2015
Cenpatico Crisis Protocols for
Cochise County
Cenpatico Crisis Protocols for Cochise County
Table of Contents
Overview & Purpose ............................................................................................................................................... 1
Goals of the Crisis System ....................................................................................................................................... 2
Definitions ............................................................................................................................................................... 2
Crisis during Business Hours ................................................................................................................................... 6
Crisis Services .......................................................................................................................................................... 6
The NurseWise crisis line (NW) ........................................................................................................................... 6
Crisis Mobile Teams ............................................................................................................................................ 7
Intake and Care Coordination Agencies (ICC Agencies) ...................................................................................... 7
What is considered a crisis? ................................................................................................................................ 7
Crisis Mobile Team Response in the Community.................................................................................................... 7
Services available ................................................................................................................................................ 7
Services available to private psychiatrists (in office)/persons at a local psychiatrist’s office ............................ 7
Crisis Services at Fort Huachuca, US Army Post .................................................................................................. 8
Involuntary Persons in Need of Mental Health Treatment..................................................................................... 8
A person in a Cochise County ER, in the community or at an outpatient clinic during office hours .................. 8
Special Questions .................................................................................................................................................. 10
Involuntary Treatment of Service Men/Women at Fort Huachuca, US Army Post .............................................. 10
During Business Hours ...................................................................................................................................... 10
After Hours ........................................................................................................................................................ 10
A person who is detained and not voluntary for mental health evaluation ......................................................... 11
At the Cochise County Jail ................................................................................................................................. 11
Voluntary Crisis Services for Detained Persons .................................................................................................... 11
At the Cochise County Jail ................................................................................................................................. 11
At a Juvenile Detention Center ......................................................................................................................... 11
Non-Emergent Requests for Involuntary Evaluation (PAD or GD) ........................................................................ 12
Revocation of the outpatient treatment portion of an Existing COT.................................................................... 12
During Regular Business Hours ......................................................................................................................... 12
Revocation of the outpatient treatment portion of a court order by a Judge .........Error! Bookmark not defined.
Cenpatico Crisis Protocols for Cochise County
After Hours ........................................................................................................................................................ 14
Direct Admission to a Behavioral Health Inpatient Facility (Acute or Sub-Acute) ................................................ 14
By outpatient providers (voluntary only) .......................................................................................................... 14
By crisis mobile teams (voluntary only) ............................................................................................................ 14
By another hospital (ED or medical floors) ....................................................................................................... 14
Coordination of Care with local hospitals ............................................................................................................. 15
Enrolled Persons................................................................................................................................................ 15
NON-enrolled persons ...................................................................................................................................... 15
Medically admitted members enrolled with an outpatient service provider................................................... 15
Persons Admitted to a Medical Floor who meet Title 36 requirements .......................................................... 15
Meeting Attendance ............................................................................................................................................. 16
The Cochise County Crisis System Meeting ...................................................................................................... 16
Regular Crisis Team Meetings ........................................................................................................................... 16
Problem Resolution Process.................................................................................................................................. 16
Drug and/or Alcohol Use ....................................................................................................................................... 16
Community Bridges (CBI) .................................................................................................................................. 17
Signatures .............................................................................................................................................................. 18
Involved parties:
Arizona’s Children Association (AZCA)
Arizona Counseling & Treatment Services (ACTS)
Benson Hospital
Benson Police Department
Bisbee Police Department
Canyon Vista Medical Center
Cenpatico
Cochise County Attorney’s Office
Cochise County Adult Probation Department
Cochise County Jail
Cochise County Juvenile Court Services
Cochise County Sheriff’s Office
Community Bridges
Community Intervention Associates (CIA)
Copper Queen Community Hospital
Corazon
Douglas Police Department
Northern Cochise Community Hospital
NurseWise
Pinal Hispanic Council (PHC)
Sierra Vista Police Department
Southeast Arizona Medical Center
Southeastern Arizona Behavioral Health Services
(SEABHS)
Tombstone Police Department
US Army Garrison Fort Huachuca
Huachuca City Police Department
Raymond W. Bliss Army Health Center
Overview & Purpose
The Protocols are guidelines that describe how we will all work together to ensure that behavioral health
services are delivered in Cochise County. The Purpose is to enhance the network and response capability to
address behavioral health crisis in Cochise 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 Cochise County Community
Stakeholders agree to coordinate activities to facilitate the implementation of crisis services in Cochise 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 Cochise 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- Terminology used to distinguish a person who is on AHCCCS and therefore ‘auto’enrolled with Cenpatico as the payer of behavioral health services and is also enrolled and is receiving services
from a Cenpatico contracted agency.
