Division of Behavioral Health Services

Definitions

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BHS Definitions ListPDF (revised 10/01/14)

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C

Caregiver

An individual who has the principal responsibility for caring for a child or dependent adult.

Care Management Program (CMP)

The process, methods and activities to identify high/risk high/cost SMI members receiving physical health services and designing clinical interventions or alternative treatment to reduce risk, cost and help members achieve better health care outcomes.

Certification of Need (CON)

A CON is a certification made by a physician that inpatient services are or were needed at the time of the person's admission to an inpatient facility. Although a CON must be submitted prior to a person's admission (except in an emergency), a CON is not an authorization tool designed to approve or deny an inpatient service, rather it is a federally required attestation by a physician that inpatient services are or were needed at the time of the person's admission. The decision to authorize a service that requires prior authorization is determined through the application of admission and continued stay authorization criteria. In the event of an emergency, the CON must be submitted:

  • For persons age 21 or older, within 72 hours of admission; and
  • For persons under the age of 21, within 14 days of admission.

Certified Nurse Midwife (CNM)

A person certified by the American College of Nursing Midwives (ACNM) on the basis of a national certification examination and licensed to practice in Arizona by the State Board of Nursing. CNMs practice independent management of care for pregnant women and newborns, providing antepartum, intrapartum, postpartum, gynecological, and newborn care, within a health care system that provides for medical consultation, collaborative management, or referral.

Change

Any modification to a client's status on any demographic record field that occurs after the Demographic has been accepted by ADHS/DBHS.

Child

An individual who is under eighteen years of age.

Child and Adolescent Service Intensity Instrument (CASII)

The CASII is a tool to determine the appropriate service intensity for a child or adolescent. The CASII assessment method consists of quantifying the clinical severity and service needs on six dimensions (eight ratings) that are standardized using anchor points. The ratings are quantified in order to convey information easily, but also provide a rating spectrum along which a child/adolescent may score on any given dimension. This can be done for any child/adolescent ages 6-18 in any setting regardless of diagnosis or the system with which the child is involved. The instrument also considers three distinct types of disorders: psychiatric disorders, substance use disorders, or developmental disorders (including autism and mental retardation), and has the ability to integrate these as overlapping clinical issues. Once the dimensional ratings are done, the scores are combined to generate a service intensity recommendation.

Child and Family Team

The Child and Family Team (CFT) is a defined group of people that includes, at a minimum, the child and his/her family, a behavioral health representative, and any individuals important in the child's life and who are identified and invited to participate by the child and family . This may include, for example, teachers, extended family, members, friends, family support partners, healthcare providers, coaches, community resource providers, representatives from religious affiliations, agent from other service systems like Child Protective Services (CPS) or the Division of Developmental Disabilities (DDD), etc. The size, scope and intensity of involvement of the team members are determined by the objectives established for the child, the needs of the family in providing for the child, and by which individuals are needed to develop an effectiveISP, and can therefore expand and contract as necessary to be successful on behalf of the child.

Child and Family Team (CFT) Facilitator

Although, individuals other than the behavioral health service provider may lead a CFT meeting, ultimately the behavioral health service provider is responsible for facilitating the CFT practice. If designated by the CFT, a team member may assume responsibility for leading team meetings and moderating discussions to facilitate consensus in the development of Service Plan goals and interventions. Individuals other than behavioral health service providers (i.e. family members, Child Protective Services' case managers, and natural supports) can learn to lead effective Child and Family Team meetings.

Children with Complex Needs

Children who are identified as being at level 3, 4, 5, or 6 using the CASII.

Children with Standard Needs

Children who are identified as being at level 0, 1, or 2 using the CASII.

Claim

A service billed under a fee-for-service arrangement.

Claim Dispute

A dispute involving a payment, denial or recoupment of payment on a claim, or the imposition of a sanction.

