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"Other" employment positions include volunteer, transitional employment, work crew, sheltered employment. Please also make note of anyone enrolled in school.#EL��UVW ST1; ST2; EP1ST5;EP2 ST7; ST8; EP3CP2;PP4� Indicate whether treatment participation is a condition of their housing/ residence and further note if the requirement is that they receive any services (note 'any'), or specifically ACT (note 'ACT'). ST�� XCT7HEALTH/LIFESTYLE INTERVENTIONS (Column N): These services include skills or strategies targeting positive changes in health and/or lifestyle (e.g., smoking cessation, weight management, diabetes management). Indicate the specific type of program or strategies and the health/lifestyle target (e.g., Learning About Healthy Living for smoking cessation, Integrated-Illness Management and Recovery [I-IMR] for health behaviors in general, InShape for weight management, individual weekly walk for cardiovascular health). +dIn the column below, note whether the client has been enrolled in ACT services for at least 90 days.9For working clients, specify where they currently work. G For working clients, specify the type of position they currently hold.�For working clients, indicate whether they got the job themselves or the team assisted with getting the position. Indicate 'self' or 'team.' �Does the client attend clubhouse, day treatment, drop-in center services or a partial hospitalization program? (Specify which type) ,ACT Client (Use unique identifier, NOT name);Please indicate how individuals are receiving oral psychiatric medications: (1) on own; (2) from natural supports; (3) from residential staff; (4) from ACT Team. If from ACT Team, please also indicate the amount of oral medications the individual receives at a given time (e.g., daily, 2X/wk, weekly, monthly)� " Many items prompt you to document and reflect on services directly provided by the ACT team. Therefore, it is important to determine the boundaries of your ACT team staff, which is defined here as a staff member who is employed with the team at least 16 hours a week and attends at least 2 daily team meetings per week. Psychiatric care providers, when the team has more than one, must be employed with the team for at least 8 hours per week to be considered as part of the team. For example, there may be an agency therapist who provides services to several clients and this provider has frequent contact with ACT team members, but does not regularly attend daily team meetings and rarely participates in treatment planning. This provider would NOT be considered part of the ACT team and clients receiving services from this provider should be noted as "non-ACT." For some items, clients may receive a particular service (e.g., vocational services) from both ACT team and non-ACT team staff. If this is the case, please note BOTH. . `INTEGRATED SUBSTANCE ABUSE TREATMENT (Column B): These include services provided by the Co-Occurring Disorder Specialist as well as other team members well-versed in integrated, stage-wise treatment for co-occurring substance use disorders. Core services include: (1) systematic and integrated screening and assessment and interventions tailored to those in (2) strategies to assist those in early stages of change readiness (e.g., outreach, motivational interviewing) and (3) and strategies to assist those in later stages of change readiness (e.g., motivational interviewing, CBT, relapse-prevention). Integrated substance abuse treatment reported here should be reflected across other data sources (e.g., progress notes, treatments plans, client schedules). Where someone is in a pre-contemplation stage of change readiness, the use of outreach should be strategic and there are clear efforts by the team to pay attention to substance use for the sake of ongoing assessment. NOTE: To be considered a group participant, client attends group at least 1 time per month. To be considered an individual substance abuse service recipient (inclusive of deliberate outreach aiming to eventually address substance use while using motivational interviewing efforts), at least 20 minutes per week is spent with the person attending to and/or addressing substance use. Substance abuse services, including deliberate engagement efforts, reported here should be reflected across other data sources (e.g., progress notes, treatments plans, weekly client schedules). 0�PSYCHIATRIC SERVICES (Column C): Core psychiatric services include psychopharmacologic treatment and regular assessment of clients' symptoms & response to medications, including side effects, provided by the team's psychiatric care provider; and medication monitoring and supports provided by other ACT team members. If the team has more than one psychiatric care provider, please indicate who the client typically sees (Provider 1 as "Pr1" or Provider 2 "Pr2," etc.). If the client receives psychiatric services from Non-ACT provider, please indicate "Non-ACT." NOTE: If a team has a psychiatric care provider that does not meet the inclusion criteria noted in CP3 (e.g., employed with team less than 8 hours per week if the team has more than one psychiatric care provider), then that psychiatric care provider is not to be counted as a Team Provider -- clients receiving services exclusively from this provider may not count as receiving psychiatric services directly from the team).�EMPLOYMENT AND EDUCATIONAL SERVICES (Column E): These include all services provided by the employment specialist as well as other team members well-versed in supported employment and supported education services. Core services include: (1) engagement; (2) employment and educational assessment; (3) job development; (4) job placement (including going back to school, classes); & (5) job coaching & follow-along supports (including supports in academic/school settings). Supported education services also should be noted in this column. Employment and educational services reported here should be reflected across other data sources (e.g., progress notes, treatments plans, weekly client schedules). .