary consumers if they are actively engaged in the treatment planning and/or delivering services and supports for the child or youth. A secondary consumer is an individual who is concerned and involved in supporting and treating primary consumers. This category includes family members and significant others involved in the treatment and support processes; sponsors for persons who engage in substance abuse; children of parents who have mental illness or substance abuse issues; and persons who advocate for vulnerable populations;
   8. (H) Consumer advocate—individuals who will assist consumers with treatment planning, care issues and the complaint/grievance and resolution process;
   9. (I) Consumer satisfaction—a measure of the degree to which an individual, who is receiving or has received ACI services from the department, perceives the services to be successfully addressing, or to have successfully addressed their individual needs for professional services;
   10. (J) Division—the Division of Comprehensive Psychiatric Services;
   11. (K) Internal agency protocol—a specific method indicating how the agency plans to respond to guidelines set forth by the department;
   12. (L) Mental health coordinator—as defined in 632.005(10), RSMo;
   13. (M) Mental health professionals—as defined in 9 CSR 30-4.030(2)(HH);
   14. (N) Mobile crisis response—specialized staff available to assess and intervene face-toface with consumers where the crisis is occurring or another secure location in the community;
   15. (O) Risk assessment—the process of assessing dangerousness to self or others;
   16. (P) Residential crisis services—a service used for persons who are at high risk for hospitalization or who are being diverted from hospitalization and can include specific crisis stabilization units, group homes, residential, apartments, motels/hotels, and foster home type settings;
   17. (Q) Specialized program—programs operated by an agency that provide specific services to designated eligible consumers enrolled in that program;
   18. (R) Telephone hotline services twenty-four (24)-hour—a published, centralized, twentyfour (24)-hour staffed toll-free telephone number to provide direct means of crisis assessment and triage for consumers in crisis, their families, and agencies needing assistance.

4. (4) Consumer Records.

   1. (A) Consumers receiving only telephone hotline or mobile outreach through the ACI program do not require a treatment plan, however, for current clients of the department or those who are in the process of being admitted to a mental health program, there shall be evidence of coordination between the ACI staff and the treating staff.

   2. (B) At a minimum, those programs funded for ACI must keep the following records for telephone hotline services when possible to obtain from caller:

      1. 1. Date and time of telephone call;
      2. 2. Identity of caller, including but not

limited to, parent, client, law enforcement, judge, hospital, emergency room, mental health professional;

1. 3. Name, address, telephone number,

and date of birth;

1. 4. Presenting problem;
2. 5. Disposition and follow-up.
3. (C) ACI programs must have a method for retaining hotline data in compliance with 9 CSR 10-7.030.
4. (D) When a call is received regarding another person, the identified consumer for the purpose of intervention must be the person calling, as well as, the person being called about. For data collection, the identified consumer is the person being called about.

5. (E) At a minimum, those agencies providing ACI services must keep the following records for mobile outreach services when the individual agrees to provide identifying information:

   1. 1. Date and time of referral;
   2. 2. Date, time and place of face-to-face

contact;

1. 3. Person accompanying mobile worker;
2. 4. Person in attendance at face-to-face

contact;

1. 5. Name, address, telephone number,

date of birth;

1. 6. Presenting problem;
2. 7. Disposition and follow-up.
3. (F) The agency must document when the consumer does not provide identifying information.
4. (G) Agencies providing ACI services must submit to the department, reports and documentation as prescribed by the department according to the department’s standardized form.
5. (H) Agencies providing ACI services must meet the confidentiality requirements as defined in 9 CSR 10-7.030.

1. (5) Treatment.

   1. (A) Each administrative agent must provide or arrange for the delivery of ACI services.
   2. (B) Consumers receiving only telephone hotline or mobile outreach through the ACI program do not require a treatment plan, however, for current clients of the department or those who are in the process of being admitted to a mental health program, there should be evidence of coordination between the ACI staff and the treating staff.

   3. (C) ACI programs must operate or arrange for a twenty-four (24)-hour telephone hotline. Each program shall have a written description of the telephone hotline system including the following:

      1. 1. Name of the agency or contractor that

operates the hotline;

1. 2. Numbers and qualifications of hotline

staff;

1. 3. Written documentation that clinical

supervision is provided including but not limited to: meeting minutes, supervision logs, or peer review processes;

1. 4. Written description of how the tele-

phone hotline is staffed;

1. 5. Written documentation of case

reviews and quality assurance activities relating to hotline services;

1. 6. Written documentation of how tele-

phone hotline services are provided to hardof-hearing, deaf and persons who have a limited understanding of the English language;

1. 7. Written description of ongoing hotline

outreach activities;

1. 8. Written description of a process for

identifying and utilizing community resources in the delivery of telephone hotline services.

