ࡱ> qtpW  Tbjbjɪ 4\ȣeȣe 8)t|+&l~7,c*******$-_0x*i{{{*4=+{F*{*:J","Ts(dv" *S+0+"R0%L0""0b(8{{{{{{{**qv{{{+{{{{0{{{{{{{{{ : ANNEX A PROGRAM COMMITMENTS INVOLUNTARY OUTPATIENT COMMITMENT (IOC) Involuntary Outpatient Commitment (IOC) programs coordinate community based mental health services for individuals, who are court ordered into mental health treatment. IOC programs enroll individuals who have been assessed by mental health professionals and adjudicated by a court as meeting the legal standard for involuntary outpatient treatment. IOC programs offer: Court ordered out-patient based mental health treatment; Assistance with linking with community based mental health services; Monitoring of adherence to the court order plan ; Ongoing assessment of clinical progress; Interface with the judiciary including transportation to court hearings. NAME OF AGENCY: CONTRACT NUMBER: BUDGET MATRIX CODE: BUDGET MODIFICATION NO: (0 = Original) ___ Volume Indicators: Target Enrollment (e.g. Capacity Caseload)  FORMTEXT       Total Unduplicated Individuals Served  FORMTEXT       Staffing: Full-Time-Equivalent (FTE) Program Coordinator/Director  FORMTEXT       Licensed Clinicians  FORMTEXT       Case Workers/Managers  FORMTEXT       Peer Provider Staff  FORMTEXT       Psychiatrist  FORMTEXT       Other Direct Care  FORMTEXT       TOTAL DIRECT CARE  FORMTEXT       Note: Staffing amounts must align with Annex B. Outputs: Face-to-Face Contacts Individual Group Psychiatric Evaluations:  FORMTEXT       Medication Monitoring:  FORMTEXT       Psycho-education:  FORMTEXT        FORMTEXT       Psycho-therapy:  FORMTEXT        FORMTEXT       Family Therapy:  FORMTEXT       Case Management:  FORMTEXT       Collateral:  FORMTEXT       TOTAL CONTACTS:  FORMTEXT       Aggregate Hours of Telephone Contacts with Consumers/Collateral:  FORMTEXT       Access: 100% of consumers will be offered a psychiatric evaluation within 24 hours of referral to the IOC program. YES NO Evaluation: Agency will complete an annual program evaluation that, at a minimum, includes consumer specific data and aggregated program data on consumers pre-post IOC use of: designated screening services visits, in-patient psychiatric hospitalization, housing status, arrests, incarceration and quality of life. YES NO STAFF SCHEDULE: Please provide the schedule for each IOC staff member. Reflect only the portion of the staff persons time that is allocated to the IOC program. Staff PositionMondayTuesdayWednesdayThursdayFriday SaturdaySunday INVOLUNTARY OUTPATIENT COMMITMENT FACE-TO-FACE CONTACTS: Individual Therapy: 1 contact is 30 continuous minutes of face-to-face with the consumer. Group Therapy: 1 contact is 30 continuous minutes of face-to-face with each consumer. Do not CDE ' ) * +  𵤐kkkZk?k4h+5>*CJOJQJ\^JaJehr h*{h*{CJOJQJ^JaJ&h*{h*{5CJOJQJ\^JaJ h O5CJOJQJ\^JaJ&h*{h5CJOJQJ\^JaJ h5CJOJQJ\^JaJ&hh5CJOJQJ\^JaJhE5OJQJ\^Jh $5OJQJ\^Jh5OJQJ\^Jhk]h*{5OJQJ\^J E ; o gd*{&$d%d&d'dNOPQgd)$$d%d&d'dNOPQa$gd $)$$d%d&d'dNOPQa$gd+ * +   L N }VV&$d%d&d'dNOPQgd+.@ $d%d&d'dNOPQ^@ `gd'&$d%d&d'dNOPQgdV!gd*{&$d%d&d'dNOPQgd+    > J L N p ~ ͼxgVxIA1Ij *heT"hbvU *heT"hbvj *heT"hbvU h`m5CJOJQJ\^JaJ h^5CJOJQJ\^JaJ h5CJOJQJ\^JaJ hCXS5CJOJQJ\^JaJ hbv5CJOJQJ\^JaJ h(75CJOJQJ\^JaJ hC3;5CJOJQJ\^JaJ)h*{h*{5>*CJOJQJ\^JaJ:h+h*{5>*CJOJQJ\^JaJehr  $ , . 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Family Therapy: 1 contact is 30 continuous minutes of face-to-face with the consumer. Do not count each family member. Medication Monitoring: 1 contact is 15 continuous minutes of face-to-face with the consumer. Psychiatric Evaluation: 1 contact is 30 continuous minutes of face-to-face contact with the consumer. Case Management: 1 contact is 15 continuous minutes of face-to-face with or on behalf of the consumer. For the therapies, please note that the face-to-face time can include up to 5 minutes per 30 minute session for the completion of progress notes, limited to a maximum of 10 minutes for a 90 minute session (3 QCMR units). COLLATERAL CONTACTS: Refers to face-to-face contacts made to persons by the case management staff on behalf of the enrolled client. May include contacts with persons such as other service providers, friends, landlords, etc. TELEPHONE CONTACTS: Aggregate phone time with or on behalf of the consumer.     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