Timing of Screenings, Evaluations, and First Services

The Department of Health and Human Services (HHS) has developed criteria for CCBHC certification. Access the complete CCBHC certification criteria – 2016 (PDF | 755 KB).

Regarding screening and evaluation, the criteria require CCBHCs to provide the following:

• A preliminary screening and risk assessment at the point of first contact with a consumer. If the screening identifies an emergency or crisis need, an immediate response with appropriate services is required. The criteria do not specify the content of the preliminary screening and risk assessment.
• An initial evaluation and services. If the preliminary screening reveals emergency or urgent needs, the initial evaluation must be completed within one business day and, for urgent needs, services must be provided within one business day. If the preliminary screening reveals routine needs, the initial evaluation must be completed and services provided within 10 business days. Criterion 4.d.3 specifies the content of the initial evaluation.
• A comprehensive person- and family-centered diagnostic and treatment planning evaluation. This evaluation must be completed within 60 calendar days of the first request for services. Criterion 4.d.5 includes suggestions for states to consider in determining the content of this evaluation, although it is up to states to establish the final content. This criterion also recognizes that state, federal, or accreditation content requirements might already exist that apply to the CCBHC.

At times the criteria can be confusing. For example criterion 2.b.1 says that “appropriate action” must be taken immediately if the initial evaluation reveals an emergency or crisis need, but criterion 2.c.1 says that crisis management services must be delivered within three hours. Some responses to emergency or crisis needs can be dealt with in-house immediately by the CCBHC staff, and that should be the first recourse where it is appropriate. If, however, a crisis team must be involved, the relevant maximum response time of three hours applies, but the CCBHC staff must, while waiting, take any necessary actions to assure the consumer’s safety and the safety of others.

Conducting Screenings and Evaluations

The preliminary screening may be by telephone. It is preferred that the initial evaluation be conducted in person, but it is recognized that is not always possible. If the preliminary screening reveals emergency or urgent needs, the initial evaluation may, if necessary, be conducted by phone or by telehealth/telemedicine. Once the emergency is resolved, the next encounter must be in person and the initial evaluation must be reviewed.

Completing a Comprehensive Evaluation

A comprehensive evaluation actually begins at intake with the preliminary screening, continues with the initial evaluation and subsequent assessment, and culminates in the comprehensive and treatment planning evaluation, which must be completed within 60 days of first contact. Nothing precludes earlier completion of the evaluation or the provision of any services. Sixty days are designed to allow the consumer time to bond with the clinician conducting the evaluation, to develop trust to allow a complete and meaningful evaluation, and to accommodate consumers who might have difficulty sitting through a complete evaluation in a limited period of time.

Components of the Comprehensive Evaluation

The preliminary screening and risk assessment is designed to determine acuity of needs and whether the new consumer presents a risk to self or others. The information gleaned from this screening/assessment feeds into the initial evaluation, which requires the gathering of very basic information designed to guide preliminary treatment and determination of other needs. The initial evaluation, in turn, feeds into the comprehensive diagnostic and treatment planning evaluation, which gathers more complete information to allow a full diagnosis and adequate basis for treatment plan development. The content of the comprehensive evaluation will vary by state-established certification requirement, individual needs, and other requirements such as accreditation to which the CCBHC may be subject.