1. (D) Each administrative agent must have designated agency staff person on call to the ACI system twenty-four (24) hours per day and seven (7) days per week.
2. (E) If the consumer, consumer advocate, or family member requests to speak with an individual from a specialized program, including but not limited to, the Community Psychiatric Rehabilitation Program (CPRC) community support worker and, the ACI clinical staff have determined that this action is clinically necessary, the ACI hotline staff shall contact the appropriate designated agency staff person.
3. (F) The ACI hotline staff shall remain in contact with the caller until a successful hand-off contact between caller and designated agency staff person has occurred.
4. (G) Once this contact has occurred, the designated agency staff person shall respond to the caller and/or secure the appropriate requested specialized program personnel involved.
5. (H) The designated agency staff person shall remain in contact with the caller until a successful hand-off or contact between specialized program personnel and caller has occurred.
6. (I) Each administrative agent must have a written internal agency protocol in place for how the designated agency staff person will be able to contact staff from specialized programs that require twenty-four (24) hour, seven (7) day per week crisis intervention as a component of their service menu.
7. (J) If ACI staff does not follow the procedure listed in (I) and (J) of this section, there must be a written protocol for contacting the ACI supervisor and the specialized program supervisor within twenty-four (24) hours to review the immediate action taken and then reviewed for a quality assurance process within forty-eight (48) hours.

8. (K) ACI programs must have a written description for resource and referral to the following services:

   1. 1. Acute hospitalization;
   2. 2. Medical services;
   3. 3. Alcohol and drug detoxification ser-

vices;

1. 4. Priority outpatient scheduling within

twenty-four (24) hours or the next working day;

1. 5. Children and youth services;
2. 6. Psychiatric availability;
3. 7. Civil involuntary detentions when ini-

tiated by the mental health coordinators.

1. (L) ACI programs must operate a twentyfour (24)-hour mobile response system. Each program shall have a written description of the mobile response system including the following:

   1. 1. Name of the agency or contractor that

operates the hotline; 9 CSR 30-4

1. 2. Written description of how mobile

crisis response teams are staffed twenty-four (24) hours per day, seven (7) days per week;

1. 3. Numbers and qualifications of staff;
2. 4. Written documentation that clinical

supervision is provided including but not limited to: meeting minutes, supervision logs, or peer review processes;

1. 5. Written documentation of case

reviews and quality assurance activities relating to mobile response services;

1. 6. Written documentation of how mobile

response services respond to hard-of-hearing, deaf and persons who have a limited understanding of the English language.

1. (M) ACI programs shall provide mobile response to known and unknown consumers twenty-four (24) hours per day and seven (7) days per week at the location of the crisis or to another secure community location.
2. (N) Mobile response shall not be provided exclusively in emergency rooms, jails or mental health facilities.
3. (O) When a call is referred to mobile response, a phone only response is appropriate if the clinical needs of the person who is in crisis can be addressed over the phone and/or the crisis has been deescalated.

4. (P) Each agency providing ACI services must have safety mechanisms in place for mobile response. These may include but are not limited to:

   1. 1. Mobile phones;
   2. 2. Risk assessments both for phone and

continually during contact;

1. 3. Availability of multiple staff to

respond for face-to-face contact;

1. 4. Backup available by pager;
2. 5. Written protocols for mobile response

to be delivered in safe locations when necessary.

1. (Q) In crisis situations in which law enforcement need to be contacted by the ACI staff, the ACI staff must make the initial contact and remain involved until the crisis is resolved, either by phone or with the mobile response team.
2. (R) If the caller is not satisfied, the grievance procedure must be followed as defined in 9 CSR 10-7.020(7)(A)–(C).

1. (6) Quality Assurance.

