Behavioral Health Glossary

AAC- Arizona Administration Code

ACC- AHCCCS Complete Care
Begins on October 1, 2018. This new integrated system will join physical and behavioral health services together to treat all aspects of our members’ health care needs under a chosen health plan. AHCCCS Complete Care encourages more coordination between providers within the same network which can mean better health outcomes for members. The Complete Care program only applies to individuals with a General Mental Health/Substance Use Disorder (GMH/SU).  Individuals with an SMI diagnosis will continue to be served by their assigned RBHA (Regional Behavior Health Authority).

ACDL- Az Center for Disability Law

ACT- Assertive Community Treatment
A multi-disciplinary clinical team approach of providing 24-hour intensive community services in the individual’s natural setting that help individuals with serious mental illness live in the community. Assertive Community Treatment (ACT) is an evidence-based practice model that has consistently demonstrated effectiveness in helping people with mental illness achieve their desired goals. This service delivery model is designed to help adults with serious mental illness who have the highest needs – individuals whose psychiatric disorders impair their ability to function in the community. This includes those likely to interface with the criminal justice system, experience homelessness or substandard housing, or have higher than average use of emergency and inpatient services.

Research over the past 30 years has consistently concluded that individuals participating in ACT programs experience the following benefits:

• Decreased psychiatric hospitalization
• Increased housing stability
• Increased individual and family satisfaction

ADHS/DBHS- AZ Department of Health Services/Division of Behavioral Health Services

ADL- Activities of Daily Living

AHCCCS: Arizona Health Care Cost Containment System
The state agency that oversees the use of federal and state funds to provide behavioral health services, Title 19 Title XIX/ (Medicaid), Title 21/Title XXI, Substance Use Block Grant, and Arizona Long Term Care Services (ALTCS) programs. They are also responsible for State Only funds which are currently directed to the SMI population. 

AHCCCS Glossary- https://azahcccs.gov/shared/acronyms.html​ 

ALTCS- Arizona Long Term Care System
ALTCS (pronounced ALTECS) is an acronym for the Arizona Long Term Care System. ALTCS is an Arizona Medicaid program that is designed to help fixed-income seniors and other disabled individuals afford the care that they need. ALTCS pays for the care that you need after savings are exhausted. AHCCCS contracts with several program contractors to provide long-term care services. An ALTCS program contractor works like a Health Maintenance Organization (HMO). The program contractor works with doctors, nursing homes, assisted living facilities, hospitals, pharmacies, specialists, etc. to provide care.

You will also be assigned a case manager who will coordinate your care. If you are in the SMI category you can still receive some services such as housing from the RBHA. In addition to the services listed above, people who qualify for long term care can receive services such as:

• Nursing Facility
• Hospice
• Attendant Care
• Assisted Living Facility
• Adult Day Care Health Services
• Home Health Services, such as nursing services, home health aide, and therapy
• Home Delivered Meals
• Case Management
• Dental Services (up to $1000 per contract year)

Amendment-
Generally, a violation of the COT orders results in a pick-up order for police to bring the person to an urgent psychiatric center such as UPC. 

AOT- Assisted outpatient treatment
The practice of delivering outpatient treatment under court order to a small, highly targeted population: adults with serious mental illnesses such as schizophrenia and bipolar disorder who meet specific criteria, such as repeated past hospitalizations, violence, or arrests due to their failure to comply with treatment. AOT allows judges to require these individuals to stay in closely monitored treatment for up to a year, while they continue to live in the community. By mid-2016, 46 states and the District of Columbia had AOT laws on the books.

Anosognosia-
Also called “lack of insight,” is a symptom of severe mental illness experienced by some that impairs a person’s ability to understand and perceive his or her illness. It is the single largest reason why people with schizophrenia or bipolar disorder refuse medications or do not seek treatment. Without awareness of the illness, refusing treatment appears rational, no matter how clear the need for treatment might be to others.

Approximately 50% of individuals with schizophrenia and 40% with bipolar disorder have symptoms of anosognosia. Long recognized in stroke, Alzheimer’s disease, and other neurological conditions, studies of anosognosia in psychiatric disorders is producing a growing body of evidence of anatomical damage in the part of the brain involved with self-reflection. When taking medications, insight improves in some patients.

Arnold v. Sarn- A class-action suit
Arnold v. Sarn—was filed in 1981 against the State of Arizona alleging that the Arizona Department of Health Services/Division of Behavioral Health Services (ADHS) and Maricopa County did not provide a comprehensive community mental health system as required by statute.
In 1986, the trial court entered a judgment holding the State (ADHS) and Maricopa County violated its statutory duty; the Supreme Court affirmed this decision in 1989.

In January 2014, officials at ADHS, Maricopa County, and the office of the Governor reached an agreement with Plaintiffs, an exit to the Arnold v. Sarn Stipulation for Providing Community Services and for Terminating the Litigation, signed in January 2014, whereby they agreed to provide certain community services and terminate the litigation. The agreement includes an increase of services in four areas: Assertive Community Treatment, Supported Employment, Supportive Housing, and Peer and Family Services. The agreement also provides for the use of several tools by the parties to evaluate services provided in Maricopa County, including a quality service review, network capacity analysis, and SAMHSA fidelity tools.

