As part of the contract between the North Carolina Department of Health and Human Services (DHHS) and Alliance Behavioral Healthcare, Alliance is responsible for ensuring that appropriate services are provided, including ensuring calls to providers are returned within one hour. Alliance has elected to monitor this requirement through routine testing of our network providers’ first responder capacity and quality throughout its coverage area.
Additionally, as part of its accreditation Alliance is required to complete Quality Improvement Projects. Alliance’s Global Quality Management Committee has selected First Responder as the focus of one of Alliance’s QIP for FY15, continuing the QIP from FY14.
There are three purposes for the following information. First is to provide the definitions of first responder and the first responder requirements. Second is to provide first responder recommendations and to encourage agencies to review their policies related to first responder. Finally, we want to ensure that providers are aware of the process by which Alliance will test first responder lines across its coverage area. If you or anyone at your agency has any questions after receiving this communication or at any point during the first responder testing processes, please contact the point of contact whose information can be found at the end of this letter.
First Responder Definitions and Requirements
First Responder Definition from NC DHHS Glossary: The provider designated in the PCP to provide crisis response on a 24/7/365 basis. Typically, the first responder is the provider who has the most sustained contact and familiarity with the clinical dynamics of the individual being served.
First Responder Requirements by Service Type (from DMA Enhanced Service Definitions)
The services listed below are not intended to be a comprehensive list of all providers with first responder requirements. However, they represent the majority of service types contracted with Alliance that will be part of the first responder testing process.
Multisystemic Therapy (MST) – Organizations that provide MST must provide “first responder” crisis response on a 24/7/365 basis to consumers who are receiving this service.
Assertive Community Treatment Team (ACTT) – Organizations that provide ACTT services must ensure service availability 24 hours per day, 7 days per week, 365 days per year and be capable of providing a full range of treatment functions including crisis response wherever and whenever needed to recipients who are receiving ACTT services.
Substance Abuse Intensive Outpatient Program (SAIOP) – Organizations that provide SAIOP must provide “first responder” crisis response on a 24/7/365 basis to recipients receiving this service.
Substance Abuse Comprehensive Outpatient Treatment (SACOT) – Organizations that provide SACOT must provide “first responder” crisis response on a 24/7/365 basis to recipients receiving this service.
Intensive In-Home (IIH) – This team service includes a variety of interventions that are available 24 hours a day, 7 days a week, 365 days a year and are delivered by the IIH staff, who maintain contact and intervene as one organizational unit. The IIH Team shall provide “first responder” crisis response, as indicated in the Person Centered Plan, 24 hours a day, 7 days a week, 365 days a year to recipients of this service.
Community Support Team (CST) – This team service includes a variety of interventions that are available 24 hours a day, 7 days a week, 365 days a year and are delivered by the CST staff who maintain contact and intervene as one organizational unit.
Child and Adolescent Day Treatment (MH/SA) – As part of the crisis plan of the Person Centered Plan, the Day Treatment provider shall coordinate with the Local Management Entity and recipient to assign and ensure “first responder” coverage and crisis response, as indicated in the Person Centered Plan, 24 hours a day, 7 days a week, 365 days a year to recipients of this service.
First Responder Recommendations
Below are some common recommendations generated after several first responder testing events:
- Keep Alliance informed with up-to-date contact information.
- Check Alliance’s website under Provider Search for your agency’s contact information and website, if applicable. If there are errors, notify Alliance’s Provider Network Department at [email protected] to ensure all information is up-to-date and accurate.
- Implement a 15 minute time limit for returning crisis calls and include that time in all phone messages enrollees may call during a crisis.
Have a voicemail message that states the agency’s name and informs callers what to do if they do not receive a response within 15 minutes
- Identify yourself with agency name, name of person answering call, and title when answering the crisis line. Many during checks answer by simply saying “hello” with no other identification.
- Be able to respond face-to-face and/or schedule follow up appointments over the phone if necessary.
- Have access to crisis plans for all consumers receiving services that require first responders.
- Periodically do an internal check of your own system to make sure it is working. Check should ensure covering staff and/or voice messages are loud and clear enough. Voice messages should repeat any phone numbers referenced a second time.
- Providers using an answering service will be evaluated by the same standards and should ensure that calls are directed to appropriate staff.
Alliance’s First Responder Evaluation Process
To ensure tests calls are made using the correct contact information, provider crisis numbers will be gathered from consumer crisis plans submitted for authorizations. These crisis plans will be randomly selected from any authorizations for services listed above.
Providers that performed well in previous First Responder tests will be tested less frequently than those that have not yet been tested or had deficiencies on previous test calls.
Following the completion of the first responder test calls, Alliance staff will follow-up directly with agencies where issues were identified and work to provide Technical Assistance where applicable.
Results from the telephonic tests will be combined and presented to Alliance’s Continuous Quality Improvement (CQI) Committee, Provider Advisory Council and Global Quality Management Committee. First Responder System strengths and areas for improvement will be identified, and an action plan for improvement will be developed.
General results from the First Responder Evaluation will be shared with providers and guidance and feedback from providers will be incorporated to future telephonic checks and testing efforts.
Thank you for taking the time to review this information in its entirety. Questions regarding the First Responder Quality Improvement project may be directed to Michelle Work, Alliance Quality Review Coordinator.