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.
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.
Application for Emergency Admission for Evaluation (Form A3)-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. Note: the attempt to complete the screening must still be documented and filed
with the original petition paperwork.
Application for Involuntary Evaluation (Form A2)-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.
Authorization for Apprehension and Transport (Form A-9.1) - Pursuant to A.R.S. §§ 36-524(E) and 36-525
which allows a peace officer to transport a person to a screening or evaluation agency.
Behavioral Health Inpatient Facility- 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 these protocols, a Behavioral Health Inpatient Facility does not
include residential treatment.
Business Hours-Monday through Friday from 8am to 5pm.
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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 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.
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 that, as a result of a mental disorder, will, without hospitalization, result 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 and University of Arizona
Medical Center-South Campus (UAMC-South). The preferred Evaluation Agency is Canyon Vista Medical Center
in Sierra Vista.
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.
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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.
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.
ICC Agencies are further divided into High Needs Recovery Centers (HNRC) and Low to Moderate Needs
Recovery Centers (LMNRC). ICC Agencies are required to screen members and refer them to either an HNRC or
an LMRC. ICC Agencies in Cochise County include Arizona Children’s Association, ACTS, CIA, Corazon, Pinal
Hispanic Council (PHC) and SEABHS.
Natural supports- Refers collectively to support commonly identified as:
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
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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- (Form MH 105) The prescribed form used to request a petition for
court-ordered evaluation. This form must be reviewed and signed by the Medical Director.
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, self-care, employment and recreation. Persons who are
deemed SMI are eligible for RBHA covered services.
Title 36- Arizona’s state law for mental health commitments. The law is located in the Arizona Revised
Statutes, Title 36 (Public Health and Safety) Chapter Five (Mental Health Services).
Title 36 prepetition screening-The review of an application requesting court ordered 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 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.
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.
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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 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 Generalist agency to provide the necessary wraps.
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 do 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. If medical clearance is requested the outpatient team 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.
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 and intake providers require all contracted agencies 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 (NW)
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.
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Crisis Mobile Teams
Mobile team providers in Cochise County include Community Bridges Inc. (CBI) and CIA. CIA covers Douglas
and Bisbee, and CBI covers Benson, Willcox and Sierra Vista. 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 Cochise County are ACTS, CIA 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.
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 them in overcoming a crisis
situation, assessing the need for an out-of-home placement, and coordinating 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, 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 cell
phones and laptops for communications.
Services available to private psychiatrists (in office)/persons at a local psychiatrist’s office
A 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
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admission by coordinating with the person’s insurance carrier and/or facilitating a direct admission to a
psychiatric facility. NOTE: This does not prevent a CMT from completing a T36 pre-petition screening at a
private psychiatrist’s office.
Crisis Services at Fort Huachuca, US Army Post
Fort Huachuca permits the CMT to respond with the premises of Fort Huachuca when contacted by a provider
at Raymond W. Bliss during normal duty hours. If NurseWise is contacted about a person in crisis on post and
the person is not an imminent danger to self/others, then arrangements can be made for the CMT to meet the
person away from Fort Huachuca. In this case, it is not necessary to send the person to the local ER since the
CMT can travel near the post and assess the person in the community. If NurseWise is contacted about a
person in crisis on post and the person poses an immediate risk, then Military Police must be notified at (520)
533-3000.
Involuntary Persons in Need of Mental Health Treatment
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].
In Cochise County the Crisis Mobile Teams (CMT) will conduct pre-petition screenings on behalf of the County
until the County secures a contract for these services. Pre-petition screening services are not a RBHA covered
service. The Crisis Mobile Team is accessed through NurseWise, the 24 hour crisis line for the County (1-866495-6735).