ASH- Arizona State Hospital
Scope of Services The Arizona State Hospital (ASH) is located on a 93-acre campus at 24th Street and Van Buren, in Phoenix, Arizona.  ASH provides long-term inpatient psychiatric care to Arizonans with mental illnesses who are under court order for treatment.  The hospital operates programs within a 260-bed funded facility, is accredited by The Joint Commission, and the Civil Hospital is certified to receive reimbursement from the Centers for Medicare and Medicaid Services (CMS).
Pursuant to A.R.S. § 36-201 through 36-217, ASH provides inpatient care and treatment to patients with mental disorders, personality disorders or emotional conditions. Treatment at ASH is considered “the highest and most restrictive” level of care in the state. Patients are admitted as a result of an inability to be treated in a community facility or due to their legal status.  Interdisciplinary care is delivered in collaboration with the patient, family, legal representatives and community providers with a focus on recovery and community reintegration.

Civil adult patients
Involuntarily court-ordered to ASH if they have not responded to a minimum of 25 days in a community hospital setting.  The Civil Adult Rehabilitation Program (116 beds) consists of six (6) treatment units specializing in providing services to adults who are civilly committed as a danger to self, danger to others, gravely disabled and/or persistently and acutely disabled, who have completed a mandatory 25 days of treatment in a community inpatient setting prior to admission. Medical beds are also available. There are only 52 beds assigned to Maricopa County based on the Arnold lawsuit.

Forensic patients 
Court-ordered for pre-or post-trial treatment as a result of involvement with the criminal justice system due to a mental health issue. The Forensic Adult Program (143 beds) consists of court-ordered commitments through a criminal process for either:

• • Pre-Trial RTC: Restoration to Competence Program: These patients are currently housed on one unit providing pre-trial evaluation, treatment, and restoration to competency to stand trial.
  • Post-Trial Forensic Program: These patients are adjudicated as Guilty Except Insane (“GEI”) serving determinate sentences under the jurisdiction of the Psychiatric Security Review Board (PSRB), or for those adjudicated prior to 1994 as Not Guilty by Reason of Insanity(“NGRI”).  These patients are currently housed on six separate units.

BH: Behavioral health

Behavioral Health In-Patient- DVH or DV: Desert Vista- Annex: Level 1:
Desert Vista Behavioral Health Center
Adolescent Inpatient Treatment
The adolescent unit at Desert Vista is a 14-bed unit that specializes in caring for patients between 13 and 17 years of age with a variety of behavioral and psychiatric problems. Collaborative and Proactive Solutions, our model of care, is an innovative approach to inpatient adolescent psychiatric care, developed by Dr. Ross Greene. This model allows us to provide breakthrough quality and service to our community.

This model was developed based on the idea that kids don’t have all the skills necessary to handle certain demands and expectations. Because of this, they respond with challenging behavior because the demands are more than they are able to respond to adaptively. Dr. Greene developed a treatment model which uses collaborative problem solving and focuses on teaching the necessary skills to resolve disagreements in a collaborative manner. This approach has been proven to be effective (Greene, Ablon & Goring, 2003).

Adult Involuntary Treatment
The adult team at our Desert Vista Behavioral Health Center in Mesa works mainly with individuals who have been court-ordered to undergo mental health evaluation and mental health treatment. The court proceedings take place on-site at the Behavioral Health Annex on the main Medical Center campus.
Our team consists of experts in helping individuals and their families through this often confusing and frightening process of involuntary evaluation and treatment. Our goal is to maintain the highest respect and compassion throughout the process and facilitate effective aftercare services to ensure ongoing recovery.

Behavioral Health Annex

Adult Involuntary Treatment
The team at our Behavioral Health Annex works mainly with individuals who have been court-ordered to undergo mental health evaluation and mental health treatment. The court proceedings take place in a specially designed mental health courtroom that is in the Desert Vista facility. MIHS staff members transport the Annex patients to and from their court hearings.

Because the Behavioral Health Annex is located on our main Medical Center campus, patients who have complex medical conditions will most likely be admitted there rather than at our Desert Vista facility.

Our team members are experts in helping individuals and their families through this often confusing and frightening process of involuntary evaluation and treatment. We strive to maintain the highest respect and compassion throughout the process and facilitate effective aftercare services to ensure ongoing recovery.

Geriatric/Medical Psychiatric Inpatient
Our Behavioral Health Annex has expertise in meeting the medical needs of patients admitted for an inpatient mental health Court-Ordered Evaluation. Along with psychiatrists who specialize in working with geriatric patients, internal medicine physicians with experience working with psychiatric patients round regularly on the units at the Behavioral Health Annex. In addition, many other medical specialists provide onsite consultation and treatment interventions for our Behavioral Health Annex patients.

BHT- Behavioral Health Technician- They help doctors, nurses, and other mental health professionals with the treatment of patients who have various behavioral problems, developmental disorders, or mental illnesses. … The position involves assisting patients with activities of daily living and self-care.

CASS– Central Arizona Shelter Services- Founded over 35 years ago, CASS is the largest and longest-serving homeless emergency shelter provider in Arizona. Both our adult and family shelters operate at full capacity 24/7, 365 days of the year. Serving the entire Phoenix metropolitan area, CASS is a regional solution to homelessness, working to fill service gaps and help thousands of people transform their lives, get a roof over their head, a job, and a chance at a new life.

CCC– Clinical Care Coordinator- A Care Coordinator assists with the treatment of patients who have various behavioral problems, such as substance abuse and mental health disorder.

CD– Chemical Dependency- Chemical dependency is a primary disease in which a person becomes addicted to drugs or alcohol. People with chemical dependency continue to use drugs or alcohol, even knowing that continued use causes damages to their bodies, families, finances, and all other aspects of life. 

