Purpose

To determine whether the Office of Mental Health (Office) is effectively overseeing the Assertive Community Treatment (ACT) program to ensure that ACT provider teams are complying with requirements and that program goals are achieved. The audit covers the period April 1, 2012 through October 31, 2014.

Background

The Office promotes the mental health and well-being of all New Yorkers. Its mission is to facilitate recovery for adults receiving treatment for serious mental illness; to support children and families in their social and emotional development and in the early identification and treatment of children’s serious emotional disturbances; and to improve the capacity of communities across New York to achieve these goals. One way the Office accomplishes its mission is through the ACT program, which uses evidence-based practices to provide treatment, rehabilitation, and support services to individuals diagnosed with severe mental illness whose needs have not been well met by more traditional mental health services. Currently, 78 ACT provider teams are licensed by the Office and operate throughout the State to provide services for up to 5,000 recipients. ACT provider teams are required to conduct recipient assessments every six months, develop treatment plans based on assessment outcomes, and track progress. The Office uses its Child and Adult Integrated Reporting System (CAIRS) to collect, analyze, trend, and report recipient data and outcomes. To ensure effectiveness in delivering services, ACT provider teams are required to complete mandatory training. ACT program teams received over $74 million in 2014, most of which (89 percent) came through the Department of Health for services provided to Medicaid recipients, with the remainder being funded directly by the State.

Key Findings

• The Office is not effectively overseeing the ACT program to ensure that provider teams are complying with certain important program requirements. Provider teams are not recertified timely; program data in the CAIRS system is not complete or accurate; some program staff do not receive required training; and program recipients’ treatment plans are not completed on time, with required team leaders’ approvals. As a result, program recipients’ service needs may not be adequately addressed.
• The Office has also not established methods to assess the extent to which it is achieving overall program goals. Of 457 recipients who were discharged from the program during the audit period, 24 percent (110) met program objectives. Absent criteria to measure performance against expectations, it is unclear to what extent, if any, the other 76 percent of discharged recipients, including 10 percent who were eventually jailed and another 12 percent who required hospitalization, should be considered program successes.

Key Recommendations

• Establish controls to effectively oversee the ACT program to ensure provider teams are complying with program requirements and recipients are receiving needed services. Improve monitoring to ensure:
  • Provider teams are recertified timely.
  • Program data is complete and accurate.
  • All program staff complete required training.
  • Program recipients’ treatment plans are completed on time, with required clinical approvals.
• Establish measurements to assess achievement of overall program goals.