�PSYCHIATRIC REHABILITATION SERVICES (Column J): These services focus on targeted skills training in the areas of community living, which includes skills needed to maintain independent living (e.g., shopping, cooking, cleaning, budgeting, and transportation) and socialization (e.g., enhancing social and/or romantic relationships, recreational and leisure pursuits that contribute to community integration). Psychia<� tric rehabilitation should address functional deficits as well as the lack of necessary resources, all of which are identified through the assessment process. As such, deliberate and consistent skills training which typically includes staff demonstration, client practice/role-plays, and staff feedback, as well as ongoing prompting and cueing for learned skills in more generalized settings. Psychiatric rehabilitation services reported here should be reflected across other data sources (e.g., progress notes, treatments plans, and weekly client schedules). NOTE: Assessment and services focused on education or employment should be reflected in the Vocational Services column. Delivery of Illness Management and Recovery (IMR) services should be reflected in the Wellness Management and Recovery column. /�WELLNESS MANAGEMENT AND RECOVERY SERVICES (Column K): These services include a formal and/or manualized approach to working with clients to build and apply skills related to their recovery. Examples of such services include development of Wellness Recovery Action Plans (WRAP) and provision of the Illness (or Wellness) Management and Recovery (IMR) curriculum. Wellness management and recovery services reported here should be reflected across other data sources (e.g., progress notes, treatment plans). NOTE: When completing the column for the provision of wellness management services, please specify the type of manualized or formal approach the client is receiving (e.g., IMR group, individual WRAP). 7�C CURRENT HOUSING (Column O): Clients live in many different residential settings. We are interested in knowing which clients are residing in an environment where a large proportion of fellow residents (whether referred to as "patients," "tenants," or "residents") also likely have a disability. Please simply indicate with a "Yes" if client lives in a residence where at least 25% of neighbors/roommates also likely have a disability and that housing is DESIGNATED for serving this particular population. Follow-up questions will further clarify whether this environment is an institution, substance abuse treatment facility, nursing home, group home, congregate housing (e.g., apartment complex or boarding home), family home, or other type of organization. AFFORDABLE AND SAFE HOUSING (Columns P and Q): We are interested in clients who are residing in housing that is affordable and safe. Most clients who receive ACT services rely on disability benefits alone and a large proportion of their money goes toward housing expenses; they are then left with few choices other than unsafe housing that is more affordable. Subsidized housing is one of the ways in which clients gain access to more affordable and safe housing. Indicate in Column O if a client is currently receiving a housing subsidy, or is at least on a waitlist to receive such a subsidy. For those who are not indicated as not currently receiving or waitlisted to receive a subsidy, indicate in Column P if they are paying less than 30% of their income on housing expenses (rent and utilities). NOTE: We do NOT expect teams to conduct precise calculations to determine whether a client meets criteria for Column P. Instead, we recommend that teams consider a client's approximate income, then calculate what 30% of that income amounts to, and judge whether housing expenses are less than that amount (resulting in an "X" for that client in Column P). Exclude clients who may be paying less than 30%, but are living in unsafe housing. For example, Mary is not receiving, nor waitlisted to receive, a housing subsidy (nothing marked in Column O). The team knows that Mary only receives disability benefits for $610 per month. Thirty percent of $610 is $183 (610 * 0.30); the team knows that Mary is definitely paying more than $200 per month in housing subsidies, resulting in no mark ("X") for Column P. �%COLUMNSLNATURAL SUPPORTS (Column X): Contacts with informal natural supports include face-to-face, telephone, or email. This includes people in the client's life who are NOT paid service providers (e.g., family, friends, landlord, employer, clergy - if a family member is also a paid service provider, they are counted as a natural support). Contacts with primary care physicians, parole officers, residential staff, and employed payees should NOT be counted in this item. Do not answer yes or no for this item. Please provide a specific number of contacts (in past month) for each client listed.JBACKGROUND: Your responses will be used to guide follow-up questions during the interviews and will be cross-referenced with the progress notes, assessments, and treatment plans in client charts. The chart review will be used to help verify that the services recorded in this spreadsheet are actually provided with relative consistency. Credit will not be given for services that are reported in this spreadsheet, but not clearly reflected in other data sources, per Protocol guidelines noted in TMACT Part II. TO BEGIN COMPLETING THIS SPREADSHEET: Please assign a unique identifier to all clients served by your team. Please keep a list of those unique identifiers so that we can ask about the work you are doing with each client during the on-site fidelity review. In the next spreadsheet, list all clients you serve using that unique identifier - DO NOT LIST NAMES OR USE INITIALS. Please indicate whether or not the client meets stated criteria and/or is receiving the listed services. While it is important to be accurate, please do not spend too much time laboring over completion of this spreadsheet (e.g., going through each client's chart); most ACT teams know the clients they serve well enough to be able to complete this information relatively quickly and accurately. Also be sure to delegate various team members to complete sections that are most in line with the services they provide and/or are most familiar (e.g., substance abuse specialist completes list of clients who receive integrated substance abuse services, nurses complete list of clients who receive