Arnold v. Sarn

A class action suit—Arnold v. Sarn—was filed in 1981 against the State of Arizona alleging that the Arizona Department of Health Services/Division of Behavioral Health Services (ADHS) and Maricopa County did not provide a comprehensive community mental health system as required by statute.

In 1986, the trial court entered judgment holding the State (ADHS) and Maricopa County violated its statutory duty; the Supreme Court affirmed this decision in 1989.

In January 2014, officials at ADHS, Maricopa County, and office of the Governor reached an agreement with Plaintiffs, an exit to the Arnold v. Sarn Stipulation for Providing Community Services and for Terminating the Litigation, signed in January 2014, whereby they agreed to provide certain community services and terminate the litigation. The agreement includes an increase of services in four areas: Assertive Community Treatment, Supported Employment, Supportive Housing and Peer and Family Services. The agreement also provides for the use of several tools by the parties to evaluate services provided in Maricopa County, including a quality service review, network capacity analysis and SAMHSA fidelity tools.

ADHS has until the end of fiscal year 2016 to see these increases in services are met.

Fidelity Tools

As part of the Arnold v. Sarn Stipulation for Providing Community Services and for Terminating the Litigation, signed in January 2014, the Arizona Department of Health Services/Division of Behavioral Health Services (ADHS) and the State of Arizona agreed to the following:

  • Increase ACT teams from 15 in fiscal year 2014 to 23 by the end of fiscal year 2016.
  • Increase the capacity of supported employment in Maricopa County. By the end of fiscal year 2016, the system will be capable of handling 750 more members with supported employment services.
  • Increase the number supportive housing slots in Maricopa County. By the end of fiscal year 2016, 1200 more seriously mentally ill members will receive supportive housing services.
  • Increase the number of peer and family members who may receive these support services in Maricopa County. By the end of fiscal year 2016, space for an additional 1,500 peer and family members to receive the aforementioned support services will be made available.

Officials at the Substance Abuse Mental Health Services Administration (SAMHSA) have developed fidelity tools to evaluate ACT, supported employment, supportive housing, and peer and family (aka consumer operated) services.

DBHS contracted with SAMHSA to provide training on each of these fidelity tools to providers and interested community members in February 2014.

Learn about each individual fidelity tool below:

Assertive Community Treatment (ACT) teams are to be available 24 hours per day, 7 days per week for those seriously mentally ill members in Maricopa County who have been assigned to an ACT team. ACT teams provide individualized, flexible services to those living in the community, and each team includes no less than 10 professional health care workers with varied experience, including: a psychiatrist, nurse, social worker, substance abuse specialist, vocational rehabilitation specialist, and a peer specialist.

SAMHSA's ACT fidelity tool is being used to evaluate each ACT team in Maricopa County annually for fiscal year 2015-2016.

Supported employment services help the seriously mentally ill prepare, identify, attain and maintain competitive employment. These services include job coaching, transportation, assistive technology, specialized job training, and individually tailored supervision.

SAMHSA's Supported Employment fidelity tool is being used to evaluate each supported employment provider in Maricopa County annually for fiscal years 2015-2016Providers may bill for peer and family services through the following codes found in the state's covered services guide:

  • H2027 – Psychoeducational services (pre-job training and development): Services which prepare a person to engage in meaningful work-related activities may include: career/educational counseling, job shadowing, assistance in the use of educational resources, training in resume preparation, job interview skills, study skills, work activities, professional decorum and dress, time management, and assistance in finding employment. Billing unit: 15 minutes. Provider qualifications must be met.
  • H2025 – Ongoing support to maintain employment: includes support services that enable a person to complete job training or maintain employment. Services may include monitoring and supervision, assistance in performing job tasks, work-adjustment training, and supportive counseling. Billing unit: 15 minutes. Provider qualifications and service standards must be met.
  • H2026 – Ongoing support to maintain employment. See aforementioned definition. Billing unit: per diem. Provider and service standards must be met.

Supportive Housing is permanent housing with tenancy rights and services that support the seriously mentally ill to attain and keep affordable housing. Supportive housing is both the housing, and the support services to help someone stay in integrated housing. Critical aspects of supportive housing are: tenancy rights, the tenant pays no more than 30% of his or her income toward rent, and that the tenant has a choice of where he/she can live.

This program also includes rental subsidies, vouchers, bridge funding.

SAMHSA's Supportive Housing fidelity tool is being used to evaluate each supportive housing provider in Maricopa County twice a year for fiscal years 2015-2016.

Peer support is provided for those who have personal experience with mental illness and substance abuse. These services, which can be provided in individual or group settings, are aimed at assisting in the creation of skills to promote long-term, sustainable recovery.

Family support services are for those family members interested in supporting their family member's treatment and recovery from mental illness and/or substance abuse. Family members receive training to enable them to identify and provide assistance when their family member may be experiencing an episode of crisis. Support services also generally include education about mental illness and substance abuse, and the related community services which are available.

SAMHSA officials call these services Consumer Operated. SAMHSA's fidelity tool is being used to evaluate each peer and family service provider in Maricopa County for fiscal years 2015-2016.