CFSS– Child & Family Support Services, Inc.

Civil Commitment- At times, it may be necessary to initiate a civil commitment process to ensure the safety of a person or the safety of other persons
The process is called Title 36 because the statutes that govern the process are located in Title 36 of the Arizona Revised Statutes.

CIT – Crisis Intervention Training- The Crisis Intervention Team (CIT) program is a community partnership of law enforcement, mental health and addiction professionals, individuals who live with mental illness and/or addiction disorders, their families, and other advocates. … It also promotes officer safety and the safety of the individual in crisis.

CL – Clinical Liaison- A clinical liaison admits new patients to a hospital or other medical facility and serves as an intermediary for them throughout their treatment process. This position establishes a relationship between the patient and their medical team. Clinical Liaisons work for facilities such as hospices and post-acute care centers, where they establish patients’ eligibility for care.

CM – Case Manager. A behavioral case manager in the healthcare field is primarily a social worker who works with clients who have behavioral disorders such as, drug or substance abuse, eating disorders, or other mental illnesses detrimental to their health.

CMHC – Community Mental Health Center-In 1963, President John F. Kennedy signed into law the Community Mental Health Centers Act. This act required that federal and state funding be made available for indigent and low-income people with mental health disorders so that they could receive a diagnosis and treatment. These locally-based community mental health centers offer easy access, are typically located near public transportation, and offer free or sliding-scale care for the people who need it.

COE- Court-Ordered Evaluation or Court Ordered mental Health evaluation 
A competency evaluation is a court-ordered mental health assessment to determine how much a defendant remembers and understands about his or her charges and alleged offense, as well as his or her capacity to understand court proceedings and assist a lawyer in their defense.
A judge or lawyer can request an evaluation whenever there are questions about a defendant’s mental state.

Evaluation
A professional multidisciplinary analysis that may include firsthand observations or remote observations by interactive audiovisual media and that is based on data describing the person’s identity, biography, and medical, psychological, and social conditions carried out by a group of persons consisting of not less than the following:

• (i) Two licensed physicians, who shall be qualified psychiatrists, if possible, or at least experienced in psychiatric matters, and who shall examine and report their findings independently.  The person against whom a petition has been filed shall be notified that the person may select one of the physicians.  A psychiatric resident in a training program approved by the American medical association or by the American osteopathic association may examine the person in place of one of the psychiatrists if the resident is supervised in the examination and preparation of the affidavit and testimony in court by a qualified psychiatrist appointed to assist in the resident’s training, and if the supervising psychiatrist is available for discussion with the attorneys for all parties and for court appearance and testimony if requested by the court or any of the attorneys.
• (ii) Two other individuals, one of whom, if available, shall be a psychologist and in any event a social worker familiar with mental health and human services that may be available placement alternatives appropriate for treatment. An evaluation may be conducted on an inpatient basis, an outpatient basis or a combination of both, and every reasonable attempt shall be made to conduct the evaluation in any language preferred by the person.
• (b) A physical examination that is consistent with the existing standards of care and that is performed by one of the evaluating physicians or by or under the supervision of a physician who is licensed pursuant to title 32, chapter 13 or 17 or a registered nurse practitioner who is licensed pursuant to title 32, chapter 15 if the results of that examination are reviewed or augmented by one of the evaluating physicians.

COT Time Limits
The court sets time limits for both inpatient and outpatient treatment. The maximum period for court-ordered treatment is 365 days. The maximum period for inpatient treatment is up to 90 days for a person found to be a danger to self, up to 180 days for a person found to be dangerous to others or persistently or acutely disabled, and up to 365 days inpatient days for a gravely disabled person.

Consequences of Non-Treatment
An estimated 8.3 million American adults live with diagnoses of schizophrenia or severe bipolar disorder – just over 3% of the US adult population. About half of these individuals are untreated at any given time, most commonly because they lack insight into their condition.
When untreated, these individuals are at high risk for a number of negative circumstances that profoundly impact them and those around them.

• Homelessness: 30% of the chronically homeless population is estimated to have SMI.
• “Psychiatric boarding:” People in mental health crisis wait for days – even weeks – in ERs because of psychiatric bed shortages.
• Arrest: More than 1.8 million people with SMI are booked into jails every year.
• Incarceration: 20% of jail and prison inmates are estimated to have SMI.
• Victimization: 25% of individuals with mental illness are victimized in some way each year.
• Suicidality: Up to 50% of those with schizophrenia or bipolar disorder attempt suicide, and far more kill themselves than people without these disorders.
• Familial violence: 29% of family homicides are committed by someone with SMI.
• Danger to others: 7% of all homicides, 20% of all law enforcement officer fatalities, and up to 50% of mass homicides are associated with SMI.

The human, social and economic impact of not treating serious mental illness is beyond calculation.

Contraindicated items in psychiatric settings
Contraindicated items mean that access is reasonably likely to endanger the life or physical safety of the patient or another person.

• May be small items that can be swallowed- choking hazard
• Shoelaces or belts- strangling or hanging hazard
• Hygiene items containing alcohol- may be ingested
• Regular pens or pencils- may be used as weapons or swallowed
• Batteries- can be swallowed- dangerous (guaranteed visit to the ER)

CPS – Child Protective Services- Child Protective Services (CPS) is a branch of your state’s social services department that is responsible for the assessment, investigation, and intervention regarding cases of child abuse and neglect, including sexual abuse. In all of its procedures, CPS must follow state and federal laws.

