Oregon Health Authority
Health Systems Division: Behavioral Health Services - Chapter 309
Division 19
OUTPATIENT BEHAVIORAL HEALTH SERVICES
309-019-0155
Enhanced Care Services (ECS) and Enhanced Care Outreach Services (ECOS)
(1) To be eligible for ECS/ECOS, an individual shall:
(a) Be APD service eligible;
(b) Meet the diagnostic criteria of severe mental illness with complex behaviors or be approved by the enhanced care services team;
(c) Require intensive community mental health services to transition to a lower level of care;
(d) Have a history of multiple APD placements due to complex behaviors; and
(e) Be currently or have been a patient at the Oregon State Hospital or have received inpatient services in an acute psychiatric unit for over 14 days and have been referred to non-enhanced APD facilities and denied admission due to severe mental illness with complex behaviors and be currently exhibiting two or more of the following: self-endangering behavior, aggressive behavior, intrusive behavior, intractable psychiatric symptoms, complex medication needs, sexually inappropriate behavior, and elopement behavior.
(2) ECS/ECOS providers shall:
(a) For ECS, provide a minimum of four hours per day or additional hours as required to support the needs of the enhanced care facility, seven days per week of mental health staffing provided or arranged for by the contracted mental health provider;
(b) Coordinate interdisciplinary team meetings (IDT) to develop the service plan, review the behavior support plan, and to coordinate care planning with the Department of Human Services (Department) licensed provider staff, APD case manager, QMHP, prescriber and related professionals such as the Department licensed facility or program direct care staff, the Department licensed facility RN, and facility administrator. IDTs in ECS programs shall be held weekly and at least quarterly for ECOS;
(c) Coordinate quarterly behavioral health trainings for Department-licensed providers and related program staff providing services to ECS and ECOS recipients; and
(d) Ensure the availability of consultation and crisis services staffed by a QMHP or the local CMHP available to the ECS and ECOS provider and the Department licensed facility direct care staff 24-hours per day.
(3) Behavior support services shall be designed to facilitate positive alternatives to challenging behavior and to assist the individual in developing adaptive and functional living skills. Providers shall:
(a) Develop and implement individual behavior support strategies based on a functional or other clinically appropriate assessment of challenging behavior;
(b) Document the behavior support strategies and measures for tracking progress as a behavior support plan in the service plan;
(c) Establish a framework that ensures individualized positive behavior support practices throughout the program and articulates a rationale consistent with the philosophies supported by the Division, including the Division’s trauma-informed services policy;
(d) Obtain informed consent from the individual or guardian, if one is appointed, in the use of behavior support strategies and communicate both verbally and in writing the information to the individual or guardian, in a language understood;
(e) Establish outcome-based tracking methods to measure the effectiveness of behavior support strategies in:
(A) The use of least restrictive interventions possible; and
(B) Increasing positive behavior.
(f) Require all program staff to receive quarterly mental health in-service training in evidence-based practices to promote positive behavior support and related to needs of each individual; and
(g) Review and update behavior support policies, procedures, and practices annually.
(4) Providers shall develop a transition plan for each individual as part of the initial assessment process. Each individual’s mental health service plan shall reflect their transition goal and the supports necessary to achieve transition.
(5) Staffing requirements include:
(a) Each ECS and ECOS program shall have a minimum of one FTE QMHP for programs serving five or more individuals who is responsible for coordinating entries, transitions, and required IDT’s; assuring the completion of individual assessments, mental health service, and behavior support plans; providing supervision of QMHP’s and QMHA’s; and coordinating services and trainings with facility staff;
(b) Each ECS and ECOS program shall have psychiatric consultation available. For ECS programs serving more than ten individuals, the psychiatrist shall participate.
(6) In ECS programs, the CMHP and the Department licensed provider shall develop a written collaborative agreement that addresses at a minimum: risk management, census management, staff levels, training, treatment and activity programs, entry and transition procedures, a process for reporting and evaluating critical incidents, record keeping, policy and procedure manuals, dispute resolution, and service coordination.
Statutory/Other Authority: ORS 161.390, 413.042, 430.640 & 443.450
Statutes/Other Implemented: ORS 161.390 - 161.400, 428.205 - 428.270, 430.010, 430.205 - 430.210, 430.254 - 430.640, 430.850 - 430.955 & 743A.168
History:
MHS 4-2018, amend filed 02/27/2018, effective 03/01/2018
MHS 10-2017(Temp), f. 9-15-17, cert. ef. 9-15-17 thru 3-13-18
MHS 6-2017, f. & cert. ef. 6-23-17
MHS 26-2016(Temp), f. 12-27-16, cert. ef. 12-28-16 thru 6-23-17
MHS 4-2014, f. & cert. ef. 2-3-14
MHS 6-2013(Temp), f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14