20152016
Cenpatico Crisis Protocol for
Yuma County
Cenpatico Crisis Protocol for Yuma County
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Table of Contents
Overview & Purpose: ........................................................................................................................... 1
Definitions............................................................................................................................................ 2
Crisis During Business Hours .............................................................................................................. 6
Crisis Services ..................................................................................................................................... 7
The NurseWise Crisis Line ............................................................................................................... 7
Crisis Mobile Teams ............................................................................................................................ 8
The Recovery Opportunity Center (ROC) – Living Room Model....................................................... 9
Involuntary Persons in Need of Mental Health Treatment .................................................................... 9
A person in the ER ........................................................................................................................... 9
A person in the community ............................................................................................................. 11
A person at an outpatient clinic during office hours ........................................................................ 12
When law enforcement are involved (ARS 36-525(B)) ................................................................... 13
A person who is detained and involuntary for treatment at the Yuma County Jail ........................... 14
An involuntary person on the Cocopah Indian Reservation ............................................................ 14
Non-Emergency Requests for Involuntary Evaluation (PAD or GD) ................................................... 14
Voluntary Crisis Services for incarcerated persons ............................................................................ 15
At the Yuma County Jail ................................................................................................................. 15
At a Juvenile Detention Center ....................................................................................................... 15
Revocation of the outpatient treatment of an existing COT (ARS.36-540.01 I) ................................... 15
During Regular Business Hours ..................................................................................................... 15
Process for T19, Non-Medicare members who will be admitted to MHW-SAF ............................... 16
Medicare members and medically compromised persons who will not be admitted to MHW-SAF .. 17
After Hours ..................................................................................................................................... 18
Direct Admission to a Licensed Hospital (Acute or Sub-Acute) Psychiatric Inpatient Facility.............. 18
By outpatient providers (voluntary only) ......................................................................................... 18
By crisis mobile teams (voluntary only) .......................................................................................... 18
Title 36 Transports to Mountain Health and Wellness by Law Enforcement ....................................... 19
Cenpatico Crisis Protocol for Yuma County
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Basic Transport .............................................................................................................................. 19
Medically compromised clients ....................................................................................................... 19
Coordination of Care.......................................................................................................................... 20
Coordination with the ER on Enrolled Persons ............................................................................... 20
Coordination with the ER on NON-enrolled persons....................................................................... 20
Coordination with YRMC on medically admitted patients enrolled with an outpatient service provider
....................................................................................................................................................... 20
Meeting Attendance ........................................................................................................................... 21
The Yuma County Mental Health Crisis Systems Meeting.............................................................. 21
Regular Crisis Team Meetings ....................................................................................................... 21
Problem Resolution Process.............................................................................................................. 21
Drug and or Alcohol Use - Services Available .................................................................................... 21
Crossroads Mission:....................................................................................................................... 22
Yuma SAF (MHW Sub-Acute Facility) ............................................................................................ 23
Crisis Transportation for Voluntary Title 19 & 21 persons in need of a higher level of care ................ 23
Signature Pages ................................................................................................................................ 24
Cenpatico Crisis Protocol for Yuma County
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Arizona Counseling & Treatment Services
(ACTS)
Cenpatico Integrated Care
CHA Crisis Mobile Team (CMT)
Cocopah Tribal Police
Community Bridges
Community Health Associates (CHA)
Crossroads Mission
Helping Associates, Inc.
Horizon Health and Wellness
NurseWise (NW)
Providence Service Corp
San Luis Police Department
Somerton Police Department
Wellton Police Department
Yuma County Attorney’s Office
Yuma County Juvenile Justice Center
Yuma County Sheriff’s Office (YCSO)
Yuma Police Department (YPD)
Yuma Regional Medical Center (YRMC)
Overview & Purpose:
The Protocols are guidelines that describe how we will all work together to ensure that behavioral
health services are delivered in Yuma County. The Purpose is to enhance the network and response
capability to address behavioral health crisis in Yuma County through ongoing communication and
collaborative agreements between community stakeholders and behavioral health provider agencies
developing an environment where there is no wrong door.
Cenpatico Behavioral Health of Arizona, LLC and Cenpatico of Arizona, Inc. dba Cenpatico Integrated
Care (herein referred to as Cenpatico) and their contracted providers and identified Yuma County
Community Stakeholders agree to coordinate activities to facilitate the implementation of crisis
services in Yuma County. The elements of the Crisis System (including referral, assessment and
service implementation processes) and the roles and responsibilities of each agency are outlined
below.
Cenpatico and their contracted providers and identified Yuma County Community Stakeholders agree
to work in partnership on behalf of persons experiencing a behavioral health crisis to ensure they
receive the appropriate services and level of care that promote resiliency and protect the community.
These guidelines will be active from date of signature until modified by the involved parties. These
guidelines do not create or delegate obligations or financial responsibilities. These guidelines are not
a legal and binding contract or Memorandum of Understanding. These guidelines should never
override the obligation to provide the most clinically appropriate intervention based on each individual
situation nor should they override law or professional responsibility to members. Agencies are
encouraged to have adequate clinical supervision and guidance to support such actions.
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Goals of the Crisis System
To ensure persons receive the appropriate services and level of care, stabilize persons in the
community whenever possible, support individuals in their recovery, promote resiliency and protect
the community.
Definitions
Active episode of care-means they have been opened with and are receiving services at a
contracted RBHA funded agency. The person may have any of the following eligibility and
entitlements:
o T19 (AHCCCS or SSI/MAO)
o T 21 (kids)
o SMI only
o Medicare and T19
o Medicare and SMI
Note: Cenpatico will be the health plan for persons designated with a serious mental illness (SMI)
enrolled as Title XIX -Admitting Officer –Per ARS 36-501.1 Admitting officer is a psychiatrist or other physician or
psychiatric and mental health nurse practitioner with experience in performing psychiatric
examinations who has been designated as an admitting officer of the evaluation agency by the person
in charge of the evaluation agency.
Application for Emergency Admission for Evaluation Paperwork completed to initiate an
emergency evaluation of a person who, based on probable cause, is believed to be, a danger to self
or others and that during the time necessary to complete the prepetition screening procedures the
person is likely without immediate hospitalization to suffer serious physical harm or serious illness or
to inflict serious physical harm on another person
Application for Involuntary Evaluation Paperwork completed to initiate a request for an evaluation
of a person who is alleged to be Persistently or Acutely Disabled (PAD), or Gravely Disabled (GD), or
Danger to Self (DTS) or Danger to Others (DTO), or any combination of these. This process of
requesting an involuntary evaluation is for situations that are considered non-emergency requests for
an evaluation.