A person in a Cochise County ER, in the community or at an outpatient clinic during office
hours
If a person in the community is in need of mental health treatment but not voluntary, NurseWise will be
contacted at 1-866-495-6735 and a Crisis Mobile Team (CMT) will be requested. The 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 (if PAD or GD please refer to Non-Emergency Requests for
Involuntary Evaluation) the CMT will need to evaluate for involuntary treatment and begin the screening
process to refer the person to an evaluation facility for a Title 36 screening as follows: The CMT will ensure that
the Application for Emergency Admission for Evaluation (Form A3), witness statements and a behavioral health
assessment are completed and available for review. The person that witnessed the petitionable behavior will
need to fill out the Application for Emergency Admission for Evaluation (Form A3), the Applicant Statement re:
COE (Form A2b), and at least two Witness Statements. Notes: The CMT must ensure that witnesses are aware
that they will be required to testify in court. The applicant cannot fill out a witness statement.
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1. The CMT will complete a the petition packet which includes the following:
a. Form A01 Request to Initiate
b. Form A02 information sheet
c. Form A2 Application for Evaluation (must be signed and notarized)
d. Form A2b Applicant statement re: COE
e. Form A 3 Application for Emergency Admission for Evaluation
f. Form A5-Pre-petition screening report. Note: the attempt to complete the screening must
still be documented and filed with the original petition paperwork even if it is unable to be
completed.
g. Form A6.1 Petition for Evaluation signed by the medical director
h. Form A1.1– Two Witness statements - Emergency or A1.2 Non Emergent
i. Form A9.1 Authorization for apprehension and transport signed by the CMT’s medical
director or the evaluation agency’s admitting officer when there is an allegation of
dangerousness
2. The CMT will fax the paperwork to the receiving evaluation agency for review.
3. The admitting officer of the evaluation agency will decide if the person meets criteria to be admitted
for an evaluation and either accept or deny the patient. If the evaluation agency does not have a bed,
the CMT would complete a bed search for a receiving agency and would staff the petition with the
admitting officer of that receiving agency. NOTE: The need for medical clearance will be determined
on a case by case basis. The mobile team or agency should coordinate with the admitting officer of the
evaluation agency to identify the need for such clearance.
4. Once the bed is secured, the CMT will facilitate transportation to the evaluating agency. Per ARS §36525, when there is an allegation of dangerousness, a peace officer shall, upon the advice of the
admitting officer (the psychiatrist, medical doctor or mental health nurse practitioner at the
evaluation agency) apprehend and transport the person to an evaluation agency. Transportation will
be facilitated as follows:
a. The CMT staff will call local law enforcement and advise them they need a peace officer
transport for a T36 emergency evaluation.
b. Law enforcement will arrive on scene and transport the person to the evaluation agency.
5. The CMT will ensure that the original petition paperwork is filed with the County Attorney’s Office
within 24 business hours of the admission. Note: the paperwork should be scanned and emailed to
the following parties: Kaguilar@cochise.az.gov ; eorduno@cochise.az.gov ;
sblanchard@cochise.az.gov , aweems@cochise.az.gov
6. The agency or Crisis Mobile Team must advise the witnesses that they must be available to testify at a
hearing. The County Attorney’s Office will notify potential witnesses at their earliest convenience.
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Special Questions
1. What if the person is found to be petitionable on a non-emergent basis (PAD and/or GD)? The
evaluation agency will facilitate the Title 36 process on a non-emergent 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.
2. 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.
3. 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 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).
4. 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.
Involuntary Treatment of Service Men/Women at Fort Huachuca, US Army Post
During Business Hours (7:30am-3:30pm)
Active duty persons in crisis are received by the Raymond W. Bliss Army Health Center behavioral health unit
(BHU). If the person is a danger to self/others and needs hospitalization, the treatment professionals at the
BHU will coordinate admission and treatment. Civilian family members in crisis are received by the BHU. If the
civilian admission is on a voluntary basis, then the treatment professionals at the BHU will coordinate
admission and treatment. If the civilian admission is on an involuntary basis, then treatment professionals will
arrange transportation to Canyon Vista Medical Center.
After Hours (3:30pm-7:30am)
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Ft. Huachuca’s medical center closes at 3:30pm and reopens at 7:30am. Per Fort Huachuca internal protocol,
active duty service members AND civilian family members in crisis are transported by natural supports (family,
friends, etc) or ambulance to the Canyon Vista Medical Center.