daily and depot medications). � STAGES OF CHANGE READINESS (Column A): Early stage of change readiness includes clients who are actively using substances, regardless of whether they view their use as a problem or not. These individuals may have expressed some desire to reduce or quit, but have not enacted the change. Late stage of change readiness includes clients who are committed to reducing or quitting substance and are seeking treatment to help make this change. Individuals may have experienced several trials of abstinence or significant reductions in use (with lapses/relapses) or may have maintained abstinence for an extended period of time (e.g., more than 6 months). NOTE: As individuals may use several substances (e.g., alcohol, marijuana, cocaine), stage of change is often substance-specific. Report each client s stage based on what seems to be the most problematic substance, excluding nicotine and caffeine abuse, which is addressed elsewhere. Assessments and treatment plans will be reviewed and cross-referenced with this item on the<�� spreadsheet. Please do not leave this section blank. If your team does not assess for stages of change readiness or if the team has not yet assessed a specific client, please indicate this in the appropriate space. G >��For each client with a co-occurring substance use disorder, indicate whether they are in an 'early' or 'late' stage of change readiness. See definitions. 1/ Does the client receive integrated treatment for co-occurring disorders directly from the ACT team? Indicate 'individual' (more than 20 mins per week), 'group' (more than 1 time per month), or 'both.' If client receives co-occurring disorders services from non-ACT providers, note as 'non-ACT.' " ` Does the client receive psychiatric services directly from the ACT psychiatric care provider? Indicate 'yes' for single team prescriber and 'Pr1' and 'Pr2,' etc. for multiple team psychiatric care providers. If client sees non-ACT provider, note as 'non-ACT.' /� Does the client live in a supervised residential setting where medication monitoring services are received from non-ACT staff? Indicate 'yes' or 'no.' :A_� Does the client receive employment and educational services directly from the ACT team? (see definition) If receives employment and educational services from non-ACT providers, note 'non-ACT.'S� Is the client currently employed and/or enrolled in school? If employed, indicate whether it is competitive employment, school, or 'other.' (see definition). =� Does the client receive formal and/or manualized wellness management and recovery services directly from the ACT team? (See definition) If yes, please specify the type of WMR service used and whether it is group or individual. w�Does the client receive psychiatric rehabilitation services directly from the ACT team? (PLEASE carefully read definition provided). If receives psychiatric rehabilitation services from non-ACT providers, note 'non-ACT.' QR W� Has the client received individual and/or group psychotherapy in the past year from ACT team? (See definition) If yes, please specify the type of therapeutic strategies used. If sees a non-ACT provider for therapy, note non-ACT. ^�Does the client receive health/lifestyle intervention services directly from the ACT team? (See definition) If yes, please specify the type of service provided and targeted condition or behavior. \Indicate whether the client's current housing is in a residence where 25% or more of the other residents or tenants likely have a known disability (See definition). If the client is currently unsheltered (street homeless) or emergency sheltered, please type in HOMELESS.��Indicate whether the client is currently receiving a housing subsidy ("subsidy") or is on a waitlist for a subsidy ("waitlist"). 5D� Of those clients who do not receive a housing subsidy, mark ( x ) which clients pay 30% of their income or less on safe housing, including rent and utilities. (NOTE: Exclude individuals in affordable, but clearly unsafe, housing.)H€mIs the client on involuntary outpatient commitment or conditional release? If yes, please specify which one. 2/ If the client has a representative payee, indicate if the payee is agency/team, natural support, or independent organization/individual. Also note whether money is disbursed weekly or more or less often (e.g., individual receives allowance weekly or two times per week). E.g., "Indep Org; Weekly." *'Does this client have a legal guardian? &vIs this client on an antipsychotic depot medication (i.e., injection)? Please note the IM injection medication name. 3� Indicate the number of contacts the team had with clients natural supports this past month (see definition). Please indicate the number of contacts (i.e., do NOT answer yes or no).;K��ACT Client (Use unique identifier, NOT name). North Carolina Teams - If client is a TCLI/DOJ client, please add an (*) after ID.5EVIDENCE-BASED PSYCHOTHERAPY (Column M): These services include formal therapeutic approaches that are based on established theory and techniques. Therapies are selected and employed given the presenting problem (e.g., behavioral activation for depression; cognitive behavioral therapy for psychosis; dialectical behavioral therapy for emotion dysregulation). Psychotherapy sessions are tied to clients' goals and written into the client's treatment plan and Weekly Client Schedule. Sessions are planned, are a minimum of 20 minutes in length every other week, and are conducted by a trained therapist. Psychotherapy services reported here should be reflected across other data sources (e.g., progress notes, treatments plans, weekly client schedules). NOTE: Report any clients who have received formal psychotherapy in the past year and specify what type of therapy was provided (e.g., CBT, interpersonal therapy). Do not count motivational interviewing in both this column and in the Integrated Substance Abuse Treatment column, unless the client is receiving MI to address both substance abuse and other areas of his/her life where they may be in an earlier stage of change readiness (e.g., in precontemplation about moving from unsafe housing). Both sets of interventions must be documented separately in the treatment plan. 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