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Amendment of the outpatient portion of a court order- The process outlined in ARS 36-540 (E) 5.
in which the medical director of the mental health treatment agency can order a person court ordered
to outpatient treatment back into inpatient treatment.
Business Hours-Monday through Friday from 8am to 5pm.
Crisis - An acute, unanticipated, or potentially dangerous behavioral health condition, episode or
behavior.
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 telephonebased 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
Danger to Self (DTS)-(a) Behavior which, as a result of a mental disorder, constitutes a danger of
inflicting serious physical harm upon oneself, including attempted suicide or the serious threat thereof,
if the threat is such that, when considered in the light of its context and in light of the individual's
previous acts, it is substantially supportive of an expectation that the threat will be carried out.
(b) Behavior which, as a result of a mental disorder, will, without hospitalization, results in serious
physical harm or serious illness to the person, except that this definition shall not include behavior that
establishes only the condition of gravely disabled.
Danger to Others (DTO)-The judgment of a person who has a mental disorder is so impaired that he
is unable to understand his need for treatment and as a result of his mental disorder his continued
behavior can reasonably be expected, on the basis of competent medical opinion, to result in serious
physical harm to others.
Evaluation Agency- Per ARS 36-501 (13) “a health care agency that is licensed by the department
and that has been approved pursuant to this title, providing those services required of such agency by
this chapter.” There are several evaluation agencies located in Tucson including Palo Verde, Sonora
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and University of Arizona Medical Center-South Campus (UAMC-South). The preferred Evaluation
Agency is the SAF in HHW.
Intake and Coordination of Care Agency (ICC Agency ) - (Also referred to as Outpatient
Treatment Agencies or Provider Agencies). ICC Agencies are contracted provider type requiring
full execution of Intake Provider functions and requirements. ICC Agencies must accept all requests
for services for eligible populations and are required to manage members’ care by performing the
following roles: intake, assessment, service planning, clinical oversight of all services, service tracking
and data reporting, enrollment and demographic submissions, education, engagement activities,
psychiatric services and ensure adequate treatment service availability to all enrolled members. Local
ICC Agencies in Yuma include ACTS, CIA, Community Bridges, Crossroads Mission, Horizon Health
and Wellness (HHW) and Providence.
ICC Agencies are further divided into High Needs Recovery Centers (HNRM) and Low to Moderate
Needs Recovery Centers (LNMRC). ICC Agencies are required to screen members and refer them to
either an (HNRM) or an (LMNRC).
Gravely Disabled (GD)-A condition evidenced by behavior in which a person, as a result of a mental
disorder, is likely to come to serious physical harm or serious illness because he/she is unable to
provide for his/her basic physical needs.
Guardian- A guardian is a person who has the legal authority to make personal decisions for the ward
relating to living arrangements, education, social activities, and authorization or withholding of medical
or other professional care, treatment, or advice. The guardian must always make decisions that are in
the best interests of the ward. The guardian must always make sure that the ward is living in the least
restrictive environment in which the ward can remain safe. Under §14-5312.01 (a) a guardian is able
to consent to medical treatment outside a level one behavioral health facility. A mental health
guardian is given under §14-5312.01 (b) for placement in a level one behavioral health facility. It is
based on evidence produced from a licensed mental health expert that the ward is in need of such
hospitalization due to a mental disorder as listed in §36-501. It is renewed every year with an affidavit
from a mental health expert stating that it is likely that the ward will need to be placed in a level one
behavioral facility.
Licensed Hospital - A facility licensed per 9 A.A.C. 20 and includes a psychiatric acute hospital
(including a psychiatric unit in a general hospital), a residential treatment center for persons under the
age of 21, or a sub-acute facility. For the purposes of this protocol, a Licensed Hospital facility does
not include Behavioral Health (BH) treatment.
Natural supports- Refers collectively to support commonly identified as:
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a. "Informal Support " (support provided by those individuals who know or are related to the
individual/family, but do not provide a paid service, such as a grandparent or neighbor who is
connected to the individual/family) and
b. "Community Support" (those supports that are part of the individuals/family's community, such
as faith community, neighborhood or community organizations).
Persistently and Acutely Disabled (PAD)-A severe mental disorder that meets all the following
criteria:
(a) If not treated has a substantial probability of causing the person to suffer or continue to suffer
severe and abnormal mental, emotional or physical harm that significantly impairs judgment, reason,
behavior or capacity to recognize reality.
(b) Substantially impairs the person's capacity to make an informed decision regarding treatment and
this impairment causes the person to be incapable of understanding and expressing an understanding
of the advantages and disadvantages of accepting treatment and understanding and expressing an
understanding of the alternatives to the particular treatment offered after the advantages,
disadvantages and alternatives are explained to that person.
Petition for court ordered Evaluation- The prescribed form used to request a petition for courtordered evaluation. This form must be reviewed and signed by the Medical Director.
Revocation of the outpatient treatment portion of a court order - The process outlined in ARS 36540-01. Section I in which the medical director of the mental health treatment agency can order a
person court ordered to outpatient treatment back into inpatient treatment.
Serious Mental Illness (SMI) - A condition of persons who are eighteen years of age or older and
who, as a result of a mental disorder as defined in A.R.S. 36-501, exhibit emotional or behavioral
functioning which is so impaired as to interfere substantially with their capacity to remain in the
community without supportive treatment or services of a long -term or indefinite duration. In these
persons mental disability is severe and persistent, resulting in a long-term limitation of their functional
capacities for primary activities of daily living such as interpersonal relationships, homemaking, selfcare, employment and recreation.
Title 36 - Arizona’s state law for involuntary mental health commitment. The law is located in the
Arizona Revised Statutes, Title 36 (Public Health and Safety) Chapter Five (Mental Health Services).
Title 36 pre-petition screening-The review of an application (MH 100 or MH 104) requesting courtordered evaluation, including an investigation of facts alleged in such application, an interview with
each applicant, and an interview, if possible, with the proposed patient. The purpose of the interview
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with the proposed patient is to assess the problem, explain the application and, when indicated,
attempt to persuade the proposed patient to receive, on a voluntary basis, evaluation or other
services. Note: Horizon Health and Wellness currently serves this function in Yuma and La Paz
Counties.
Warm Line Transfer – a live transfer where the call is introduced to and accepted by the recipient
before the call is transferred.
WRAP Plan-Wellness Recovery Action Plan-is a self-management and recovery system developed
by a group of people who had behavioral health difficulties and who were struggling to incorporate
wellness tools and strategies into their lives. WRAP plans are developed by the consumer. The plan
helps people to monitor uncomfortable and distressing symptoms and identify ways to help reduce,
modify or eliminate those symptoms by following plan strategies. The plan includes an outline of who
can help and how they can help as well as preferred management strategies and treatments.