A person who is detained and not voluntary for mental health evaluation
At the Cochise 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 liaison will complete the required paperwork to complete the Title 36
process. If a petition needs to be completed after regular business hours a CMT can be requested by calling
NurseWise. The jail staff shall give a verbal summary of the presenting issues to the CMT 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 contact the jail liaison
or the CMT, who will fill out the paperwork to initiate an evaluation for involuntary treatment. Jail staff shall
never be responsible for completing any Title 36 petition. After the Jail staff refers a person to the jail liaison or
CMT for evaluation, the jail liaison or CMT will perform all assessments, and will draft all necessary forms and
petitions besides witness statements. The jail staff must remain available as a witness for the Title 36 petition,
and the County Attorney’s Office should notify any potential witnesses at their earliest convenience if they are
to be named as a witness.
Voluntary Crisis Services for Detained Persons
At the Cochise County Jail
If a person in the jail appears to be in a psychiatric crisis, jail staff 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 provide its treatment recommendations to the jail for
provision to the County Attorney’s Office and the jurisdictional judge. The CMT cannot authorize the removal
of a patient from the jail to facilitate further treatment. If the CMT recommends further inpatient treatment,
they shall provide a written recommendation to the jail staff, who shall provide that document to the County
Attorney’s Office and the jurisdictional judge. If the judge orders the patient released for further treatment, jail
staff shall coordinate with the Civil Division of the County Attorney’s Office to make an arrangement for a
placement in a treatment facility, and will provide the transport of the patient to the treatment facility.
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
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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.
NOTE: Contractual agreements between Cenpatico and local intake provider agencies require all said agencies
to coordinate care of enrolled members with jails and detention centers. Coordination of care can be achieved
by visiting the person or participating in treatment and release planning for enrolled members.
Non-Emergent Requests for Involuntary Evaluation (PAD or GD)
All non-emergent petitions for persons who are NOT enrolled should be coordinated by calling NurseWise at
866-495-6735 and requesting a crisis mobile team.
All non-Emergent petitions for persons who are enrolled in an active episode of care with a local provider
should be facilitated by the person’s clinical team. In these situations the CMT would still need to complete the
screening and filing of paperwork.
NOTE: In these situations, safety plans must be put in place until the paperwork is approved.
Revocation of the outpatient treatment portion of an Existing COT
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. A revocation would result in rehospitalization of the member. Per ARS 36-540 (E) when a member returns to an inpatient setting under a COT
revocation, the member must be informed of their right to judicial review and the right to consult with counsel
pursuant to section 36-546. This must be documented in the clinical record.
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.
During Regular Business Hours
Revocations are the responsibility of the member’s clinical team. The team will ensure the proper paperwork
is filled out and filed with the court. The clinical team will be responsible for locating a bed. If the person on
COT has Medicare or other third party coverage, a thorough Medicare/TPL, a thorough Medicare bed search
must be completed. Transportation to the inpatient facility is arranged by the clinical team if the amendment
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is emergent and by the County Attorney’s office if it is non-emergent. In either case, coordination will occur
with local law enforcement.
Revocation of the outpatient treatment portion of a court order
a. The clinical team will complete the request for revocation of an outpatient treatment plan (Form C1)
and ensure it is signed by the agency’s medical director. The medical director can sign the form by
the next business day after a member is admitted to an inpatient facility.


For Emergent Revocations, the Clinical Team will prepare an Authorization for
Apprehension and Transport form (Form A91) which is signed by the medical director of
the outpatient facility. The clinical team will fax the Authorization for Apprehension and
Transport form (Form A91) to Local Law Enforcement Agency Dispatch and will call to
verify receipt of the fax. The Local Law Enforcement Agency will pick up the person and
transport to them to the receiving facility.
For Non-Emergent Revocations the County Attorney must prepare an order to Apprehend
and Transport to be signed by the court.
b. The clinical team will locate a bed for the person. (If the person on COT has Medicare or other third
party coverage, a thorough Medicare/TPL bed search must be completed). The receiving hospital
will need a copy of the original court order and request for revocation as well as clinical
documentation.
c. The clinical team will make 4 copies of the request for revocation of an outpatient treatment plan
form and, if appropriate, the Authorization to Apprehend and Transport. One to be ‘copy
stamped’ for the agency medical record, one copy for law enforcement to show at the time of pick
up, one to be scanned and emailed to the following parties: Kaguilar@cochise.az.gov;
eorduno@cochise.az.gov ; sblanchard@cochise.az.gov , aweems@cochise.az.gov and one for the
receiving inpatient facility.
d. Once a bed is found, the clinical team will arrange for transportation to the receiving facility as
follows:
e. The medical director’s original request for revocation of an outpatient treatment plan and the
original Application for Authorization to Apprehend and Transport will be mailed or hand
delivered to the County Attorney’s Office (attn. Kathy Aguilar) by the Clinical Team no later than
the next working day.