CRU – Crisis Recovery Unit (I & II)- The Crisis Residential Unit or The CRU (pronounced “crew”) is a short-term program that offers recovery-based treatment options, services, and interventions in a home-like setting 24 hours a day, and 365 days a year.

CSP – Comprehensive Service Provider

CT – Clinical Team

Crisis Services
AHCCCS recognizes that the processes and practices currently in place may be different depending on the area, hospital, crisis service provider and/or RBHA.

See table below for behavioral health services/assessment responsibility by specific service codes for by population and various settings.

CSC- Coordinated Specialty Care: CSC uses a team of health professionals and specialists who work with a person to create a personal treatment plan based on life goals while involving family members as much as possible.

CSC has the following key components:

• Case management
• Family support and education
• Psychotherapy
• Medication management
• Supported education and employment
• Peer support

CSC  or CM: CASE MANAGER– This member of the CSC treatment team helps clients with problem-solving and coordinates social services. The case manager has frequent in-person meetings with the clinician, the client, and the client’s family.

CSC or CM: TEAM LEADER-This member of the CSC treatment team coordinates the client’s treatment, leads weekly team meetings, oversees treatment plans and case review conferences, and develops transitions to and from the CSC program.

DAC- Disabled Adult Child- The Social Security Administration (SSA) defines a Disabled Adult Child (DAC) as someone who becomes disabled prior to age 22, who’s eligible for disability benefits. In order to qualify for SSD as a DAC, you must be unmarried, 18 years old or older, and have become disabled before turning 22 years old. A Disabled Adult Child (DAC) claim provides Social Security Disability Insurance benefits to a disabled adult who can prove a medical disability resulting in an inability to work, prior to age 22.

DD- Development Disability-Developmental disabilities are a group of conditions due to an impairment in physical, learning, language, or behavior areas. These conditions begin during the developmental period, may impact day-to-day functioning, and usually last throughout a person’s lifetime. Developmental disability is a diverse group of chronic conditions that are due to mental or physical impairments that arise before adulthood. Developmental disabilities cause individuals living with them many difficulties in certain areas of life, especially in “language, mobility, learning, self-help, and independent living”. Developmental disabilities can be detected early on, and do persist throughout an individual’s lifespan. Developmental disability that affects all areas of a child’s development is sometimes referred to as global developmental delay.

DDD- Division of Development Disability

Developmental Disabilities (DD) DDD is a part of the Arizona Department of Economic Security (DES). It helps people with developmental disabilities achieve independence. It also provides support to family members and other caregivers.

Most common developmental disabilities:

• Down syndrome is a condition in which people are born with an extra copy of chromosome 21. Normally, a person is born with two copies of chromosome 21. However, if they are born with Down syndrome, they have an extra copy of this chromosome. This extra copy affects the development of the body and brain, causing physical and mental challenges for the individual.
• Fragile X syndrome (FXS) is thought to cause autism and intellectual disability, usually among boys.
• Pervasive developmental disorders (PDD) are a group of developmental disabilities that can cause significant social, communication and behavioral challenges.
• Fetal alcohol spectrum disorders (FASD) are a group of conditions that can occur in a person whose mother drank alcohol during pregnancy.
• Cerebral palsy (CP) is a group of disorders that affect a person’s ability to move and maintain balance and posture. CP is the most common motor disability in childhood.[1]
• Intellectual disability, also (sometimes proscriptively) known as mental retardation, is defined as an IQ below 70 along with limitations in adaptive functioning and onset before the age of 18 years.[2]

DES – Arizona Department of Economic Security

DH – Developmental History

DHHS (US) – Department of Health and Human Services

DHS – (AZ) Department of Health Services

DTS: Danger to Self– (a) Means behavior that, as a result of a mental disorder:

(i) Constitutes a danger of inflicting serious physical harm on oneself, including attempted suicide or the serious threat thereof, if the threat is such that, when considered in the light of its context and in light of the individual’s previous acts, it is substantially supportive of an expectation that the threat will be carried out.

(ii) Without hospitalization will result in serious physical harm or serious illness to the person. 

DTO- Danger to Other means that the judgment of a person who has a mental disorder is so impaired that the person is unable to understand the person’s need for treatment and as a result of the person’s mental disorder the person’s continued behavior can reasonably be expected, on the basis of competent medical opinion, to result in serious physical harm.

D/O – Disorder

DSM IV-TR – Diagnostic and Statistical Manual of Mental Disorders, Version 4, Text Revision

D-SNP – Dual Special Needs Plan

DSP – Direct Support Providers

DUAL DIAGNOSIS- Having a mental health disorder and an alcohol or drug problem at the same time.

DUP- DURATION OF UNTREATED PSYCHOSIS: The length of time between the beginning of psychotic symptoms and the beginning of antipsychotic treatment.

DV – Domestic Violence

DVT – Division of Vocational Rehabilitation

DX – Diagnosis

EBP – Evidence-Based Practice- Evidence–based practice is a conscientious, problem-solving approach to clinical practice that incorporates the best evidence from well-designed studies, patient values and preferences, and a clinician’s expertise in making decisions about a patient’s care.

ECT – Electro Convulsive Treatment-Electroconvulsive therapy (ECT) is a procedure, done under general anesthesia, in which small electric currents are passed through the brain, intentionally triggering a brief seizure. ECT seems to cause changes in brain chemistry that can quickly reverse symptoms of certain mental health conditions.