Wrap Services-Also referred to as ‘wrap around services;’ these are supportive services provided to
a person at home or in the community designed to provide additional support to a person in crisis or to
prevent a crisis. Planned services are available 24/7/365. Wrap services include an array of
professional, community, and natural (i.e., family, friends) supports and are individualized based on
the needs of the person and the family.
Crisis During Business Hours
During regular business hours outpatient service providers will provide crisis intervention to enrolled
members who are in a crisis and in the presence of their treatment provider. Crisis assessment and
intervention should occur where the member is and when it is needed by the outpatient service
provider that is with the member at the time of crisis. Therefore, the “provider” may be the assigned
clinical team or another provider agency engaged in providing services to a member.
Crisis intervention services include assessment, de-escalation techniques and crisis counseling as
well as crisis and follow up planning by a case manager, clinical liaison, behavioral health
professional, or prescriber. In some situations crisis intervention may include need for an evaluation
for a medication change by a prescriber followed by close monitoring by the clinical team.
Other times, the intervention may involve providing wrap around services to the person in the
community such as accessing the person’s support system, activating the person’s WRAP plan and or
advance directive, seeking respite services, or coordinating with a High Needs Recovery Center and
Low/Moderate Needs Recovery Center to provide the necessary wraps.
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If there are no other safe alternatives, placement in a psychiatric facility may be needed on an
emergency basis. In these situations, the prescriber can facilitate a direct admission to a receiving
psychiatric facility. If hospitalization is needed, the prescriber must have knowledge of and be able to
attest to the need for an inpatient admission. Case managers and other direct service staff will
conduct bed searches and make arrangements for admission. The prescriber will be required to
complete a doc to doc phone call to the admitting agency. In these situations, there is no need to
send the member out for medical clearance unless the receiving facility (or sending prescriber) has a
symptom generated concern that must be evaluated medically.
Outpatient providers will ensure there is sufficient staff coverage including protocols outlining the
chain of command when a member is in crisis and in need of immediate intervention. In addition,
contractual agreements between Cenpatico Integrated Care and intake providers require all said
agencies (ACTS, Community Bridges, CHA, Crossroads Mission, Helping Associates, HHW, and
Providence) to have urgent and emergency appointments available to ensure that enrolled members
can be seen at the agency when an emergency arises.
Crisis Services
The NurseWise Crisis Line
The NurseWise crisis line is available 24 hours a day, 7 days per week by calling 866-495-6735. If a
crisis mobile team (CMT) is needed the request must be made to NurseWise who will triage and
dispatch CMTs. NOTE: All intake provider agencies are also available to members for intensive
wrap (supportive) services providing the necessary supports to avoid crisis and or out of
home placement.
Crisis Mobile Teams
The Mobile team provider in Yuma is CHA. Crisis Mobile Team assessment and intervention services
are available to any person in the County regardless of insurance or enrollment status.
Intake and Care Coordination Agencies (ICC Agencies)
ICC Agencies are also available to members for intensive wrap (supportive) services providing the
necessary supports to avoid crisis and/or out of home placement and can conduct crisis assessment,
brief intervention and treatment for members at their facility who are in crisis. High Need Recovery
Centers are also available after hours as needed. The High Needs Recover Centers in Yuma County
are ACTS, CHA and SEABHS.
What is considered a crisis?
A crisis is measured by the person experiencing it. If the situation exceeds the person’s coping skills,
the person is in crisis.
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Can the crisis system take calls for people diagnosed with a developmental disability, Alzheimer’s or
dementia? Yes. There are no medical conditions that exclude a person from receiving crisis services.
The crisis line and/or crisis team can assess, intervene and make recommendations for any person in
crisis. It is important to note that in order for the person to be admitted to a psychiatric facility under
his or her insurance, he or she must have a treatable psychiatric condition.
Crisis Mobile Team Response in the Community
Services Available
A Crisis Mobile Team is available to all persons in the community to assist persons in overcoming a
crisis situation, assess for the need for an out-of-home placement, and coordinate safety planning.
Crisis Mobile Teams are committed to responding to the community including but not limited to places
such as the home, school, church, the streets, the ER, and jails. There is no need to bring a person in
crisis to the Emergency Room unless there is a medical emergency. NOTE: CMTs are required to
have vehicles to facilitate transportation and field interventions as well as lap tops, and cell
phones for communications.
Services available to private psychiatrists (in office)/persons at a local psychiatrist’s officeA crisis mobile team can be requested by a local psychiatrist by calling NurseWise at 866-495-6735.
The CMT will provide assessment, crisis intervention and recommendations for further treatment (if
applicable). A CMT is not able to facilitate an inpatient admission for a person with private insurance
under the care of a private psychiatrist. In these situations, the private psychiatrist would be
responsible for facilitating an inpatient admission by coordinating with the person’s insurance carrier
and or facilitating a direct admission to a psychiatric facility.
Response on the ReservationsSee the IHS [Indian Health Services] Guide for Services from Cenpatico Integrated Care for more
details. Cenpatico Integrated Care serves the entire county and is obligated to provide crisis services
to any person who requests services in the county. CMTs are permitted to provide mental health and
crisis services on reservation land. Police escorts can be arranged on reservations as needed.
Reservation areas included in Yuma County are:


Cocopah Indian Community
Fort Yuma Indian Community-NurseWise is available by phone. CMTs will be
dispatched within the Yuma County section of the reservation.
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Note: Neither Cenpatico Integrated Care nor its contracted agencies have the authority
to remove a Native American person involuntarily from tribal land or petition a person
under a Title 36 on Tribal land.
The Recovery Opportunity Center (ROC) – Living Room Model
The ROC is a program run by CHA that offers crisis services 24 hours per day, 7 days per week, in a
safe and supportive environment. The ROC accepts law enforcement referrals 24/7 and referrals
from other agencies after 5:30PM Monday through Friday or anytime on Saturday, Sunday or
Holidays. There are no limitations on who is served other than the person needs to be voluntary and
want help for a behavioral health crisis (this includes substance use). Services are for those 18 years
and older and who are voluntary. Services cannot exceed 23 hours. The number is (928) 376-0026,
extension 1236.
Involuntary Persons in Need of Mental Health Treatment
Yuma County contracts with HHW to provide Involuntary (Title 36) pre-petition screenings and
inpatient evaluations.
HHW has several 24/7 phone numbers that can be called to request T36 screenings: 928-373- 6751;
6753; or 6754. There is also a dedicated fax for paperwork related to a T36 or (928-726-9799).
