SECTION 450:55-3-10. Required services

(a)   The PACT program shall minimally provide the following comprehensive treatment, rehabilitation, and support services as a self-contained service unit on a continuous basis. The PACT program shall provide or make arrangements for treatment services, which shall minimally include:

(1)   Crisis intervention. Crisis intervention shall be provided to individuals who are in crisis as a result of a mental health and/or substance abuse related problem.

(A)   Crisis intervention services shall be provided in the least restrictive setting possible, and be accessible to individuals within the community in which they reside.

(B)   Crisis assessment and intervention shall be provided 24 hours per day, seven days per week by the PACT team. These services will include telephone and face-to-face contact and will include mechanisms by which the PACT crisis services can be coordinated with the local mental health system's emergency services program as appropriate.

(C)   Crisis intervention services shall include, but not be limited to, the following service components and each shall have written policy and procedures:

(i)   Psychiatric crisis intervention; and

(ii)   Drug and alcohol crisis intervention.

(2)   Symptom assessment, management and individual supportive therapy. The PACT shall provide ongoing symptom assessment, management, and individual supportive therapy to help consumers cope with and gain mastery over symptoms and impairments in the context of adult role functioning. This therapy shall include but not necessarily be limited to the following:

(A)   Ongoing assessment of the consumer's mental illness symptoms and the consumer's response to treatment;

(B)   Education of the consumer regarding his or her illness and the effects and side effects of prescribed medications, where appropriate;

(C)   Symptom-management efforts directed to help each consumer identify the symptoms and occurrence patterns of his or her mental illness and develop methods (internal, behavioral, or adaptive) to help lessen their effects; and

(D)   Psychological support to consumers, both on a planned and as-needed basis, to help them accomplish their personal goals and to cope with the stresses of day-to-day living.

(3)   Medication prescription, administration, monitoring and documentation. The PACT shall have medication policies and procedures that are specific to the PACT program and meet the unique needs of the consumers served. All policies and procedures shall comply with local, state and federal pharmacy and nursing laws.

(A)   Medication related policies and procedures shall identify processes to:

(i)   Record physician orders;

(ii)   Order medication;

(iii)   Arrange for all consumer medications to be organized by the team and integrated into consumers' weekly schedules and daily staff assignment schedules;

(iv)   Provide security for medications and set aside a private designated area for set up of medications by the team's nursing staff; and

(v)   Administer delivery of and provide assistance with medications to program consumers.

(B)   The PACT team psychiatrist shall minimally:

(i)   Assess each consumer's mental illness symptoms and behavior and prescribe appropriate medication;

(ii)   Regularly review and document the consumer's symptoms of mental illness as well as his or her response to prescribed medication treatment;

(iii)   Educate the consumer regarding his or her mental illness and the effects and side effects of medication prescribed to regulate it; and

(iv)   Monitor, treat, and document any medication side effects.

(C)   All qualified PACT team members shall assess and document the consumer's mental illness symptoms and behavior in response to medication and shall monitor for medication side effects.

(4)   Rehabilitation. The PACT shall provide or make arrangements for rehabilitation services. The PACT shall provide work-related services as needed to help consumers find and maintain employment in community-based job sites. These services shall include but not be limited to:

(A)   Assessment of job-related interests and abilities, through a complete education and work history assessment as well as on-the-job assessments in community-based jobs;

(B)   Assessment of the effect of the consumer's mental illness on employment, with identification of specific behaviors that interfere with the consumer's work performance and development of interventions to reduce or eliminate those behaviors;

(C)   Development of an ongoing employment rehabilitation plan to help each consumer establish the skills necessary to find and maintain a job;

(D)   Individual supportive therapy to assist consumers to identify and cope with the symptoms of mental illness that may interfere with their work performance;

(E)   On-the-job or work-related crisis intervention; and

(F)   Work-related supportive services, such as assistance with grooming and personal hygiene, securing of appropriate clothing, wake-up calls, and transportation.

(5)   Substance abuse services. The PACT shall provide substance abuse services as clinically indicated by consumers. These shall include but not be limited to individual and group interventions to assist consumers to:

(A)   Identify substance use, effects and patterns;

(B)   Recognize the relationship between substance use and mental illness and psychotropic medications;

(C)   Develop motivation for decreasing substance use; and

(D)   Develop coping skills and alternatives to minimize substance use and achieve periods of abstinence and stability.

(6)   Services to support activities of daily living. The PACT shall provide as needed services to support activities of daily living in community-based settings. These shall include individualized assessment, problem solving, side-by-side assistance and support, skill training, ongoing supervision, e.g. prompts, assignments, monitoring, encouragement, and environmental adaptations to assist consumers to gain or use the skills required to:

(A)   Carry out personal hygiene and grooming tasks;

(B)   Perform household activities, including house cleaning, cooking, grocery shopping, and laundry;

(C)   Find housing that is safe and affordable (e.g., apartment hunting, finding a roommate, landlord negotiations, cleaning, furnishing and decorating, procuring necessities, such as telephone, furnishings, linens, etc.;

(D)   Develop or improve money-management skills;

(E)   Use available transportation; and

(F)   Have and effectively use a personal physician and dentist.

(7)   Social, interpersonal relationship and leisure-time skill training. The PACT shall provide as needed services to support social, interpersonal relationship, and leisure-time skill training to include supportive individual therapy, e.g., problem solving, role-playing, modeling, and support, etc.; social-skill teaching and assertiveness training; planning, structuring, and prompting of social and leisure-time activities; side-by-side support and coaching; and organizing individual and group social and recreational activities to structure consumers' time, increase their social experiences, and provide them with opportunities to practice social skills and receive feedback and support required to:

(A)   Improve communication skills, develop assertiveness and increase self-esteem as necessary;

(B)   Develop social skills, increase social experiences, and where appropriate, develop meaningful personal relationships;

(C)   Plan appropriate and productive use of leisure time;

(D)   Relate to landlords, neighbors, and others effectively; and

(E)   Familiarize themselves with available social and recreational opportunities and increase their use of such opportunities.

(8)   The PACT will assign each consumer a primary case manager who coordinates and monitors the activities of the individual treatment team and has primary responsibility to write the treatment plan, to provide individual supportive therapy, to ensure immediate changes are made in treatment plans as consumer's needs change and to advocate for consumer rights and preferences.

(9)   The PACT shall provide support and direct assistance to ensure that consumers obtain the basic necessities of daily life that includes but is not necessarily limited to:

(A)   Medical and dental services;

(B)   Safe, clean, affordable housing;

(C)   Financial support;

(D)   Social services;

(E)   Transportation; and

(F)   Legal advocacy and representation.

(10)   The PACT shall provide services as needed on behalf of identified consumers to their families and other major supports, with consumer's written consent, which includes the following:

(A)   Education about the consumer's illness and the role of the family in the therapeutic process;

(B)   Intervention to resolve conflict; or

(C)   Ongoing communication and collaboration, face-to-face and by telephone, between the PACT team and the family.

(b)   Compliance with 450:55-3-10 shall be determined by on-site observation, a review of the clinical records, ICIS information and the PACT policy and procedures.

[Source: Added at 20 Ok Reg 683, eff 2-27-03 (emergency); Added at 21 Ok Reg 1093, eff 7-1-04; Amended at 23 Ok Reg 1445, eff 7-1-06]