ED – Emergency Department

E/D – Emotionally Disturbed- Emotional disturbance means a condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree that adversely affects a child’s educational performance: (A) An inability to learn that cannot be explained by intellectual, sensory, or health factors.

EHR – Electronic Health Record

EMPACT-SPC – Suicide Prevention Center, Inc.

EPSDT – Early Periodic Screening Diagnosis and Treatment

ER – Emergency Room

ETP- EARLY TREATMENT PROGRAM (RAISE-ETP): One of the two studies that make up the RAISE research project. RAISE-ETP compares a coordinated specialty care program for first-episode psychosis called NAVIGATE to care typically found in community clinics.

FACT- Forensic Assertive Community Treatment team under the direction of Community Bridges. The new FACT team will address the unique needs of people who have been diagnosed with a serious mental illness and who have had involvement with the criminal justice system. Providing the same service as the ACT team A multi-disciplinary clinical team approach of providing 24-hour intensive community services in the individual’s natural setting that help individuals with serious mental illness live in the community.

FAS – Fetal Alcohol Syndrome

FEP– FIRST EPISODE PSYCHOSIS: The first time an individual experiences an episode of psychosis. Epicenter provides early intervention services

• Early Or First-Episode Psychosis Early treatment of psychosis, especially during the first episode, leads to the best outcomes. Research has shown significant success using a treatment approach called Coordinated Specialty Care (CSC).
• Traditional treatment for psychosis involves psychotherapy  

FPL – Federal Poverty Level

GAL – Guardian ad Litem

GD- Gravely disabled, defined as when a person’s mental disorder prevents him from providing for his own basic life-sustaining needs, such as an inability to provide for his own food, clothing, or shelter.[2] Grave disability can be the basis for civil commitment if there are no existing resources for such provision.

GMH/SA– General Mental Health/Substance Abuse

Guardian– a person who looks after and is legally responsible for someone who is unable to manage their own affairs, especially an incompetent or disabled person or a child whose parents have died.

HCV- The Housing Choice Voucher Program: also known as Section 8, is a rental assistance program funded by the U.S. Department of Housing and Urban Development (HUD). It is designed to assist low-income families to rent apartments or homes in the private market. The lease amount is established based on rents paid for comparable unassisted units in the private market in the neighborhood where the unit is located. Rents may not exceed the Fair Market Rent (FMR) amounts established by HUD. If a person is eligible, he or she is placed on a waiting list. When available, a voucher is issued which the person uses to find an appropriate unit in an area served by the Housing Authority of Maricopa County (HAMC). Utilizing the voucher, a person or family pays approximately 30% to 40% of their income toward rent and utilities, and HAMC pays the difference.

HIPAA – Health Insurance Portability & Accountability Act- The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law that required the creation of national standards to protect sensitive patient health information from being disclosed without the patient’s consent or knowledge.

History of present illness- the elements of the psychiatric evaluation:

• Timing, intensity, and duration of symptoms
• Effect of symptoms on patient’s function at work, with family, and caring for self
• Presence of “vegetative symptoms” – i.e., effects on sleep, appetite, and energy level
• Presence of mood or anxiety symptoms, including irritability, panic attacks, anhedonia (loss of pleasure in everything).
• Psychomotor agitation or retardation
• Pathologic guilt
• Patient’s subjective judgment regarding cognitive deficits (problems with memory, attention, concentration)
• Presence of psychosis (hallucinations, delusions, or disorganized thought process)
• Obsessions (intrusive thoughts) and compulsions
• Eating disorder symptoms (compulsive dieting, binging, purging)
• Substance use
• Problematic sexual behaviors
• Suicidal or homicidal thoughts/intent/plans/access to means

HNCM – High Needs Case Manager- The Behavioral Health High Needs Case Manager provides case management services that support the treatment goals of the patients’ care plan. … The Behavioral Health High Needs Case Manager reports directly to the Behavioral Health Youth Services Coordinator.

IMD- Institutions of Mental Disease Exclusion– the Medicaid IMD Exclusion: An Overview and Opportunities for Reform. The Medicaid Institutions for Mental Diseases (IMD) exclusion prohibits the use of federal Medicaid financing for care provided to most patients in mental health and substance use disorder residential treatment facilities larger than 16 beds. The exclusion is one of the very few examples of Medicaid law prohibiting the use of federal financial participation (FFP) for medically necessary care furnished by licensed medical professionals to enrollees based on the health care setting providing the services.  The exclusion applies to all Medicaid beneficiaries under age 65 who are patients in an IMD, except for payments for inpatient psychiatric services provided to beneficiaries under age 21, and has long been a barrier to efforts to use Medicaid to provide non-hospital inpatient behavioral health services.   

The IMD exclusion is found in section 1905(a)(B) of the Social Security Act, which prohibits “payments with respect to care or services for any individual who has not attained 65 years of age and who is a patient in an institution for mental diseases” except for “inpatient psychiatric hospital services for individuals under age 21.”  The law goes on to define “institutions for mental diseases” as any “hospital, nursing facility, or other institution of more than 16 beds, that is primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases, including medical attention, nursing care, and related services.”  The IMD exclusion was intended to ensure that states, rather than the federal government, would have principal responsibility for funding inpatient psychiatric services.  