For all enrolled persons who have received CMT services and are admitted to the HHW SAF, HHW
will provide NurseWise with a disposition upon discharge including the present legal status of the
person. Per ARS 36-545.06 “Each county… shall provide directly or by contract the services of a
screening agency and an evaluation agency for the purposes of this chapter” [Title 36 Chapter 5].
A person in the ED
NOTE: YRMC ED staff DO NOT need to wait until the person is medically cleared before calling
MHW. The only exception would be if the person is unable to communicate or is severely
medically compromised.
If a person is in need of mental health treatment but is not voluntary, Horizon Health & Wellness will
be contacted. If NW is called, they will warm line transfer the call to HHS. The person who observed
the petitionable behavior will need to fill out the Application for Emergency Admission (form MH 104).
The petition paperwork will need to be faxed to Mountain Health & Wellness. The “applicant” will be
asked by the ED staff to leave contact information with the ED so the applicant can be contacted
should MHW have additional questions about the petition. Note: Witness statements should be
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gathered by HHW staff and not the CMT. If the CMT is on scene, they can provide HHW with
information about other potential witnesses on scene.
1. HHW, as the screening and mental health evaluation agency will determine based on the
paperwork submitted and any assessments completed, if there is probable cause to believe
that the person is a danger to self or others due to mental disorder and the person is
involuntary.
2. If the HHW psychiatrist agrees that the person should be admitted for involuntary evaluation,
HHW will arrange placement and transportation as follows:
3. Transports will be handled individually based on the parameters outlined below:
a. Persons who are medically compromised must go by ambulance
b. Persons who are going out of town should be looked at on an individual basis and may
be transported by ambulance or law enforcement.
c. Law Enforcement should be contacted if the person is combative or there is a threat to
the safety of the community. Law Enforcement will determine if they need to transport
the person after arriving on scene.
4. Whoever transports the person under a COE will also need to obtain the original Application
for Emergency Admission (form MH 104) and deliver it to the receiving facility.
5. Note: Applications that need to be notarized during normal business hours or after hours need
to be coordinated with Mountain Health & Wellness (HHW). HHW has several 24/7 phone
numbers that can be called to arrange the notary process: 928-373- 6751; 6752; 6753; or
6754.
Special questions
What if the person is found to be petitionable on a non-emergent basis (PAD and/or GD)?
MHW will facilitate the Title 36 process on a non-emergency basis. In this situation only a judge can
order a mental health pick up and the paperwork is filed with the court for this authorization. In these
situations, safety plans must be put in place until the paperwork is approved.
1. What if the person does not meet criteria to be screened for a T36 and the evaluating
agency’s admitting officer does not agree that the person should be brought in? The
CMT would need to ensure that there is a safety plan in place for the person before clearing
the scene. NOTE: A screening should not be declined solely due to the person being under
the influence of a substance. T36 does require evidence of a mental illness but this does not
preclude the presence of a co-occurring disorder.
2. What if a bed is secured but the evaluating agency is requiring medical clearance for a
person in the community? The County Attorney’s office will work on getting an order from
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the Court requiring law enforcement to take the member to the hospital for medical clearance
and then to the evaluating agency. If the medical director is issuing the apprehend and
transport order, he or she can also edit it to state that the member first has to go to the hospital
for med clearance (identify hospital and address to take patient to) and then to facility (identify
facility and address).
3. Can an outpatient agency call a mobile team at any time during business hours for a
crisis intervention? No, the CMT is only contacted when the outpatient provider cannot
engage the person in treatment voluntarily.The outpatient clinic can complete the petition and
fax it to HHW and wait for a reply, unless it is a PAD.
A person in the community
If a person in the community is in need of mental health treatment but not voluntary, NurseWise will
be contacted and a Crisis Mobile Team (CMT) will be requested. The CIA CMT will meet with the
person where they are and attempt to engage the person in treatment voluntarily. If the CMT is
unable to do so, and the person is dangerous to self or others, the CMT will need to refer the person
to MHW for a Title 36 screening following steps 1-7 listed below. Note: Witness statements should
be gathered by MHW staff and not the CMT. If the CMT is on scene, they can provide MHW
with information about other potential witnesses on scene
1. The CMT will call MHW and give a verbal summary of the presenting issues, results of the
assessment, and any other pertinent information needed for a Title 36 screening and for
subsequent discharge planning. The person that witnessed the petitionable behavior will need
to fill out the Application for Emergency Admission (form MH 104) and will need to be available
to MHW staff in case additional information is needed.
2. If possible, the petition should be faxed to Mountain Health & Wellness (MHW). If this is not
possible, it can be read over the phone to the triage RN at MHW.
3. MHW, as the screening and mental health evaluation agency, will determine based on the
information received if there is probable cause to believe that the person is a danger to self or
others due to mental disorder and that the person is involuntary.
4. If the MHW “Admitting Officer” (a psychiatrist or Nurse Practitioner trained in psychiatry)
agrees that the person should be admitted for involuntary evaluation, MHW will arrange
placement and transportation as follows:
a. Transportation from the community to the SAF: MHW prepares a pick up order which
is signed by the Admitting Officer. MHW will fax the pick-up order form to the
appropriate law enforcement (LE) agency dispatch and will call to verify receipt of the
fax. The LE agency will pick up the person from the community and transport to MHW.
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Note: At the time of pick up, law enforcement will also obtain the original Application for
Emergency Admission (form MH 104) and will deliver it to MHW
5. ALL other transports* will be handled individually based on the parameters outlined below:
a. Persons who are medically compromised must go by ambulance
b. Persons who are going out of town should be looked at on an individual basis and may
be transported by ambulance or law enforcement.
c. Law Enforcement (LE) should be contacted if the person is combative or there is a
threat to the safety of the community. Law Enforcement will determine if they need to
transport the person after arriving on scene.
* “Other” Transports include those from the community to a Licensed Hospital facility
outside of Yuma, transports from the ER or other facility (such as an outpatient agency)
6. Whoever transports the person under a COE will also need to obtain the original Application
for Emergency Admission (form MH 104) and deliver it to the receiving facility.
7. The CMT will be available as a witness for the Title 36 petition if needed. MHW will notify the
CMT member at their earliest convenience if they are to be named as a witness.
A person at an outpatient clinic during office hours
During regular business hours, service providers will provide crisis intervention to members enrolled in
their agencies who are in a crisis and in the presence of their treatment provider. The clinical team
should provide services as outlined in the section entitled Crisis During Business Hours. If the team is
unable to engage the person in treatment voluntarily, and the person is danger to self or others, the
team will need to refer the person to HHW for a Title 36 screening following steps 1-6 listed below.
