AHCCCS Integrated System of Care (ISOC)
In 2001, the Jason K. Settlement Agreement established the Arizona System of Care as a set of values and principles to guide behavioral health service delivery to children in Arizona.
On July 1, 2016, the Arizona Department of Health Services, Division of Behavioral Health moved to AHCCCS to further integrate physical and behavioral health care within the AHCCCS health care delivery system. Since then, AHCCCS has continued to advance the System of Care model to include the adult population and to incorporate an integrated health perspective.
The goal of the Integrated System of Care is to ensure appropriate, adequate, and timely services for all persons across the lifespan, with a primary focus on improving quality of life throughout all system intersections and service interactions that individuals may encounter.
Learn How to Use the ECSII
The Early Childhood Service Intensity Instrument© (ECSII) is a standardized, biopsychosocial assessment tool to help anyone who provides services to infants, toddlers, and children from ages 0 to 5.
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System Oversight Structure
Policies related to SOC
- Integrated System of Care Structure, Values and Principles - AMPM 100
- Table of AHCCCS Covered Services - AMPM 300
- Title XIX XXI Behavioral Health Service Benefit - AMPM 310-B
- Services With Special Circumstances – AMPM 320
- AMPM 320-O Behavioral Health Assessments, Service, and Treatment Planning
- AMPM 320-P Serious Mental Illness Eligibility Determination
- AMPM 320-R Special Assistance for Members with Serious Mental Illness
- AMPM 320-S Behavior Analysis Services
- AMPM 320-U Pre-Petition Screening, Court Ordered Evaluation, and Court Ordered Treatment
- AMPM 320-V Behavioral Health Residential Facilities
- AMPM 320-W Therapeutic Foster Care for Children
- AMPM 320-X Adult Behavioral Health Therapeutic Homes
- Coordination of Care with Other Government Agencies – AMPM 541
- Behavioral Health Services for Children in Department of Child Safety (DCS) Custody and Adopted Children – ACOM 449
Forms related to SOC
- Conditional Release Monthly Monitoring Report
- Arizona State Hospital Admission and Discharge Deliverable Template
Behavioral Health Clinical Chart Audit
In February 2023, AHCCCS reinitiated the Behavioral Health Clinical Chart Audit process. Based on health plan and stakeholder feedback, multiple enhancements have been made to the audit process. The Behavioral Health (BH) Audit portal was developed and formally released for use on May 18, 2023. The BH Audit portal will be utilized by the managed care organizations (MCOs) to conduct the behavioral health audit. It will allow completion of audits in real time as well as efficient opportunities for data analysis. The BH Audit portal follows the BH Audit Tool and the accompanying Behavioral Health Clinical Chart Audit Instruction Guide.
- BH Audit Tool
Note: The BH Audit tool is a template only and is not meant to be used to conduct the audit process.
- Behavioral Health Clinical Chart Audit Instruction Guide
- Behavioral Health Clinical Chart Audit Findings and Summary Report
System of Care and Workforce Development Efforts:
Child and Family Team Practice
Since the adoption of CFT, numerous changes have occurred to the children’s system of care that prompted AHCCCS to evaluate the CFT program, its curriculum, and approach to develop CFT facilitators.
In partnership with its managed care organizations (MCOs), the AHCCCS ISOC and Workforce Development teams created the following timeline for CFT training:
- From May 2022, provider agencies with staff that facilitate Child and Family Team meetings will need to identify a qualified “CFT Champion” to be the trainer of the CFT Facilitator training at their agency. Refer to the AZAHP Workforce Alliance notification for additional information.
- Starting June 2022, CFT Champions will be trained on the updated and revised CFT curriculum, and be taught how to provide this training at their agencies. The goal is a single, statewide, in-person, experiential approach focused on the competencies required to perform the nine CFT activities.
- AHCCCS developed specialized training In an effort to continually monitor CFT facilitators' skills and the fidelity of the practice. This training will teach supervisors how to evaluate a facilitator's skills using the CFT Supervisory Fidelity Review Tool, and how to coach skills for each of the nine essential elements of the CFT process. The CFT Champions will need to complete the additional supervisor training starting in September 2022. WFD will require the CFT Champions to attend tri-annual meetings starting in 2023 to ensure they are supported in their role and have the opportunity to bring questions back from their agency.
Once provider agency supervisors have been trained, supervisors will use the CFT Supervisory Fidelity Review Tool to evaluate the skills of current and new facilitators, in compliance with AMPM 220, Child and Family Team. Supervisors will ensure the competency of their staff and monitor the fidelity of the CFTs being facilitated under their supervision. Supervisors will provide coaching on the nine essential elements of CFT practice as needed, but can also have staff re-trained in the new curriculum, if needed.
Additional plans to ensure the fidelity of the CFT process include the following to begin in 2023:
- Create an optional 2-hour orientation level program for families and children who will participate in the CFT process,
- Create an optional 4-hour training program for any community member who wants to participate in the CFT process.
Court Ordered Evaluation and Treatment
On September 4, 2020, the Arizona Supreme Court Committee on Mental Health and the Justice System provided a number of recommendations to improve the justice system for those with mental health care needs.
This included a focus on developing strategies to engage and intervene prior to entry into the justice system. In response to the Committee’s recommendations, AHCCCS created a Court Ordered Evaluation / Court Ordered Treatment (COE/COT) committee, which includes members from the Committee on Mental Health and the Justice System and additional system stakeholders (e.g. members of the Court, district attorney’s, mental health providers, state health plan members and the Office of Individual and Family Affairs) and community members.
This committee’s goal is to develop an effective and standardized statewide training on Court Ordered Evaluation and Treatment by the end of 2023. This training will include individual county processes, resources, and user experience from the peer-member/family perspective. The training will be publicly available and intended for a variety of audiences.
For more information related to COE/COT processes, please visit AHCCCS COE/COT webpage.
Current and Future Projects & Goals
- Review of ISOC related policy deliverables
- Oversight of Behavioral Health Clinical Chart Audit Process
- Implementation of Early Childhood Service Intensity Instrument (ECSII) as option for assessment of infants and toddlers (children birth through five)
- Child and Adolescent Level of Care Utilization System (CALOCUS) FAQs
- Serious Emotional Disturbance (SED) Eligibility Determination FAQs
- Serious Mental Illness (SMI) Eligibility Determination FAQs
- Behavioral Health Continuum of Care Annual 2022 Report
- Behavioral Health Continuum of Care Fact Sheet
- Oversight of Mercer and WICHE Contracts for monitoring Arnold v. Sarn Settlement Terms
- Continuing implementation of initiatives related to expanded access to behavioral health services and integrated care
- Behavioral health in schools
- Updates to the Behavioral Health Practice Tools for children's systems of care using evidenced-based practices
- Addition of practice tool for treatment guidelines of intellectual and developmental disability (ID/D) population including specific treatment requirements for Autism Spectrum Disorder (ASD)
- Addition of Adult System of Care tools utilizing evidence-based practices
- Continued monitoring of oversight of the MCOs for members on conditional release under the jurisdiction of the Psychiatric Security Review Board
- Involvement in development of workforce competencies related to the System of Care
Learn How to Navigate the Health Care System
Here are more resources to help you access services and take care of your health care needs.
- Office of Individual and Family Affairs
- One-page Empowerment Tools for Members and Families
- Learn more about AHCCCS
- How to Apply for AHCCCS
- AHCCCS Medical Policy Manual of Covered Services
- Upcoming public meetings at AHCCCS