This rule establishes certification standards and minimum requirements for Assertive Community Treatment (ACT) teams in Utah. ACT teams must adhere to SAMHSA evidence-based practice fidelity standards (measured via DACTS or TMACT), maintain a client-to-staff ratio not exceeding 10:1, and provide integrated, mobile, multidisciplinary mental health services 24/7 including crisis response. Operators must obtain and maintain state certification through initial and annual fidelity reviews conducted or approved by the Division of Integrated Healthcare.
View official sourceR523. Health and Human Services, Substance Use and Mental Health. R523-22. Assertive Community Treatment Standards. R523-22-1. Authority. (1) This rule establishes guidelines, procedures and standards for the establishment of Assertive Community Treatment (ACT) as directed in Section 26B-5-606. R523-22-2. Purpose. (1) This rule is enacted for the purpose of promoting the availability of comprehensive ACT services by: (a) Creating minimal standards of certification, care and practice for ACT teams; and (b) Outlining the responsibilities of ACT teams including Evidence-Based Practice (EBP) models, and clients to team ratios. R523-22-3. Definitions. (1) Assertive Community Treatment (ACT) is known as a "hospital without walls". ACT is a person-centered service delivery model that provides an integrated set of evidence-based treatments, rehabilitative services, case management, and support services that are delivered by a mobile, multidisciplinary mental health treatment team. ACT teams serve clients who have a serious mental illness that greatly impairs their functioning in the community. Priority is given to clients with schizophrenia, other psychotic disorders, and mood disorders including bipolar disorder or major depression. R523-22-4. General Provisions and Minimum Standards of Care. (1) An ACT team must adhere to fidelity as outlined in Section R523-22-5. The ACT team approach is based on treatment, rehabilitation and support. (2) An ACT team will administer direct services as follows: (a) Services will promote a sense of hope, and include a full range of clinical treatment, psychosocial rehabilitation, and community support services designed to promote recovery by improving psychiatric symptoms, preventing relapse, teaching skills, providing direct assistance, and securing community resources necessary for successful functioning in the community; (b) Assertive outreach will be provided in the home, community, or wherever necessary to deliver services; (c) Frequent contacts are associated with better outcomes for clients, therefore, clients shall receive as much service time, and as many contacts as needed adhering to the following: (i) scheduled contacts will be purposeful, and designed to carry out interventions in the service plan, or to address critical needs; and (ii) the number of contacts, and length of time spent with a client will vary on a day to day basis, based on the client's need and circumstances; (d) Engaging and retaining clients in treatment is a high priority; therefore, clients will be engaged using a range of outreach strategies tailored to individual needs and preferences. Clients will receive a full explanation of the array of available services. Client choice regarding participation in services will be taken into account when developing intervention strategies; (e) Services will be continuously measured to ensure that individualized outcomes in the service plan are achieved; (f) An ACT team will broaden or refine evidence-based services that are consistent with current research, when appropriate; (g) Services will be available 7 days per week, 24 hours per day. This requirement may be accomplished by providing split staff assignment schedules to achieve needed coverage; (h) The primary responsibility of crisis response encompasses first contact for all crises, including after-hours crisis calls for clients. A continuous, and direct after-hours on-call system will be provided with staff that are experienced in the ACT program, and skilled in crisis intervention procedures; and (i) Crisis response services will be rapid for any emergency, and may be provided both in person and by telephone. This requirement may be accomplished through the use of telehealth, but only with approval from the Division of Integrated Healthcare (division). (3) An ACT team will administer integrated services as follows: (a) Provide service through a multi-disciplinary team approach including all roles as defined through the Substance Abuse and Mental Health Services Administration (SAMHSA); (b) Understanding, developing and working with each client's support system is an important part of treatment and recovery support that furthers integration into the community. Service provision will include persistent attempts to engage with the client's family and support network including formal and informal supports, and include them in the treatment and rehabilitative process with the client's consent. All staff must understand and adhere to confidentiality, HIPAA, 42 CFR part 2, client rights and informed choice as well as providing culturally responsive care; (c) Assist the client to develop and maintain recovery supports such as housing, employment, finances, transportation, and basic life skill; (d) Coordinate with other systems of care, and with hospital admissions and hospital discharges in order to ensure continuity and coordination of services; (e) Provide support and advocacy services; and (f) Ensure continuity and coordination of care for clients by working closely with local hospitals to maintain clients in the community whenever safely possible. (4) An ACT team will administer services with the low client to team ratio that does not exceed more than 6 new clients admitted per month, for a total of 100 clients with no more than a 10 clients to 1 staff ratio. R523-22-5. Certification of ACT Teams. (1) The following requirements will be met in order for a behavioral health provider to receive State certification of an ACT team: (a) Meet the minimum fidelity criteria described in SAMHSA Assertive Community Treatment Evidence-Based Practices tool kit. Any exemptions to this requirement must be pre-approved by the division; (b) The Dartmouth Assertive Community Treatment Scale (DACTS), or the Tool for the Measurement of ACT (TMACT) is used to measure its ACT team fidelity to the EBP model; (c) After initial certification of the ACT team, the division may request a new fidelity review, and all teams will have regular fidelity reviews, at a minimum of annually; (d) For initial certification, each ACT team must achieve an overall average fidelity score that meets the minimum average overall fidelity score on the DACTS or TMACT as determined by the instruments, and the division. (e) Continuing certification requires each ACT team to achieve and maintain a minimum average overall fidelity score within one year of initial certification, and have plans, and show progress toward greater fidelity; and (f) An ACT team will be staffed and supervised by individuals who meet the qualifications found in the Mental Health Professional Practice Act, Section 58-60. KEY: assertive community treatment, assertive community treatment standards, ACT teams Date of Last Change: June 2, 2025 Notice of Continuation: August 4, 2025 Authorizing, and Implemented or Interpreted Law: 26B-5-606