NOTE: Witness statements should be gathered by HHW staff and not the CMT or Clinical
Team. If the CMT or Clinical Team is on scene, they can provide HHW with information about
other potential witnesses on scene
1. The outpatient team staff member will call HHW and give: a verbal summary of the presenting
issues, results of the assessment, and any other pertinent information needed for a Title 36
screening and for subsequent discharge planning. The person that witnessed the petitionable
behavior will need to fill out the Application for Emergency Admission (form MH 104) and will
need to be available to HHW staff in case additional information is needed.
2. The outpatient team staff member(s) will ensure that the Application for Emergency Admission
(MH104) and any available recent behavioral health assessments are faxed to MHW.
3. HHW as the screening and mental health evaluation agency, will determine based in the
paperwork submitted if there is probable cause to believe that the person is a danger to self or
others due to mental disorder and that the person is involuntary.
4. If the HHW “Admitting Officer” (a psychiatrist or Nurse Practitioner trained in psychiatry)
agrees that the person should be admitted for involuntary evaluation, HHW will arrange
placement and transportation as follows:
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a. Transports will be handled individually based on the parameters outlined below:
i. Persons who are medically compromised must go by ambulance
ii. Persons who are going out of town should be looked at on an individual basis
and may be transported by ambulance or law enforcement.
iii. Law Enforcement (LE) should be contacted if the person is combative or there
is a threat to the safety of the community. LE will determine if they need to
transport after arriving on scene.
5.
Whoever transports the person under a COE will also need to obtain the original Application
for Emergency Admission (form MH 104) and deliver it to the receiving facility.
6. The outpatient team staff member(s) will be available as a witness for the Title 36 petition if
needed. MHW will notify the staff member(s) at their earliest convenience if they are to be
named as a witness.
When law enforcement are involved (ARS 36-525(B))
If law enforcement encounter a person who appears to be in a psychiatric crisis and who refuses
voluntary psychiatric evaluation the officer must determine whether there is probable cause to suspect
this person may be suffering from a mental illness and could meet the criteria for danger to self and or
others. If the peace officer determines this to be the situation, the peace officer can transport the
person to HHW or to a mental health screening agency. (See section entitled Title 36 Transports to
HHW by Law enforcement). The person that observed the petitionable behavior will need to fill out
the paperwork to initiate an evaluation for involuntary treatment. HHW will assist law enforcement
and or the applicant as needed in determining the standard by which the person will need to be
petitioned as well as the proper forms to complete. NOTE: The original Application (MH 104) must
be delivered to HHW or the evaluation and assessment agency along with the person being
petitioned. La Paz County Sheriffs will require the transport order to be notarized.
What if the person remains involuntary but does not meet DTS or DTO criteria? It is possible
that this person may need to be petitioned on a non-emergency basis (PAD and/or GD). It is
recommended that law enforcement call NurseWise and request a CMT. The CMT will complete an
assessment, intervention, and a safety plan. If applicable, the CMT will refer the person to MHW for a
non-emergency Title 36 basis. In this situation only a judge can order a mental health pick up and the
paperwork is filed with the court for this authorization. In these situations, safety plans must be put in
place until the paperwork is approved.
What if probable cause cannot be established by law enforcement?
If probable cause cannot be established and there appears to be a behavioral health crisis, law
enforcement should follow internal departmental protocols. If department protocols allow AND if it is
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safe to do so, a CMT can be requested by calling NurseWise. The CMT will assess and intervene in
the crisis.
A person who is detained and involuntary for treatment at the Yuma
County Jail
If the inmate is refusing all treatment offered and is dangerous to self or others, persistently and
acutely disabled or gravely disabled, the jail may call HHW and advise them that an inmate in the jail
is in need of an involuntary Title 36 screening. If the jail calls NurseWise, the call will be warm-lined to
HHW.
The jail staff shall give a verbal summary of the presenting issues to MHW including the results of any
recent assessments and any other pertinent information needed for a Title 36 assessment and for
subsequent discharge planning. The person that observed the petitionable behavior will need to fill
out the paperwork to initiate an evaluation for involuntary treatment. MHW will assist the jail staff in
determining the standard by person will need to be petitioned as well as the proper forms to complete.
The jail staff may also need to be available as a witness for the Title 36 petition and MHW should
notify any potential witnesses at their earliest convenience if they are to be named as a witness.
An involuntary person on the Cocopah Indian Reservation
Note: Neither Cenpatico Integrated Care nor its contracted agencies have the authority to
remove an American Indian person involuntarily from tribal land or petition an American Indian
person under a Title 36 on Tribal land.
If there is a crisis and a need for involuntary treatment of a person on the reservation, NurseWise and
the CMT will work with Tribal Police to ensure the safety of the member.
Non-Emergency Requests for Involuntary Evaluation (PAD or GD)
All non-emergency petitions should be coordinated with Mountain Health & Wellness (MHW). MHW
has several 24/7 phone numbers that can be called to request T36 screenings: 928-373-6751; 6752;
6753; or 6754. There is also a dedicated fax for paperwork related to a T36 (928-344-8950) or (928726-9799). In these situations, safety plans must be put in place until the paperwork is approved.
Note: If a person is enrolled in an active episode of care with a local agency, that agency should
facilitate the non-emergency petition and work with MHW to get the screening completed and petition
filed.
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Voluntary Crisis Services for incarcerated persons
At the Yuma County Jail
If an inmate in the jail is in a psychiatric crisis the jail can call NurseWise and request a Crisis Mobile
Team (CMT). The CMT can provide crisis assessment and short term crisis intervention as well as
recommendations to detention staff. The CMT can only make recommendations to the jail and cannot
remove a person from the jail to facilitate further treatment.
At a Juvenile Detention Center
If a juvenile in detention is in a psychiatric crisis the detention center can call NurseWise and request
a Crisis Mobile Team (CMT). The CMT can provide crisis assessment and short term crisis
intervention as well as recommendations to detention staff. The CMT can only make
recommendations to the detention center and cannot remove a person from the center to facilitate
further treatment. If the CMT does recommend a higher level of care for a juvenile in detention, the
detention center will follow internal protocols to ensure placement in an appropriate treatment setting.
The NW/outpatient clinical team can assist with locating an appropriate treatment setting. The
Detention Center has internal protocols to address a juvenile in detention who is not voluntary for
treatment.
NOTE: Contractual agreements between Cenpatico Integrated Care and local intake and care
coordination agencies (ACTS, CIA, HHS, CBI, CRM. Helping Associates, Providence and MHW)
require all said agencies to coordinate care of enrolled members with the jail system.
