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2013: ACT in North Carolina

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Stacy Smith

on 9 October 2013

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Transcript of 2013: ACT in North Carolina

Under the surface
2013: ACT in North Carolina
The tip of the iceberg
Transitions to Community Living Agreement (TCL)
Concerns were raised and validated that NC has a high number of individuals with SMI/SPMI living in supervised/congregate living when, with the right supports, they could live independently.
ACT is one of several services identified in this agreement that NC must enhance and ensure it is high fidelity and available to individuals that are at risk of or currently in supervised/congregate living.
For detailed information regarding the Transitions to Community Living Agreement, please read the full document, which can be found at http://www.ncdhhs.gov/mhddsas/providers/dojsettlement/index.htm
NEW ACT Service Definition
On August 1, 2013, a new service definition for ACT went into effect. This service definition takes into consideration the state wide need for high fidelity ACT services as well as the TCL Agreement
There are significant changes and clarification to the service definition around staffing requirements, services to be provided, when services should be provided and fidelity participation expectations
All stake holders need to understand: the ACT Service Definition and the TMACT are two completely different and separate (but somewhat related) things.
Implementation and Transition
We realize that this is a difficult time for everyone involved, as we have:
New operating structures (LME-MCOs)
New TCL agreement with the DoJ
New service definition
New fidelity monitoring
For some, new reimbursement rates and mechanisms
Systems we were used to have now changed significantly. A service definition we had been working under for years has been completely re-written. In many ways, what we have been doing for years is no longer 'good enough', it will put us out of compliance with the TCL, with the service definition, with our contracts and with fidelity.

What has brought us to where we are, and
what will get us where we need to go.

In the context of TCL and ACT services what are:
barriers around referrals?
difficulties interacting with housing specialists and the transition team?
getting individuals in housing?
tenancy supports?
What are some issues you have encountered? Solutions you have tried that worked? Solutions that haven't worked?
We want to know! This information can guide future webinars and technical assistance.
Navigating the Waters
NC ACT Service Definition
This is policy, and it must be followed!
Part of this policy is participating in fidelity monitoring using the TMACT.
Based on TMACT scores, teams will be issued a certification, which will help guide technical assistance and consultation.
DHHS is responsible for tracking adherence to fidelity monitoring as well as team certification
The Tool for Measurement of ACT, or TMACT, is the fidelity measure approved by DHHS to evaluate ACT teams.
The main function of fidelity monitoring is to identify programs of exceptional practice as well as programs that could benefit from technical assistance and consultation.
Participating in fidelity monitoring is required by the service definition.
All of the players involved:
ACT providers
MCOs & InReach/Transition Coordinators
DoJ/TCL State Workgroups
ACT Technical Assistance Center
SE Technical Assistance Center
If you have questions regarding the service definition or implementation questions, please e-mail =

If you have questions for the ACT TA Center, please e-mail

If you have questions regarding your contract (billing rate, billing mechanism), please contact your MCO directly.
Ultimately, these changes will benefit individuals with SMI.

Providing individuals with SMI high fidelity ACT services supports them in meeting their personal goals, integrating in their community and gaining or regaining valued roles (worker, daughter, resident, spouse, tenant, friend)
This is why we do what we do, and why we must excel at doing it.
ACT Teams- What can you do??
Take time each week to review part of the new service definition
Find a copy of TMACT (it's not a top secret document!)
Start to engage with your MCOs about what supports are needed to move towards high fidelity ACT
MCOs- What can you do??
Read and become familiar with the new service definition
Identify ways you, as the MCO, can support teams in providing high fidelity ACT
Consider scheduled meetings with your ACT providers to facilitate open discussions about ACT (every other month, quarterly)
Upcoming Webinar Series
Over the next four months, we will go through parts of the new service definition. These webinars are not required, but can be helpful if you are having difficulty understanding the implications of the new service definition.
Webinars are open to anyone in any position to attend, but will be directed towards a specific group of staff (ie- November's webinar is focused to leadership).
Webinars will be recorded and accessible at a later date.
Webinars do NOT take the place of attending high fidelity ACT training.
Based on need, we can continue monthly webinars for ACT and MCO staff, and identify discussion areas based on the group's needs.
Who will be TMACT'ed??
Regardless of your DACTS score, you will have a TMACT completed on you.
The scheduling of TMACT takes into consideration:
*Teams that would benefit from technical assistance
*Teams that doing well and could be identified as shadow sites, and their census could count towards our TCL goals
*Ensuring that TMACTs are spread evenly throughout the state/MCOs
Full transcript