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After Hours
If a member on court ordered treatment is in need of an emergency revocation and it is after hours, the CMT
can coordinate the placement in an inpatient setting and assist in the revocation process NW will locate a bed
and coordinate the placement with the involved parties. The medical director of the agency that completed
the paperwork is responsible for signing the authorization to apprehend.
Direct Admission to a Behavioral Health Inpatient Facility (Acute or SubAcute)
Note: A direct admission can occur without medical clearance barring any symptom driven reasons requiring a
medical screening.
By outpatient providers (voluntary only)
Outpatient providers serving enrolled Cenpatico members are able to seek direct admissions to Behavioral
Health Inpatient Facility 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
Certificate of Need. (See Crisis During Business Hours for more details.)
By crisis mobile teams (voluntary only)
CMTs can refer persons in a behavioral health crisis who are voluntary for treatment to a Behavioral Health
Inpatient Facility for direct admission. NurseWise can assist the CMT with bed searches in these situations.
Once a bed is located, the CMT should call the facility to staff the situation and get approval for the person to
be admitted. In these situations there is no reason to take the person to the ED prior to admission. The
admitting officer may request, based on symptom driven concerns that the person be medically screened for
prior to admission. If medical clearance is requested, NurseWise or the CMT, or both 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 ED staff. Once accepted to a facility, NW can
assist the CMT in arranging transportation or the CMT can transport the member if the transport does not
interfere with crisis call response.
By another hospital (ED or medical floors)
Any medical hospital has the capability of transferring a person from the ED or a medical floor directly to
another medical facility that can address the psychiatric condition of the patient. In general, this practice
would require a doc to doc and would not require a call to NW or to the CMT. This may be beneficial for
persons who have private insurance, no insurance, or those who need medical detoxification services.
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Coordination of Care with local hospitals
Per the ADHS/DBHS Provider Manual coordination and communication should occur with any known medical
provider of a RBHA enrolled member. (Please see Emergency Department Guide.)
Enrolled Persons
In order for NurseWise and the CMT to place a person in an inpatient psychiatric level of care (Behavioral
Health Inpatient Facility or sub-acute), the person must be either:
o
o
o
o
Active with AHCCCS (Title 19)
Active w/ Indian Health Services AHCCCS
Active with KidsCare (Title 21)
Active with SSI/MAO
In any
T/RBHA
NON-enrolled persons
Any person presenting in the emergency department in a behavioral health crisis is eligible for crisis services.
For those who arrive at the emergency room and have private insurance, the person’s private insurance should
be accessed to assist the person.
Medically admitted members 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 behavioral health needs are met.
2) Hospital staff facilitating discharge plans are able to access NurseWise for well checks for
members being discharged and at risk. This can be accomplished only with the agreement and
participation of the member. Hospital staff will need to clearly outline the clinical reasons for
a wellness check and will need to allow the member to speak to NurseWise about the plan.
Note: these services are available for both enrolled and non-enrolled persons.
Note: CMTs are unable to respond to medical floors.
Persons Admitted to a Medical Floor who meet Title 36 requirements
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 NurseWise and 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 barriers
about individual situations should be handled as outlined in the Problem Resolution Process as outlined below.
All parties agree to have representation at meetings and agree to participate actively in the process.
The Cochise County Crisis System Meeting
This quarterly meeting has been established to identify areas in which there is a need for procedures or
improved communication between the behavioral health system, law enforcement, the courts, the jail and
local providers. Attendance is encouraged since this meeting is a primary means for stakeholders, the RBHA
and RBHA contracted agencies to discuss and examine the current procedures to address and intervene during
a behavioral 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 holds meetings on a monthly basis to follow up with Crisis Mobile Team providers. In addition,
Cenpatico meets with NurseWise twice a month to identify system challenges and solutions.
Problem Resolution Process
Conflicts between specific agencies or regarding specific situations are handled between the agencies involved.
Cenpatico 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.
It is agreed upon that for effective problem solving, system issues that present a problem will be discussed in
the Cochise County Crisis System Meeting.
The Stakeholder Liaison is also a resource for Cochise 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 Customer Service if necessary.