The IMD exclusion has been part of the Medicaid program since Medicaid’s enactment in 1965, and while Congress has had the opportunity on numerous occasions to amend or repeal the exclusion, it has remained largely intact.  In addition, the regulations governing the IMD exclusion have not been updated since 1988.

LAI- LONG-ACTING INJECTABLE (drugs): A shot of medication administered once or twice a month. The shot is an alternative to taking a daily dose of medication. Currently, there is medication once every three months.

IDT – Interdisciplinary Team-  interdisciplinary team (IDT) approach with the core team consisting of the patient and family plus a physician (M.D.) and registered nurse (R.N.), both possessing expertise in pain and symptom management, and a social worker (L.C.S.W. or M.S.W.) proficient in bio-psychosocial care.

Mental Health Court: The Mental Health Court (MHC) is a dedicated court, with an assigned presiding judge, mental health professional, and probation staff with mental health expertise, prosecutor, and public defender.

A person eighteen years of age or older may be ordered by the court to comply with mental health treatment. If ordered to treatment, the person may be ordered to inpatient treatment at a hospital, or to outpatient treatment in a community-based clinic, or a combination of inpatient and outpatient treatment. Treatment may also include provisions such as taking medication prescribed by the provider.

Mental status exam-

• Appearance (neat, disheveled, unshaven, dirty, clad in multiple layers of clothing, dramatic makeup, shaved head, etc.)
• Level of alertness
• Level of cooperation
• Abnormal movements or other physical abnormalities (eg, unsteady gait, lack of eye contact, tremor, etc.)
• Assessment of Speech/Language –e.g., rate, rhythm, quantity, volume, fluency
• Assessment of Thought – e.g., level of organization; abnormal content (suicidal or homicidal thoughts/ intentions/plans; auditory, visual, tactile or olfactory hallucinations; illusions; delusions (fixed false beliefs not held by the patient’s sociocultural group); hyper-religiosity; grandiosity; paranoia
• Assessment of mood (patient’s description of his/her emotional state)
• Assessment of “affect” – observer’s description of patient’s emotional state, and how it varies over time
• Cognitive assessment (memory, orientation, attention, concentration)

Minimum In-Patient Beds: Provision of sufficient inpatient psychiatric treatment beds for individuals in need of treatment to meet the standard of 50 beds per 100,000 in population

From <http://www.treatmentadvocacycenter.org/mental-health-commitment-laws>

MIHS: Maricopa Integrated Health System: has a longstanding history of providing behavioral health services to the people of Maricopa County – a service area that has been undergoing significant growth in recent years.

MIHS is one of the largest providers of inpatient behavioral health services in Arizona, serving both adults and adolescents. In addition to our inpatient programs, MIHS operates several outpatient behavioral health programs for both adults and adolescents with plans for future expansion underway.

MMIC: Mercy Maricopa Integrated Care recently changed to Mercy Plan

Obsession- An obsession is an unbidden, intrusive thought, image, or urge that intrudes into consciousness; attempts to dispel it are difficult and typically lead to anxiety. These thoughts, images, or urges are recognized as part of one’s own mental life. To varying degrees, they are judged by the patient to be irrational.

PAD: Persistently or Acutely Disabled, Persistent or acute disability” means a severe mental disorder that meets all the following criteria:

(a) If not treated has a substantial probability of causing the person to suffer or continue to suffer severe and abnormal mental, emotional or physical harm that significantly impairs judgment, reason, behavior or capacity to recognize reality.

(b) Substantially impairs the person’s capacity to make an informed decision regarding treatment, and this impairment causes the person to be incapable of understanding and expressing an understanding of the advantages and disadvantages of accepting treatment and understanding and expressing an understanding of the alternatives to the particular treatment offered after the advantages, disadvantages and alternatives are explained to that person.

(c) Has a reasonable prospect of being treatable by outpatient, inpatient or combined inpatient and outpatient treatment.

PCP: Primary care provider: is the doctor who provides or authorizes all your health care needs. Your PCP refers you to a specialist if you need special health care services.

Permanent Supportive Housing:

Community Housing

In the Community Housing Program, you can choose to live in a house or in an apartment in Mercy Care’s housing network. In the house models, you would have your own bedroom and share the living space with roommates. In the apartment models, you can choose to live independently or have a roommate. If you choose to have a roommate, you would have your own bedroom and share the living space with a roommate.  Individuals have a lease in their own name and are not required to participate in any services. Although optional services are available to help you up to 24 hours a day.

Scattered Site Housing

In the Scattered Site Housing Program, you choose a home of your choice in the community. It can be a single-family home or an apartment. Optional services are available to help you up to 24 hours a day. The person also has a lease.

Bridge to Permanency

In the Bridge to Permanency Housing Program, you choose a home of your choice in the community. It can be a single-family home or an apartment. Optional services are available to help you up to 24 hours a day.  The goal of the Bridge to Permanency Housing Program is to transition the subsidy from Mercy Care to a Housing Choice Voucher/Section 8.

Permanent Supportive Housing:

Supportive services are available if you are living independently and are at risk of losing your home or need additional help to keep your housing. 

Supportive services may include assistance with daily activities, skills training and development, transportation, health education, conflict resolution, crisis response, and assistance with socialization and seeking employment.

Referrals come from the Adult Provider Network Organization (PNO) to the Supportive Housing Service Providers. Your case manager can contact one of the service providers below if you are in need assistance in your home.