CLAS Standards

The National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (the National CLAS Standards) are intended to advance health equity, improve quality, and help eliminate health care disparities by providing a blueprint for individuals and health and health care organizations to implement culturally and linguistically appropriate services. Adoption of these standards will help advance better health and health care in the United States. The Enhanced Standards are a comprehensive series of guidelines that inform, guide, and facilitate practices related to culturally and linguistically appropriate health services. The Enhanced National CLAS Standards are structured as follows:

  • Principal Standard (Standard 1): Provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs.
  • Governance, Leadership, and Workforce (Standards 2-4)
  • Communication and Language Assistance (Standards 5-8)
  • Engagement, Continuous Improvement, and Accountability (Standards 9-15)

Clean Claim

A claim that may be processed without obtaining additional information from the provider of service or from a third party but does not include claims under investigation for fraud and abuse or claims under review for medical necessity.

Client Information System (CIS)

The data system used by ADHS/DBHS.

Clinical Liaison

A behavioral health professional or a behavioral health technician who has been credentialed and privileged by the T/RBHA or their designee in accordance with ADHS/DBHS requirements to perform this function. The clinical liaison:

  • Assumes the primary responsibility of clinical oversight of the person's care
  • Ensures the clinical soundness of the assessment/treatment process
  • Serves as the point of contact, coordination and a communication with the person's team and other systems where clinical knowledge is important.

Clinical Teams

Include Child and Family Teams and Adult Recovery Teams.

Closure

The HIPAA compliant transmission of information to terminate a client's enrollment in the ADHS/DBHS behavioral health service delivery system. For TXIX/XXI individuals, this information is provided from AHCCCS to ADHS/DBHS, and from ADHS/DBHS to the T/RBHAs. For NTXIX/XXI individuals, this information is provided to ADHS/DBHS from the T/RBHAs

Commonly Encountered LEP Groups

A significant number or percentage of the population eligible to receive services, or likely to be directly affected by the covered entity's (ADHS) programs who need services or information in a language other than English to communicate effectively. All vital materials shall be translated when a language is spoken by 1,000 or 5% (whichever is less) of members who have LEP in that language. Vital materials include, at a minimum, notices for denials, reductions, suspensions or terminations of services, and consent forms. All materials shall be translated when a language is spoken by 3,000 or 10% (whichever is less) of members who have LEP.

Community-Based Services

Services that are provided in the home and community rather than in offices or institutions. In addition, to fully be considered community-based services, they must be provided in partnership with the family and preserve the child's cultural and ethnic ties. Source: "Everything is normal until proven otherwise – a book about wraparound services" Dennis, K. & Lourie, I. (2006)

Community Service Agency (CSA)

A provider (provider type A3) of non-licensed behavioral health services. Agencies or organizations must be certified by ADHS/DBHS and registered with AHCCCS to provide services for Title XIX and Title XXI members.

CSA Contractor

An independent entity contracting with a Community Service Agency to provide services. CSA Contractors must exclude T/RBHAs and Office of Behavioral Health Licensure (OBHL) licensed facilities.

Complaint

An expression of dissatisfaction with any aspect of care other than the appeal of an action involving Title XIX/XXI recipients. Complaints include, but are not limited to, concerns about the quality of care or services provided, aspects of interpersonal relationships with service providers, and lack of respect for recipients' rights.

Complementary and Alternative Medicine (CAM)

A broad range of healing philosophies (schools of thought), approaches and therapies that mainstream Western (conventional) medicine does not commonly use, accept, study, understand, or make available. A few of the many CAM practices include the use of acupuncture, ayurveda, herbs, homeopathy, naturopathy, therapeutic massage, and traditional Oriental medicine to promote well-being or treat health conditions.

Condition Requiring Investigation

An incident or condition that appears to be dangerous, illegal or inhumane, including the death of a person with Serious Mental Illness.

Confidential HIV Information

Information concerning whether a person has had an HIV-related test or has HIV infection, HIV related illness or acquired immune deficiency syndrome and includes information which identifies or reasonably permits identification of that person or the person's contacts.

Co-payment

A fixed monetary amount that a member pays directly to a contractor or provider at the time covered services are rendered.

Corrective Action

An action taken to improve the performance of the T/RBHA and/or its contracted provider to enhance quality management/performance improvement activities and the outcomes of the activities; or to correct a deficiency.