Coordination of care can be achieved by visiting the inmate and or participating in treatment
and release planning for enrolled members
Revocation of the outpatient treatment of an existing COT (RCOT)
(ARS.36-540.01 I)
If all attempts at outreach and engagement and crisis planning have failed to re-engage a member
under court ordered treatment, a revocation of outpatient treatment may be necessary. This
revocation would result in re-hospitalization of the member.
NOTE: The need for medical clearance will be determined on a case by case basis. The mobile team
should coordinate with the admitting officer of the evaluation agency to identify the need for such
clearance If medical clearance is requested by the receiving facility, the clinical team/CMT must find
out the reason for the request and document this in the clinical record. In some cases, unnecessary
medical clearance may be avoided if recent health assessment documentation can be provided to the
receiving facility or a doc to doc can help rule out medical concerns.
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During Regular Business Hours
Revocations are the responsibility of the assigned outpatient agency’s clinical team, led by their
Medical Director. MHW will provide technical assistance as needed to provider agencies during the
revocation process. Each agency will ensure the proper paperwork is filled out and filed with the
court. The agency will also be responsible for arranging for transportation of the member to a
Licensed Hospital facility. The member’s clinical team will be responsible for locating a bed.
Process for T19, Non-Medicare members who will be admitted to HHW-SAF
1. The Medical Director/Designee of the outpatient treatment agency will complete a “Re-Admit
under T-36” and the “rescission of Order” form.
2. The Medical Director/Designee of the treatment agency is required to provide an original
signature on both forms. The team will make 4 copies of each form for filing.
3. The treatment team will call the SAF triage RN and give information regarding presenting
concerns so the HHW triage paperwork can be completed.
4. The SAF RN will:
a. Run a Medifax and confirm AHCCCS coverage.
b. Contact the SAF Medical Director/Designee to discuss the case and receive admitting
orders if applicable.
c. Contact the referring treatment agency to inform them of the admission status.
5. The outpatient treatment agency will fax a Pick-Up Order signed by their Medical
Director/Designee to the appropriate law enforcement agency. Note: If the person is at a local
outpatient agency, other transportation arrangements may need to be made.
6. The referring outpatient treatment agency will deliver the original “Re-Admit Under T-36” and
“Rescission of Order” form to the Yuma County Clerk of the Superior Court. One copy is given
to the County Attorney’s office, one is given to the judge (at the information desk), one is given
to the SAF and one is placed in the client record.
7. These forms must be filed with Yuma County Superior Court within 24 hours of the admission
of the person on COT (excluding weekends and holidays).
8. When the member is ready for discharge, the following documents need to be filed by the
outpatient clinical team with the Yuma County Clerk of Superior Court within 24 hours of
discharge: “Medical Directors Order for Conditional Outpatient Treatment” and “Outpatient
Treatment Plan.” These forms must have an original signature of the Medical Director of the
Outpatient Treatment agency. The agency will make two copies of the documents to be filed
as follows:
a. One original packet to be filed with the Yuma County Clerk of Superior Court. Note:
The documents will be stamped by the Yuma County Clerk of Superior Court.
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b. One copy to be delivered to the Yuma County Attorney’s Office (located in the
basement of the Superior Courthouse).
c. One copy to be filed in the member’s medical record.
Medicare members and medically compromised persons who will not be admitted to
HHW SAF
1. The Medical Director/Designee of the outpatient treatment agency will complete a “Re-Admit
under T-36” and the “rescission of Order” form.
2. The Medical Director/Designee of the treatment agency is required to provide an original signature
on both forms. The team will make 4 copies of each form for filing.
3. A thorough Medicare bed search must be conducted by the outpatient treatment agency. The
team will contact inpatient psychiatric facilities appropriate for the member (e.g. Medicare
providers or hospitals that can take a medically compromised person) and fax referral packets so
the member can be put on the waiting list for admission. Continued communication with the
hospitals is imperative. Note: If after a thorough Medicare bed search, no bed can be found for a
Medicare funded member, the MHW SAF could admit the person to their facility. In this case,
follow steps outlined in the section above entitled “Process for T19, Non-Medicare members who
will be admitted to HHW-SAF”).
4. The outpatient treatment agency must facilitate transportation of the person to the accepting
psychiatric facility. If the member being amended is combative or threatening, local law
enforcement can be called for assistance. Upon arriving on scene, Law Enforcement will
determine if they will transport the person. If the person is medically compromised, an ambulance
can be arranged.
5. The referring outpatient treatment agency will deliver the original “Re-Admit under T-36” and
“rescission of Order” form to the Yuma County Clerk of the Superior Court. One copy is given to
the Deputy County Attorney’s office, one is given to the judge (at the information desk), one is
given to the SAF and one is placed in the client record.
6. These forms must be filed with Yuma County Superior Court within 24 hours (excluding weekends
and holidays) of the admission of the person on COT.
7. When the member is ready for discharge, the following documents need to be filed by the
outpatient team with the Yuma County Clerk of Superior Court within 24 hours of discharge:
“Medical Directors Order for Conditional Outpatient Treatment” and “Outpatient Treatment Plan.”
These forms must have an original signature of the Medical Director of the Outpatient Treatment
agency. The agency will make three copies of the documents to be filed as follows:
 One original packet to be filed with the Yuma County Clerk of Superior Court. NOTE:
The documents will be stamped by the Yuma County Clerk of Superior Court. One
copy to be delivered to the Yuma County Attorney’s Office (located in the basement
of the Superior Courthouse). One copy to be filed in the member’s medical record.
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After Hours
The CMT can be called to intervene in a crisis and will take necessary steps to assure the safety of
the person and the community. If the Medical Director/Designee of the treatment agency cannot be
located and the person remains involuntary HHW SAF about getting the person admitted under a
COE. (See section entitled “Involuntary Persons in Need of Mental Health Treatment). Note: In this
case, the assigned outpatient treatment agency would be contacted during the first regular business
hour of the week so they can complete a COT revocation and the new court order would be dropped.
They would follow the process outlined above and omit the bed search and transportation steps.
Direct Admission to a Licensed Hospital (Acute or Sub-Acute) Psychiatric
Inpatient Facility
Note: A direct admission can occur without medical clearance barring any symptom driven reasons
for a medical screening. If the person has a guardian, the guardian must consent to the treatment
and sign for admission.
For all enrolled persons who have received CMT services and are admitted to MHW Sub-Acute facility
(SAF), HHW will provide NurseWise with a disposition upon discharge including the present legal
status of the person.
