Friday, March 25, 2022



Services that have specific fidelity measures for proven effectiveness. CCBHCs and DCOs must provide EBP services that meet criteria as best practices and approaches for the purpose of the CCBHC program. The following required EBPs are meant to meet the needs of the broader focus of recipients served throughout their lifespan and set the minimum standard of practice in the application of EBPs. The CCBHC may select more population-specific EBPs listed in the SAMHSAs Evidenced-Based Practices Guide to reflect the unique needs of their communities.

1. Crisis Behavioral Health Services
a. Collaborative Management and Assessment of Suicidality
b. Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA/CIWAAr)
c. Clinical Opiate Withdrawal Scale (COWS)
d. Targeted Case Management (TCM)
e. Solution-Focused, Brief Psychotherapy (SFBT)
f. Wellness Recovery Action Plans (WRAP)
2. Screening, Assessment and Diagnostic Services
a. Achenbach Children’s Behavioral Checklists
b. Ages and Stages Questionnaire-Social Emotional
c. CRAFIT Screening Test
d. Patient Health Questionnaire-9 (PHQ-9)
e. DSM-5 Level 1 and 2 Cross-Cutting Symptom
f. Child and Adolescent Needs and Strengths (CANS)
g. Children’s Uniform Mental Health Assessment (CUMHA)
h. Child and Adolescent Services Intensity Instrument (CASII)
i. Level of Care Utilization System (LOCUS)
j. American Society of Addiction Medicine – Patient Placement Criteria (ASAM)
k. World Health Organization Disability Assessment Scale Version 2 (WHODAS 2.0)
3. Outpatient Mental Health and Substance Use Treatment
a. Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
b. Cognitive Behavioral Therapies (CBT) including Dialectical Behavior
Therapy (DBT) and Acceptance and Commitment Therapy (ACT)
c. Family Check-Up and Everyday Parenting
d. Motivational Interviewing
e. Integrated Dual Diagnosis Treatment; Life Skills Training
f. Illness Management and Recovery (IMR)
g. Medication Management
h. Body Mass Index
i. Metabolic Monitoring with Atypical Antipsychotics
4. Psychiatric Rehabilitation Services
a. Basic Skills Training and Psychosocial Rehabilitation
b. Life Skills Curriculum
c. Assertive Community Treatment
5. Behavior Change and Counseling Risk Factors
a. Screening, Brief Intervention and Referral to Treatment (SBIRT)
b. Nursing Quit-Line
c. Chronic Disease Management
6. Peer Support, Counselor Services and Family Supports
a. Peer Support Services

FAMILY-CENTERED: An approach to the planning, delivery and evaluation of care based on active participation and input from a recipient’s family and the CCBHC. Family centered care recognizes families as the ultimate decision-makers for their child, with the child encouraged to gradually take on more and more of the decision-making. Services are culturally, linguistically and developmentally appropriate and youth-guided and not only meet the behavioral, mental, emotional, developmental, physical and social needs of the child, but also support the family’s relationship with the child’s health care providers.


 Deliberately organizing, facilitating and managing a CCBHC recipient’s care. This includes coordinating all behavioral/mental and physical health activities regardless if the care is provided directly by the CCBHC and it’s DCO or through referral or other affiliation outside of the CCBHC delivery model. Care coordination

1. Ensuring access to high-quality physical health care (both acute and chronic) and behavioral health care, as well as social services, housing, educational systems and employment opportunities as necessary to facilitate wellness and recovery of the whole person. This may include the use of telehealth services. 

2. Having policies and procedures in place that comply with Health Insurance Portability and Accountability Act (HIPAA) and 42 CFR Part 2 requirements specific to adults and children, and other privacy and confidentiality requirements of state or federal law to facilitate care coordination.

3. Having policies and procedures in place to encourage participation by family members and others important to the recipient to achieve effective care coordination, subject to privacy and confidentiality requirements and recipient consent.

4. Having policies and procedures in place to assist recipients and families of children and adolescents in obtaining appointments and keeping the appointments when there is a referral to a provider outside the CCBHC delivery model, subject to privacy and confidentiality requirements and consistent with the recipient’s and heir family’s preference and need.

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