• PSA Behavioral Health Agency
• Marc Community Resources
• Southwest Behavioral Health Services
• Community Bridges, Inc (CBI)
• Arizona Health Care Contract Management Services (AHCCMS)
• Arizona Mentor
• Terros Health

Petition: A petition for court-ordered treatment is filed with the court if the affidavits of the evaluating physicians allege that the person is in need of treatment because the person, as a result of a mental disorder, is a danger to self or others, persistently or acutely disabled, or gravely disabled and unwilling or unable or unwilling to receive an evaluation on a voluntary basis. If reasonable cause exists, an examiner from the screening agency may file a petition for court-ordered evaluation subjecting the proposed patient to a mental health evaluation.

Pre-petition Screening: The application for involuntary evaluation is submitted to a health care agency that conducts a pre-petition screening of the allegedly mentally disordered person. The screening agency reviews the allegations presented in the application, gathers relevant information, and conducts an interview with the person if possible. The screening agency then determines if there is reasonable cause to believe that the person is, as a result of a mental disorder, a danger to self or to others, is persistently and acutely disabled, or is gravely disabled, and if the proposed patient is unable or unwilling to receive an evaluation on a voluntary basis. If reasonable cause exists, an examiner from the screening agency may file a petition for court-ordered evaluation subjecting the person to a mental health evaluation. The petition for court evaluation may be conducted on an outpatient basis or the court may require the person to be hospitalized for the evaluation.

Psychiatric Urgent Care Centers: these are screening agencies to determine if a person is in need of mental health further evaluation and or treatment.

• UPC: CONNECTIONS AZ URGENT PSYCHIATRIC CARE CENTER  1201 S. 7th Ave. Phoenix, AZ 85007 602‑416‑7600
• RI or RRC:  RI INTERNATIONAL RECOVERY RESPONSE CENTER  11361 N. 99th Ave. Peoria, AZ 85345 602‑650‑1212, press 2
• CPEC or CBI: COMMUNITY BRIDGES COMMUNITY PSYCHIATRIC EMERGENCY CENTER 358 E. Javelina Ave. Mesa, AZ 85210 1‑877‑931‑9142

Note: Laws permit these screening agencies to hold/observe a person with a mental illness by involuntarily detaining them for a 72-hour psychiatric hospitalization. After 72 hours the person has to be released if an evaluation and treatment bed is not obtained.

Psychomotor agitation or retardation can be a feature of several types of mental illness but is commonly used to diagnose bipolar disorder. Psychomotor changes can be indicative of a manic or depressive episode. 1 These movements, or lack thereof, are directly related to what’s going on in your brain.

Psychosis is a condition that affects the way your brain processes information. It causes you to lose touch with reality. You might see, hear, or believe things that aren’t real. Psychosis is a symptom, not an illness. A mental or physical illness, substance abuse, or extreme stress or trauma can cause it.

RBHA: Regional Behavioral Health Authority:  is the behavioral health administrator contracted with the Arizona Health Care Cost Containment System (AHCCCS) to deliver behavioral health services in a certain area of the state.

Risk assessment-

• Can use some evidence-based tools (e.g., Columbia Suicide Severity Rating Scale) to help assess risk for suicide, but suicide is a rare act and ultimately it is a clinical judgment. Increased risk with male sex, older age, concurrent substance abuse, high level of anxiety, prior suicide attempts, high impulsivity, h/o suicide of close family members, hopelessness, chronic pain, and acute psychosocial stressors
• The best predictor of future violence is past history of violence
• CANNOT do proper risk assessment in the intoxicated patient

SSDI: Social Security Disability:

These benefits are sometimes referred to as Retirement, Survivors, and Disability Insurance (RSDI) or Title II. Social security benefits are counted for all MA programs as unearned income. Ongoing benefits are paid monthly.

Term	Definition
Social Security Benefits	Paid to aged and disabled people and surviving spouses and children, based on their own or a family member’s work history and contributions to the Social Security system.
Social Security Disability	Payments to certain disabled workers under age 65 who are determined disabled by a DDSA determination.
Social Security Retirement	A payment to a retired worker who has earned a minimum of 40 Social Security work credits (10 years of work). An individual may earn a maximum of 4 credits per year. A qualified worker may retire as early as age 62 and receive a reduced “early retirement” benefit.
Social Security Survivors and Dependents Benefits	Upon the death or disability of a qualified worker, certain family members including a surviving spouse, unmarried children or a dependent parent may be eligible for benefits. An unmarried disabled son or daughter of a qualified worker may be eligible to receive benefits as a disabled, adult child if the disability began prior to age 22. Payments may begin as early as age 18.
Cost of Living Adjustment (COLA)	An increase intended to ensure that Social Security benefits are adjusted to account for inflation. The COLA amount, if any, is determined annually.

SMI- Serious mental illness: is a condition of persons who are eighteen years of age or older and who, as a result of a mental disorder as defined in A.R.S. § 36‑501, exhibit emotional or behavioral functioning which is so impaired as to interfere substantially with their capacity to remain in the community without supportive treatment or services of a long‑term or indefinite duration. In these persons, mental disability is severe and persistent, resulting in a long‑term limitation of their functional capacities for primary activities of daily living such as interpersonal relationships, homemaking, self‑care, employment and recreation.