By outpatient providers (voluntary only)
Outpatient providers serving enrolled Cenpatico members are able to seek direct admissions to
Licensed Hospital facilities for their enrolled voluntary members if they determine that an emergency
admission is needed during regular business hours. In these situations, there is no requirement for
pre-authorization or a Certification of Need (CON) (per Provider Manual section 3.14). (See the
section entitled Crisis During Business Hours for more details.
By crisis mobile teams (voluntary only)
CMTs can refer persons in a mental health crisis who are voluntary for treatment to a Licensed
Hospital facility for direct admission. NurseWise will conduct bed searches and facilitate placement in
these situations. In these situations there is no reason to take the person to the ED prior to
admission. The admitting psychiatrist may request, based on symptom driven concerns that the
person be medically screened for prior to admission. If medical clearance is requested, NurseWise
and/or the CMT will gather information about the specific medical symptoms or concerns that require
medical clearance and will ensure this is documented. This information will also be clearly relayed to
YRMC case management (in the day-time) or the charge nurse (after hours). Once accepted to a
facility, NW will arrange transportation or the CMT can transport the member if the transport does not
interfere with crisis call response. NOTE: In La Paz and Yuma Counties all T19 persons who are
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seen by a CMT and need transportation to a higher level of care are eligible and should be
transported by Saguaro Transportation. (See “Crisis Transportation for Voluntary Title 19 & 21
persons in need of a higher level of care”). NurseWise will arrange this transport.
Title 36 Transports to Mountain Health and Wellness by Law Enforcement(See section entitled “When law enforcement are involved”)
MHW’s 24 hour phone numbers are: 928-373-6751; 6752; 6753; or 6754.
Basic Transport
Law Enforcement is able to take involuntary persons directly to MHW if the following conditions have
been met. (MHW prefers a courtesy call from law enforcement prior to or en route to MHW, but this is
not required.)
1. There is probable cause to believe this person is a danger to self or others and may be
suffering from a mental disorder. (If probable cause has not been met, refer to the section
“When law enforcement are involved”).
2. There is no obvious medical emergency that must be addressed before mental health
concerns are addressed.
3. The person that observed the petitionable behavior will need to fill out the paperwork to initiate
an Application for Emergency Admission (MH 104). MHW will assist law enforcement and or
the applicant as needed in determining the standard by which the person will need to be
petitioned as well as the proper forms to complete. In these situations, the original Application
(MH 104) must be delivered to MHW along with the person being petitioned.
4. The officer/Deputy will give a verbal report to MHW staff regarding the person and the
circumstances.
Medically compromised clients
1. If there is reason to believe the person being transported may be medically compromised, it
may be recommended that the person be medically cleared prior to arriving at MHW.
2. If the person arrives at MHW and is found to be medically compromised, MHW will arrange for
an ambulance to pick up the person and take them to the ED for medical clearance. If there is
reason to believe the person is dangerous and presents as a safety risk for transport, law
enforcement can be called and a “stand by” requested. In these situations, MHW staff should
call the ED and alert the charge nurse that security will be needed on standby.
3. MHW will also make arrangements to return the person to MHW after the person is medically
cleared (if the person is not admitted to the hospital and is still under T36 Petition).
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Coordination of Care with Local Hospitals
Per the ADHS/DBHS Provider Manuel coordination and communication should occur with any known
medical provider of a RBHA enrolled member. (Please see Emergency Room Guide
Enrolled Persons
In order for a person to be placed by Cenpatico Integrated Care in an inpatient psychiatric level of
care (Licensed Hospital or sub-acute), the person must have an inpatient benefit as follows:




Active with AHCCCS (Title 19)
Active w/ Indian Health Services AHCCCS
Active with KidsCare (Title 21)
Active with SSI/MAO
In any
RBHA
NON-enrolled persons
Any person presenting in the emergency room in a mental health crisis is eligible for crisis services.
The CMT will complete a crisis assessment, crisis intervention and referral. For those who arrive at
the emergency room and have private insurance, the person’s private insurance should be accessed
to assist the person.
Coordination with YRMC on medically admitted patients enrolled with an outpatient
service provider
1. If a person who is enrolled with an outpatient provider is admitted to the hospital for medical
reasons, a member of the clinical team should be available to coordinate care with Hospital
staff within 24 hours of admission. The clinical team should also be involved in the discharge
plan for the admitted member to ensure mental health needs are met.
2. Hospital staff’s facilitating discharge plans are able to access NurseWise for well checks for
persons being discharged and at risk. This can be accomplished only with the agreement and
participation of the patient. Hospital staff will need to clearly outline the clinical reasons for a
wellness check and will need to allow the patient to speak to NurseWise about the plan. Note:
these services are available for both enrolled and non-enrolled persons.
3. CMTs are unable to respond to medical floors.
4. Please note that this does not apply to Title 36 petitions. If a medically admitted patient is
involuntary for treatment and meets the criteria for an emergent (DTS/O) or non-emergent
petition (PAD, GD), please contact MHW to request a Title 36 screening. There is no statutory
reason why the petition process cannot be facilitated on a medical floor; however, the patient
must be medically stable so the patient can be discharged from the hospital
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Meeting Attendance
The strength of the crisis system is in part dependent upon the level of participation of involved
stakeholders, the RBHA and local agencies. Successful meetings will also require a focus on
systems issues. Specific complaints about individual situations should be handled as outlined in the
Problem Resolution Process. All parties agree to have representation at meetings and agree to
participate actively in the process.
The Yuma County Mental Health Crisis Systems Meeting
This meeting has been established as a primary means for stakeholders, the RBHA and RBHA
contracted agencies to discuss and examine the current procedures to address and intervene during
a mental health crisis. The group represents a collaborative effort to identify barriers and strengths in
the crisis system and to develop agreements and processes to build on strengths and resolve
barriers.
Regular Crisis Team Meetings
Cenpatico Integrated Care holds meetings on a bi-weekly basis to follow up with Crisis Mobile Team
providers and NurseWise staff on how the crisis system is working.
Problem Resolution Process
Conflicts between specific agencies or regarding specific situations will be handled between the
agencies involved. Cenpatico Integrated Care is always willing to assist in this process if called upon
to do so. It is agreed that problem resolution is best completed in real time by following the chain of
command. A list of administrators on call has been distributed to facilitate more rapid problem
resolution.
It is agreed upon that for effective problem solving, system issues that present a problem will be
discussed in the Yuma County Mental Health Crisis Systems Meeting.
The Emergency Services Liaison is also a resource for Yuma County when concerns arise. The
Liaison can help resolve problems related to specific situations as they relate to the crisis system and
can also help file official complaints with Cenpatico Integrated Care Customer Service if necessary.
