Alternative Care Treatment Systems, Inc.

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Assertive Outreach

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The service includes activities, with and/or on behalf of an individual in need who is not registered as a client. Assertive Outreach is designed to meet some of the evaluation, treatment, habilitation, educational,
vocational, residential, health, financial, social and other needs of the individual.

The service includes the arrangement, linkage or integration of multiple services (when provided by multiple providers) as they are needed or being received by the individual either within the area program, or from other agencies with those services being received through the area program. It may include advocacy on behalf of the individual, supportive counseling, and monitoring the provision of services to the individual. It may also include training or retraining activities required for successful maintenance or re-entry into the client's vocational or community living situation.

GUIDELINES: This service is only provided to individuals NOT registered as clients.

(1) Include face-to-face and telephone time in contact with an individual, groups, collateral, other agency personnel, interagency staffing, training of volunteers, and time spent transporting the
individual to or from services.

(2) Consultations or interventions with family members of a substance abusing individual, who is not a client, are to be reported to this service type.

(3) The locally defined services most commonly included in this category include, but are not limited to:

  • Outreach and Assertive Outreach;
  • Follow-up contact with discharged clients; and
  • Institutional Liaison.

    (4) In cases when one area program staff is linking or coordinating with another staff in the same area program regarding multiple services, only one staff may claim case management/support OR assertive outreach for the interaction.

    (5) Similar services provided to clients are to be reported as Case Management/Support.

    (6) Staff Travel Time to be reported separately.

    (7) Preparation/documentation time NOT to be reported.

    (8) Structured services including Screenings or After-hours services are to be reported to the appropriate service type.

    Therapeutic Relationship and Interventions

    This process should offer evaluation of the services needed through discussion with the recipient and any significant stakeholders involved with the recipient. The provider assumes the roles of advocate, broker and monitor until the individuals engages in services.

    Structure of Daily Living

    This service is designed to assess/reassess functional deficits of the recipient and to facilitate referrals to the service system that will address the identified needs in consultation with the recipient, legal guardian, or caregiver.

    Cognitive and Behavioral Skill Acquisition

    This service assists the individual to identify mental health and community treatment and service options and the intended benefits of those services.

    Resiliency/Environmental Intervention

    This service includes activities with and on behalf of an individual who is not a client of the area program.

    Where is Assertive Outreach delivered?

    May be provided at any location.

    What is Medical Necessity/Clinical Appropriateness?

    A. Individual has previously been a recipient of services and requires Assertive Outreach to re-establish treatment.

    B. The individual appears to have an Axis I or II diagnosis or the person has a condition that may be defined as a developmental disability as defined in GS 122C-3 (12a) and would be expected to benefit from treatment if he/she participated.

    Discharge Criteria

    When the client has been admitted to the Area Program as an active client.

    Service Maintenance Criteria

    Assertive Outreach should be maintained when it can be reasonably anticipated that regression is likely to occur if the service is withdrawn.