SSDI– Social Security’s Disability Insurance Benefits are federally funded and administered by the U.S. Social Security Administration (SSA). Social Security pays disability benefits to you and certain members of your family if you have worked long enough and have a medical condition that prevents you from working for at least 12 months or is expected to end in death. Studies show that a 20-year-old worker has a 1-in-4 chance of becoming disabled before reaching full retirement age. To qualify for disability benefits, you must: Be unable to work because you have a medical condition that is expected to last at least one year or result in death. Not have a partial or short-term disability. Meet SSA’s definition of a disability. Be younger than your full retirement age. If you qualify for disability benefits, certain members of your family may be eligible to receive benefits based on your work record. To find out if you may be eligible for Social Security’s benefit programs, check out Social Security’s Benefit Eligibility Screening Tool. To see the listing of impairments that can qualify for disability, visit the “Adult Listing of Impairments” page. Even if your condition is not included in the listing, you still could get benefits.

SSI– Supplemental Security Income (SSI) is a Federal income supplement program funded by general tax revenues (not Social Security taxes):

• It is designed to help aged, blind, and disabled people, who have little or no income; and
• It provides cash to meet basic needs for food, clothing, and shelter.

SHF- State Housing Fund: State Housing Fund was established in 1988 to provide assistance in meeting the needs of low income families through development of affordable permanent and transitional rental housing units. The Housing Trust Fund is state-funded through an allocation of unclaimed property deposits, interest on unexpended funds, loan repayments, and recaptured funds. The Trust Fund receives approximately $2.5 million annually.

Supported Employment: Supported employment refers to service provisions wherein people with disabilities, including intellectual disabilities, mental health, and traumatic brain injury, among others, are assisted with obtaining and maintaining employment.

TI-Targeted Investment Programs

The Targeted Investments (TI) Program is AHCCCS’s strategy to provide financial incentives to eligible AHCCCS providers to develop systems for integrated care. In accordance with 42 CFR 438.6(c) and the 1115 Waiver, managed care plans will provide financial incentives to eligible Medicaid providers who meet certain benchmarks for integrating and coordinating physical and behavioral health care for Medicaid beneficiaries. AHCCCS will incorporate these payments into the actuarially-sound capitation rates. The TI program aims to:

• Reduce fragmentation between acute and BH care.
• Increase efficiencies in service delivery for members with BH need by improving integration at the provider level.
• Improve health outcomes for members with physical health and BH needs.

Title 19 (Medicaid; may also be called AHCCCS) is medical, dental and behavioral health care insurance for low‑income persons, children and families.

Title 21 (may also be called AHCCCS) is medical, dental and behavioral health care insurance for children under 19 years of age with low income, no other insurance and who are not eligible for Title 19 (Medicaid).

What ACC Health Plans will be available?

Beginning October 1, ACC plans will be available in the North, Central and South geographical service areas:

North GSA (Apache, Coconino, Mohave, Navajo and Yavapai Counties):	Care 1st and Steward Health Choice Arizona
Central GSA (Maricopa, Gila and Pinal Counties):	Banner University Family Care, Care 1st, Steward Health Choice Arizona, Arizona Complete Health, Magellan Complete Care, Mercy Care, UnitedHealthcare Community Plan
South GSA (Cochise, Graham, Greenlee, La Paz, Pima, Santa Cruz and Yuma Counties):	Banner University Family Care, Arizona Complete Health, UnitedHealthcare Community Plan (Pima County only)

Note: Zip codes 85542, 85192, 85550 (mostly in the San Carlos Tribal area) are included in the South GSA.

ACC Health Plans	Website	Phone #
Care1st Health Plan	www.care1staz.com	1-866-560-4042
Steward Health Choice Arizona	www.StewardHealthChoiceAZ.com	1-800-322-8670
Magellan Complete Care	www.mccofaz.com	1-800-424-5891
Mercy Care	www.mercycareaz.org	1-800-624-3879
Banner-University Family Care	www.bannerufc.com/acc	1-800-582-8686
UnitedHealthcare Community Plan	https://www.uhccommunityplan.com	1-800-348-4058
Arizona Complete Health-Complete Care Plan	www.azcompletehealth.com/completecare

This message is being sent on behalf of the Director

Did you know that the RBHA names are changing on Monday, October 1st, 2018?

When 1.5 million AHCCCS members move into integrated ACC health plans on Monday, they will receive behavioral health services through their chosen ACC plan instead of from a Regional Behavioral Health Authorities (RBHA).

However, the RBHAs and Tribal RBHAs will continue to serve:

• Foster children enrolled in the Comprehensive Medical and Dental Program (CMDP), including those CMDP members who have a CRS condition
• Members enrolled with DES/DDD
• Individuals determined to have a Serious Mental Illness (SMI).

There will be no changes to RBHA-covered services for these members.

RBHAs will also continue to provide crisis, grant funded and state-only funded services.

To align with their respective ACC health plans in each geographic service area, the names of the existing RBHAs will change on Oct. 1, 2018.

Starting October 1, 2018

North

• Health Choice Integrated Care (HCIC) will become
• Steward Health Choice Arizona

Central

• Mercy Maricopa Integrated Care (MMIC) will become
• Mercy Care

South

• Cenpatico Integrated Care (CIC) will become
• Arizona Complete Health – Complete Care Plan

See the current and ACC RBHA maps on the AHCCCS website. From <https://www.azahcccs.gov/AHCCCS/Initiatives/AHCCCSCompleteCare/>

 

Vegetative symptoms- are disturbances of a person’s functions necessary to maintain life (vegetative functions). These disturbances are most commonly seen in mood disorders, and are part of the diagnostic criteria for depression, but also appear in other conditions.