Drug and or Alcohol Use - Services Available
Per ADHS Practice Protocol Co-occurring Psychiatric and Substance Disorders, “Assessment begins
at the point of clinical contact, regardless of the client’s clinical presentation. Initiation of assessment
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should not be made conditional on arbitrary criteria such as length of abstinence, non-intoxicated
alcohol level, negative drug screen, absence of psychiatric medication, and so on.”
Thus, a person under the influence who self identifies as being in crisis is eligible for the array of crisis
services offered by the RBHA. There is no requirement for the person to reach a certain level of
sobriety before being assessed. The only requirement is that the person must be able to physically
participate in an interview.
1) The Title 36 statute does not preclude a person under the influence of substances from
being petitioned for involuntary treatment. The statute does require that there be
evidence of a “mental disorder” as defined in ARS 36-501.26. Which hospitals / clinics/
providers will treat court ordered patients?
Crossroads Mission:
Crossroads is a level four drug and alcohol treatment facility that has 16 beds available to treat
persons with substance use problems. A person can stay at Crossroads for up to 10 days based on
clinical need. They also have outpatient substance use services.
Transfers of Care-As a result of the ‘no wrong door’ philosophy, once assessed, persons in crisis
may need to be transferred from one facility to another in order to receive the most appropriate
treatment. There should be processes in place for transfers from MHW SAF to Crossroads Mission
as well as processes for Crossroads Mission to transfer clients to the SAF as clinically appropriate.
Transfers to Crossroads Mission –Crossroads’ 24 hour phone number is (928) 783-9362, extension
22. Please call first. A person under the influence of a substance may be a candidate for Crossroads
Mission if:



The person is not medically compromised
The person is voluntary for treatment
The primary concern is drugs and or alcohol
Referrals to Crossroads- (ID is required for all persons):





Law enforcement can bring persons to Crossroads; please call first
A CMT can bring a person in (please call first)
A case manager can bring a person in (please call first & bring a recent assessment, treatment
plan and referral for services)
Client can self-refer
Transfers from MHW’s SAF
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Note: Crossroads employs Emergency Medical Technicians (EMTs) who can conduct a basic
medical screening to identify any potential acute medical concerns as well as Nurse Practitioners who
can address minor medical issues. If medical care is needed, Crossroads will request an ambulance
to transport the person to the YRMC ER.
Yuma SAF (HHW Sub-Acute Facility)
The Yuma SAF accepts detox referrals from outpatient providers, CMTs, ERs and self-referrals for
any person who is voluntary and enrolled with AHCCCS. The person must be accepted for
admission prior to arriving at the SAF and medical clearance is not a pre requisite for admission. Call
the main numbers to refer: (928-373-6751; 6752; 6753; or 6754).
Crisis Transportation for Voluntary Title 19 & 21 persons in need of a
higher level of care
Transportation for psychiatric emergencies is available in Yuma County through Saguaro
Transportation for voluntary T-19, and T-21 members who have been assessed by the Crisis Mobile
Team (CMT) and for whom the recommendation is inpatient stabilization or other higher level of care.
Saguaro transports statewide. NurseWise is responsible for arranging transportation through Saguaro
for all eligible members in Yuma and La Paz County.
Transportation Requirements:
 The CMT is unable to transport the person to the inpatient psychiatric facility
 AND the person does not require wound care, oxygen, or a catheter
 AND the person does not have any other medical condition requiring trained medical staff to
transport
 AND the person is voluntary
 AND the person is Title 19 or 21
Process: Call NurseWise and they will contact Saguaro Transportation and verify eligibility.
Persons in the ER: Crisis Mobile Teams are responsible for stapling a Saguaro alert to the crisis
assessment left at an ER for all eligible members. The Saguaro alert is a brightly colored cover sheet
that alerts the ER to call NurseWise to arrange transportation through Saguaro. The ER would then
know to call NurseWise who will contact Saguaro Transportation and verify eligibility as well as
arrange transportation.
Persons in the Community: Crisis Mobile Teams will call NW and request Saguaro transportation
for the member. NW will verify eligibility and contact Saguaro Transportation to arrange
transportation.
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PLEASE NOTE: The following stakeholders and providers participated in the development and review
of this protocol. These guidelines do not create or delegate obligations or financial responsibilities.
These guidelines are not a legal and binding contract or Memorandum of Understanding. They should
never override the obligation to provide the most clinically appropriate intervention based on each
individual situation nor should they override law or professional responsibility to members. Agencies
are encouraged to have adequate clinical supervision and guidance to support such actions.
Signatures
Arizona Counseling & Treatment Services
(ACTS)
Cenpatico Integrated Care
CIA Crisis Mobile Team (CMT)
Cocopah Tribal Police
Community Bridges
Community Intervention Associates (CIA)
Crossroads Mission
Helping Associates, Inc.
Horizon Human Services (HHS)
Mountain Health & Wellness (MHW)
Effective Date: 1/15/09
NurseWise (NW)
Providence Service Corp
San Luis Police Department
Somerton Police Department
Wellton Police Department
Yuma County Attorney’s Office
Yuma County Juvenile Justice Center
Yuma County Sheriff’s Office (YCSO)
Yuma Police Department (YPD)
Yuma Regional Medical Center (YRMC)
Last Revision Date(s): 7/31/2015
_____________________________________
Arizona Counseling and Treatment Services
Date: ___________________
____________________________________
Cenpatico Integrated Care
Date: ___________________
____________________________________
Cocopah Tribal Police Department
Date: ___________________
____________________________________
Community Bridges
Date: ___________________
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____________________________________
Community Intervention Associates
Date: ___________________
____________________________________
Crossroads Mission
Date: ___________________
____________________________________
Helping Associates, Inc.
Date: ___________________
___________________________________
Horizon Human Services (HHS)
____________________________________
Mountain Health & Wellness
Date: ___________________
Date: ___________________
___________________________________
NurseWise
Date: ___________________
___________________________________
Providence Service Corp
Date: ___________________
_____________________________________
Date: ___________________
San Luis Police Department
_____________________________________
Saguaro Transportation
_____________________________________
Date: ____________________
Date: ___________________
Somerton Police Department
____________________________________
Wellton Police Department
Date: ___________________
____________________________________
Yuma County Attorney’s Office
Date: ___________________
____________________________________
Yuma County Juvenile Detention
Date: ___________________
__________________________________
Yuma County Sheriff’s Office (YCSO)
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Date: ___________________
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____________________________________
Yuma Police Department
Date: ___________________
____________________________________
Yuma Regional Medical Center (YRMC)
Date: ___________________
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