   1. (A) Each agency providing ACI services must develop a community outreach/education plan that includes details of how the following groups will become familiar with the ACI system:

      1. 1. Families;
      2. 2. Consumers;
      3. 3. Consumer advocates;
      4. 4. State agencies including the Division

of Family Services, Division of Senior Services and Division of Youth Services;

1. 5. Law enforcement agencies;
2. 6. 911 personnel;
3. 7. Schools;
4. 8. Juvenile courts;
5. 9. Emergency medical services person-

nel;

1. 10. Residential care facilities;
2. 11. Homeless shelters and/or providers;
3. 12. Public housing;
4. 13. General public.
5. (B) The community outreach/education plan must include the various action steps that will be taken in educating the community as to how to access the ACI system through written material and other means of communication.
6. (C) The community outreach/education plan must indicate how the components will be accomplished on an ongoing basis.
7. (D) Agencies providing ACI services must, at least annually, demonstrate community awareness.
8. (E) The telephone number for ACI must be published in a local telephone book.
9. (F) If the level of crisis services provided by an agency is significantly below the state average, or other established benchmarks, this circumstance must be addressed in the Quality Assurance Plan.
10. (G) Programs providing ACI services must conduct the Consumer Satisfaction ACI Interview Survey as prescribed by the department.

1. (7) Personnel and Staff Development.

   1. (A) Staff providing telephone hotline services must have a bachelor’s degree with three (3) years of behavioral health and crisis intervention experience or a master’s degree with one (1) year of behavioral health and crisis intervention experience.

      1. 1. Staff providing telephone hotline ser-

vices must be supervised by a qualified mental health professional as defined in 9 CSR 30-4.030.

1. 2. Staff providing telephone hotline ser-

vices must have immediate access to a qualified mental health professional.

1. (B) For mobile response, the mobile crisis team shall have at least one (1) qualified mental health professional to provide face-to-face crisis intervention for each mobile response.
2. (C) Each administrative agent shall designate a coordinator for ACI services who must be a qualified mental health professional as defined in 9 CSR 30-4.030.
3. (D) The agency shall have written documentation that clinical supervision is provided on a scheduled basis including but not limited to: meeting minutes, supervision logs, or peer review processes.
4. (E) For administrative agents that subcontract for hotline services this standard applies. Administrative agents shall have designated staff on call to the ACI system twenty-four (24) hours per day seven (7) days per week for specialized programs. This designated staff person shall have received training and have experience in responding to crisis situations with individuals and families.
5. (F) Each region and/or provider must have an ACI Training Plan. The training plan shall include consumers, families and consumer advocates in the development and implementation of the plan.

6. (G) Staff providing ACI services shall complete the designated ACI training required by the department, at least annually, that includes but is not limited to the following core competencies as defined by the department:

   1. 1. Crisis intervention strategies and

techniques;

1. 2. ACI and legal issues;
2. 3. Safety;
3. 4. ACI responsiveness to consumers;
4. 5. Other competencies as required by

the department.

1. (H) ACI staff shall have a working familiarity with the core competencies prior to providing crisis intervention services.
2. (I) New ACI staff shall be trained and document the demonstration of the core competencies within the first six (6) months of employment.
3. (J) The administrative agent shall describe how the core competencies will be incorporated into the ACI staff training program on an ongoing basis.

4. (K) Each agency shall provide a written plan of how it will measure the competencies of the ACI staff. The plan must include at least two (2) measurable outcomes including but not limited to:

   1. 1. Review of case documentation;
   2. 2. Review of assessment forms for

appropriate interventions;

1. 3. Question, answer and observation by

supervisory staff and peers;

1. 4. Consumer satisfaction and clinical

outcomes.

1. (L) New ACI staff must receive clinical supervision and must shadow the supervisor or experienced crisis workers for a minimum of two (2) weeks prior to providing crisis services.
2. (M) 9 CSR 10-7.110 requires that all staff participate in at least thirty-six (36) clock hours of relevant training during a two (2)- year period. All staff working within the ACI program and services shall receive a minimum of twelve (12) clock hours per year of continuing education and relevant training.
3. (N) All training activities shall be documented in employee personnel files, to include the training topic, name of instructor, date of activity, duration, skills targeted/objective of skill, certification/continuing education units (if any) and location.

1. (8) Fiscal Management. The agency will provide financial information to the department or any of its divisions upon request, relating but not limited to, program administration and services provided through any programs, services or activity using funds provided by the department.

AUTHORITY: sections 630.050 and 630.655, RSMo 2000.* Original rule filed Aug. 28, 2002, effective April 30, 2003. Amended: Filed Dec. 29, 2003, effective July 30, 2004. *Original authority: 630.050, RSMo 1980, amended 1993, 1995 and 630.055, RSMo 1980.