Drug and/or Alcohol Use
Per ADHS Practice Protocol Co-occurring Psychiatric and Substance Disorders, “Assessment begins at the point
of clinical contact, regardless of the member’s clinical presentation. Initiation of assessment 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.”
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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.
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 36-501.25.
Community Bridges (CBI)
Community Bridges: CBI has a Substance Abuse Transitional Facility in Benson. They have beds at the facility
to treat persons with substance use problems. A person can stay at CBI for up to 5 days based on clinical need.
They also have outpatient substance use services and can get people enrolled for long term services if this is
desired.
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.
Transfers to CBI: CBI is available 24 hours per day, 7 days per week to take referrals. (Benson: 520586-6171; Globe 928-425-2415; Payson 928-468-0022; Casa Grande 520-426-0088) CBI can also pick
up members upon request. A person may be a candidate for CBI if:
o The person is not medically compromised
o The person is voluntary for treatment
o The primary concern is drugs and or alcohol
o The person is currently under the influence of a substance or has used substances in the
last 7 days
Referrals to CBI:
o Law enforcement can bring persons to CBI
o A CMT can bring a person in
o A case manager can bring a person in
o A member can self-refer
Note: Community Bridges can conduct a basic medical screening to identify any potential acute
medical concerns. If medical care is needed, CBI will request an ambulance to transport the person
to the nearest ER.
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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’s Children Association (AZCA)
Arizona Counseling & Treatment Services (ACTS)
Arizona Department of Public Safety
Benson Hospital
Benson Police Department
Bisbee Police Department
Canyon Vista Medical Center
Cenpatico
Cochise County Attorney’s Office
Cochise County Adult Probation Department
Cochise County Jail
Cochise County Juvenile Court Services
Cochise County Sheriff’s Office
Community Bridges
Community Intervention Associates (CIA)
Effective Date: 01/01/2009
Copper Queen Community Hospital
Corazon
Douglas Police Department
Huachuca City Police Department
Northern Cochise Community Hospital
NurseWise
Pinal Hispanic Council (PHC)
Sierra Vista Police Department
Southeast Arizona Medical Center
Southeastern Arizona Behavioral Health Services
(SEABHS)
Tombstone Police Department
US Army Garrison Fort Huachuca
Willcox Police Department
Last Revision Date(s): 6/3/2015
End Date (if applicable): N/A
_____________________________________
Date: ___________________
Arizona’s Children Association (AZCA)
____________________________________
Date: ___________________
Arizona Counseling & Treatment Services (ACTS)
____________________________________
Date: ___________________
Arizona Department of Public Safety
____________________________________
Date: ___________________
Benson Hospital - ER
___________________________________
Date: ___________________
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Cenpatico Crisis Protocols for Cochise County
Benson Police Department
____________________________________
Date: ___________________
Bisbee Police Department
____________________________________
Date: ___________________
Canyon Vista Medical Center
_____________________________________
Date: ___________________
Cenpatico
___________________________________
Date: ___________________
Cochise County Attorney’s Office
___________________________________
Date: ___________________
Cochise County Adult Probation Department
_____________________________________
Cochise County Jail
____________________________________
Date: ___________________
Date: ___________________
Cochise County Juvenile Court Services
___________________________________
Date: ___________________
Cochise County Sheriff’s Office (PCSO)
____________________________________
Date: ___________________
Community Bridges
____________________________________
Date: ___________________
Community Intervention Associates (CIA)
____________________________________
Date: ___________________
Copper Queen Hospital - ER
____________________________________
Date: ___________________
Corazon
____________________________________
Date: ___________________
Division of Developmental Disabilities
____________________________________
Date: ___________________
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Douglas Police Department
____________________________________
Date: ___________________
Huachuca City Police
____________________________________
Date: ___________________
Northern Cochise Community Hospital
____________________________________
Date: ___________________
NurseWise
____________________________________
Date: ___________________
Pinal Hispanic Council
____________________________________
Date: ___________________
Raymond W. Bliss Army Health Center
____________________________________
Date: ___________________
Sierra Vista Police Department
____________________________________
Date: ___________________
Southeast Arizona Medical Center - ER
____________________________________
Date: ___________________
Southeastern Arizona Behavioral Health Service (SEABHS)
____________________________________
Date: ___________________
Tombstone Police Department
__________________________________
Date: ___________________
US Army Garrison Fort Huachuca
___________________________________
Date: ___________________
Willcox Police Department
___________________________________
Date: ___________________
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