Corrective Action Plan (CAP)

A written work plan that includes goals and objectives, steps to be taken, and methodologies to be used to accomplish CAP goals and objectives, as well as the staff responsible to carry out the CAP within established timelines. CAPs are generally used to improve the performance of the RBHAs and/or their contracted providers, to enhance QM/PI activities and the outcomes of the activities, and/or to correct a deficiency.

Cost avoidance

Avoiding payment of claims when third party payment sources are available.

Cost sharing

T/RBHA payment on behalf of behavioral health recipients for Medicare and private insurer costs, including premiums, deductibles and coinsurance.

Court Ordered Evaluation

A professional multidisciplinary analysis based on data describing the person's identity, biography and medical, psychological and social conditions carried out by a group of persons consisting of not less than the following:

  1. Two licensed physicians, who shall be qualified psychiatrists, if possible, or at least experienced in psychiatric matters, and who shall examine and report their findings independently. The person against whom a petition has been filed shall be notified that he may select one of the physicians. A psychiatric resident in a training program approved by the American Medical Association or by the American Osteopathic Association may examine the person in place of one of the psychiatrists if he is supervised in the examination and preparation of the affidavit and testimony in court by a qualified psychiatrist appointed to assist in his training, and if the supervising psychiatrist is available for discussion with the attorneys for all parties and for court appearance and testimony if requested by the court or any of the attorneys.
  2. Two other individuals, one of whom, if available, shall be a psychologist and in any event a social worker familiar with mental health and human services which may be available placement alternatives appropriate for treatment. An evaluation may be conducted on an inpatient basis, an outpatient basis or a combination of both and every reasonable attempt shall bemade to conduct the evaluation in any language preferred by the person.

Court Ordered Treatment (COT)

In accordance with the A.A.C. R9-21-101 and A.R.S. § 36-533 In Arizona, an individual can be ordered by the court to undergo mental health treatment if found to fit one of the following categories due to a mental disorder:

  • A Danger to Self;
  • A Danger to Others;
  • Gravely Disabled, which means that the individual is unable to take care of his/her basic physical needs; or
  • Persistently or Acutely Disabled, which means that the individual is more likely to suffer severe mental or physical harm that impairs his/her judgment such that the person is not able to make treatment decisions for himself.

Covered Behavioral Health Services Guide

The ADHS/DBHS Covered Behavioral Health Services Guide describes the comprehensive array of covered behavioral health services that will assist, support and encourage each eligible person to achieve and maintain the highest possible level of health and self-sufficiency. The goals that influenced the development of the Covered Behavioral Health Services are:

  • Aligning services to support a person/family centered service delivery model
  • Focusing services to meet recovery goals
  • Increasing provider flexibility to better meet individual person/family needs
  • Eliminating barriers to service
  • Recognizing and including support services provided by non-licensed individuals and agencies
  • Streamlining service codes
  • Maximizing Title XIX/XXI funds

This service guide outlines the array of available services and addresses critical components that must be in place to successfully encounter services.

Credentialing

Credentialing is the process of obtaining and verifying information to determine whether a behavioral health provider meets required qualifications, as outlined in ADHS/DBHS Provider Manual Section 3.20, Credentialing and Recredentialing, to provide behavioral health services to persons enrolled in the ADHS/DBHS behavioral health system.

Crisis

An acute, unanticipated, or potentially dangerous behavioral health condition, episode or behavior.

Crisis Episode

A short enrollment is allowed for crisis only individuals who are not transferred to on-going care. Only a minimum data set needs to be collected. See the Demographic Data Set User Guide for fields. These fields must be gathered within 45 days after the start of the episode of care and submitted to ADHS/DBHS within 55 days.

Crisis Intervention Services

Services provided to a person for the purpose of stabilizing an acute, unanticipated, or potentially dangerous behavioral health condition, episode or behavior.

Crisis Intervention Services (Inpatient Stabilization, Facility Based)

Crisis intervention services provided at a Level 1 psychiatric acute hospital or a Level 1 sub-acute agency (see AAC R9-20-101(37)). Persons may walk-in or may be referred/transported to these settings.

