CareOregon



CriteriaICM- Intensive Case ManagementIndividuals referred to the ICM program must meet all the following criteria:Covered diagnosis on the prioritized listAND At least two of the following2 or more inpatient admissions in the past yearDischarge from the state hospital within the past year Civil commitment or discharge from the state hospital within the past yearResiding in an inpatient bed or supervised community residence and clinically assessed to be able to live in a more independent living situation if intensive services are providedSevere deficits in skills needed for community living as well as a high degree of impairment due to symptoms of mental illness Significant PTSD or depression symptoms as a result of torture, ongoing systemic oppression, trauma or multiple losses Or at least three of the following:Intractable, severe major symptomsSignificant cultural or linguistic barriers existSignificant criminal justice involvementRequires residential placement if intensive services are not availableNot engaged in services but deemed at high risk of harm related to their mental illnessSevere deficits in skills needed for community living as well as a high degree of impairment due to symptoms of mental illnessCo-occurring substance use diagnosisRisk of loss of current living situation, in an unsafe living situation, or currently experiencing homelessness due to symptoms of mental illnesscenter271289IDDT (Integrated Dual Diagnosis Treatment) ModelDocumented Substance Use Disorder Diagnosis requiredStrength Based Model?Substance Use Disorder Diagnosis not required?CCC Waitlist Reduction Program:????Client has been referred through Multnomah County Post Commitment Services?00IDDT (Integrated Dual Diagnosis Treatment) ModelDocumented Substance Use Disorder Diagnosis requiredStrength Based Model?Substance Use Disorder Diagnosis not required?CCC Waitlist Reduction Program:????Client has been referred through Multnomah County Post Commitment Services?ACT- Assertive Community Treatment For information on ACT services please refer to the website for OCEACT-Oregon Center for Excellence for Assertive Community Treatment: information on ACT Admission Criteria as written in the Oregon Health Authority rules see: ACT ADMISSION CRITERIA: Individuals referred to the ACT program must meet all the following criteria:Primary diagnosis of severe mental illness (SMI)SchizophreniaSchizoaffective DisorderBi-Polar DisorderMajor Depressive DisorderOther: ________________________Participants with other psychiatric illnesses are eligible dependent on the level of the long-term disability Individuals with a primary diagnosis of mental retardation, brain injury, personality disorder, or substance use disorder are not appropriate for FACT-level services Individuals with co-morbidity of an SPMI diagnosis with one of the above disorders will be considered for the program Participants with significant functional impairmentsAs demonstrated by at least one of the following conditions:Significant difficulty consistently performing the range of practical daily living tasks required for basic adult functioning in the community. Impairment is demonstrated by one or more of the following:caring for personal business affairsobtaining medical, legal, and housing servicesrecognizing and avoiding common dangers or hazards to self and possessionsmeeting nutritional needsmaintaining personal hygiene) or persistent or recurrent difficulty performing daily living tasks except with significant support or assistance from others such as friends, family, or relativesOther: __________________________________________________________Significant difficulty maintaining consistent employment at a self-sustaining level or significant difficulty consistently carrying out the homemaker role (household meal preparation, washing clothes, budgeting, or child-care tasks and responsibilitiesSignificant difficulty maintaining a safe living situation (e.g., repeated evictions or loss of housing).Participants with one or more of the followingHigh utilization of psychiatric services, including acute hospitalizations (2 or more admissions within a six-month period)Intractable (e.g., persistent or very recurrent) severe major symptoms, affective, psychotic, suicidal)Coexisting substance abuse disorder of significant duration (e.g., greater than six months)High risk or recent history of criminal justice involvement (e.g., arrest, incarceration)Significant difficulty meeting basic survival needs, residing in substandard housing, homelessness, or imminent risk of becoming homelessResiding in an inpatient or supervised community residence in the community where ACT services are available, but clinically assessed to be able to live in a more independent living situation if intensive services are provided or requiring a residential or institutional placement if more intensive services are not availableInability to effectively utilize traditional office-based outpatient services or other less-intensive community-based programs (e.g., inconsistent attendance, drops out of service) -1593859487900For FACT ONLY:Moderate to high risk to re-offend as established by a standardized risk assessment (e.g., LS/CMI) and significant criminal justice involvement as evidenced by one or more of the following:Recent history of multiple police contacts, arrests, bookings, and/or incarcerationsRecent history of custody holds, peace officer holds and/or civil commitmentCurrently under supervision with Multnomah County Adult Probation and ParoleMust be included in the referral packet FORMCHECKBOX LS/CMI Report (within the past 6 months, if available)LS/CMI Score: FORMTEXT ????? Type of Referral: FORMDROPDOWN -168275151130For Outside In/RISE Program ONLYAre you screened into the Multnomah County Homeless Youth Continuum or HYC eligible (age 18-24 and experiencing homelessness)00For Outside In/RISE Program ONLYAre you screened into the Multnomah County Homeless Youth Continuum or HYC eligible (age 18-24 and experiencing homelessness) ................
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