Crisis Intervention Services (Mobile, Community Based)

Crisis intervention services provided by a mobile team or individual who travels to the place where the person is experiencing the crisis (e.g., person's place of residence, emergency room, jail, community setting) to:

  • Stabilize acute psychiatric or behavioral symptoms;
  • Evaluate treatment needs; and
  • Develop plans to meet the needs of the persons served.

Depending on the situation, the person may be transported to a more appropriate facility for further care (e.g., a crisis services center).

Crisis Intervention Services (Telephone)

Crisis intervention (telephone) services provided by qualified service providers within the scope of their practice to triage, refer and provide telephone-based support to persons in crisis. This is often the first place of access to the behavioral health system. This service may also include a follow-up call to ensure the person is stabilized.

Cross-tapering

A process by which one medication is added to a person's medication regime, and its dosage gradually increased, while the dosage of another medication that has been prescribed for the same clinical purpose is gradually reduced and discontinued. This provides a safe and cautious way to substitute one medication for another.

Cultural Competence

A set of congruent behaviors, attitudes and policies that come together in a system, agency, or among professionals which enables that system, agency or those professionals to work effectively in cross-cultural situations. 'Culture' refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups. 'Competence' implies having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors, and needs presented by behavioral health recipients and their communities.

Culture

  1. The shared values, norms, traditions, customs, arts, history, folklore, music, religion, and institutions of a group of people.
  2. Is an integrated pattern of human behavior, which includes but is not limited to, thought, communication, languages, beliefs, values, practices, customs, courtesies, rituals, manners of interacting, roles, relationships, and expected behaviors of a racial, ethnic, religious, social or political group; the ability to transmit the above to succeeding generations; dynamic in nature. Culture defines:
    • How health care information is received;
    • How rights and protections are exercised;
    • What is considered to be a health problem;
    • How symptoms and concerns about the problem are expressed;
    • Who should provide treatment for the problem; and
    • What type of treatment should be given.

In sum, because health care is a cultural construct, arising from beliefs about the nature of disease and the human body, cultural influences play a critical role in the delivery of health services treatment and preventive interventions. By understanding, valuing, and incorporating the cultural differences of America's diverse population and examining one's own health-related values and beliefs, health care organizations, practitioners, and others can support a health care system that responds appropriately to, and directly serves the unique needs of populations whose cultures may be different from the prevailing culture (Katz, Michael. Personal communication, November 1998)

Culturally based

Developed in collaboration with or by the targeted population. Refers to the preference-based strategies and processes used in decision making, perceptions, and knowledge representations of a given culture. It is the mental process of knowing, including aspects such as awareness, perception, reasoning, and judgment.

Culturally Competent Agencies and Individuals

Culturally competent agencies and individuals are characterized by their understanding of and respect for the differences between and among diverse groups (i.e., acknowledging and incorporating acceptance of customs, values, and beliefs of different groups); continuing self-assessment regarding culture; careful attention to the dynamics of difference; continuous expansion of cultural knowledge and available resources; and appropriate adaptations of service models to better meet the needs of diverse populations. Culturally competent agencies strive to hire culturally competent employees and individuals; seek advice and consultation from diverse communities; and actively assess their capability of providing responsive services to diverse clients. Culturally competent agencies are committed to strategies and practices that enhance services to diverse individuals, families, and communities.

Culturally Competent Care

  1. Children and their families receive services from all staff members that are effective, understandable, and respectful and are provided in a manner compatible with their cultural health beliefs and practices and preferred language.
  2. Acknowledges and incorporates – at all levels – the importance of culture in the assessment of cross-cultural relations, vigilance towards the dynamics that result from cultural differences, the expansion of cultural knowledge and the adaptation of services to meet culturally unique needs. Competence implies having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors, and needs presented by consumers and their communities.

Cultural Need

The unique needs of an individual which include, but are not limited to: age; ethnicity; race; national origin; sex (gender); gender identity; sexual orientation; tribal affiliation; and disability.

Culturally Relevant

A program, message, or strategy development that is meaningful to the identified population.

Curriculum

A written document which details the workshops, lessons, and/or presentations used in life skills education, parent/family education, public information & marketing, alternative activities, community education, and/or training services.