Providers may bill for peer and family services through the following codes found in the state's covered service guide:

  • H0038 — self-help/peer services: shelf-help/peer provided to an individual person for a short period of time (>2.75 hours)
  • H2016 – Comprehensive community support services: self-help/peer services provided to a person for a period of time <3 hours in duration.
  • S5110 – Comprehensive family support

Frequently Asked Questions (FAQs)

Below are some of the most frequently asked questions (FAQs) regarding the Arnold v. Sarn. If you have additional questions you would like to include in this list, please email us.

A member is someone who is: at least 18 years of age, has been medically determined to have a serious mental illness, and lives in Maricopa County.

Geographic service area six is Maricopa County.

The latest census shows there are more than 21,000 persons with serious mental illness in the county.

The Arnold v. Sarn Stipulation for Providing Community Services and for Terminating the Litigation was signed by the parties in January 2014, and again applies to members in Maricopa County. Nevertheless, the principles agreed to by the parties and incorporated into the behavioral health system in Maricopa County will be encouraged state-wide by ADHS.

Charles "Chick" Arnold is an attorney who specializes in mental health legal issues, serving the developmentally disabled, the mentally ill and the elderly. He was the guardian for the plaintiffs when the initial lawsuit was filed in 1981.

James E. Sarn, MD, MPH was the director of ADHS from 1980-1983.

ADHS worked with plaintiffs and officials at the RBHA to clearly define each service area so a census could be gathered before the increase in services. The increase in ACT teams, Supportive Housing, Supported Employment and Peer and Family Services began July 1, 2014.

Assertive Community Treatment (ACT) teams are to be available 24 hours per day, 7 days per week for those seriously mentally ill members in Maricopa County who have been assigned to a team. The teams provide individualized, flexible services to those living in the community. An ACT team includes more than 10 professional health care workers with varied experience, including: a psychiatrist, nurse, social worker, substance abuse specialist, vocational rehabilitation specialist, and a peer specialist.

Supportive Housing is permanent housing with tenancy rights and services that support persons with a serious mental illness to attain and keep affordable housing. Supportive housing is both the housing, and the support services to help someone stay in integrated housing. Critical aspects of supportive housing are: tenancy rights, the tenant pays no more than 30% of his or her income toward rent, and that the tenant has a choice of where he/she can live. This program also includes rental subsidies, vouchers, bridge funding.

Supported employment services help persons with a serious mental illness prepare, identify, attain and maintain competitive employment. This program also includes job coaching, transportation, assistive technology, specialized job training, and individually tailored supervision.

Peer support is provided by those who have personal experience with mental illness and substance abuse. These services, which can be provided in individual or group settings, are aimed at assisting in the creation of skills to promote long-term, sustainable recovery.

Family support services are for those family members interested in supporting their family member's treatment and recovery from mental illness and/or substance abuse. Family members receive training to enable them to identify and provide assistance when their family member may be experiencing an episode of crisis. Support services also include education about mental illness and substance abuse, and about those community services available.

Glossary

Below is a glossary for the most commonly used terminology in the Arnold v. Sarn suit—click on any term to reveal its definition.


Housing, either ownership or rental, for which a household will pay no more than 30% percent of its gross annual income.



A worker that assists the client's medical, psychosocial and environmental needs. Coordinates resources and access to appropriate health care system resources and other supportive services.



(HUD Definition) An unaccompanied homeless individual with a disabling condition who has either been continuously homeless for a year or more OR has had at least four (4) episodes of homelessness in the past three (3) years. Individuals who are in transitional housing or permanent supportive housing programs are not considered chronically homeless even if they have been in the program more than a year.



(HUD Definition) A community plan to organize and deliver housing and services to meet the specific needs of people who are homeless as they move to stable housing and maximum self-sufficiency. It includes action steps to end homelessness and prevent a return to homelessness.



Refers to a diagnosis of more than one of the following: emotional/behavioral disorder, substance abuse disorder or physical disability.



The conditions a person must meet in order to become a participant in a program or service.



Designed to assist homeless individuals with immediate temporary shelter/housing, with the goal of moving into transitional and/or permanent housing. Also called "Bridge Housing."



Any facility with overnight sleeping accommodations. The primary purpose, of which, is to provide temporary shelter for the homeless in general or for specific populations of homeless persons. The length of stay can range depending on the shelter's guidelines.



At or below 30% of the area median income.



HIPAA was enacted by the U.S Congress in 1996. Title II of HIPAA defines numerous offenses relating to health care and sets civil and criminal penalties for them. It also creates several programs to control fraud and abuse within the health care system. However, the most significant provisions of Title II are its Administrative Simplification rules. Title II requires the Department of Health and Human Services (HHS) to draft rules aimed at increasing the efficiency of the health care system by creating standards for the use and dissemination of health care information.



A Housing Navigator/ Specialist can help members find and maintain appropriate housing and apply for housing benefits. They can refer you to supportive services to help you maintain stable housing, including an ACT team, or case manager.



Housing First (from the National Alliance to End Homelessness): A "housing first" approach rests on two central premises: 1) Re-housing should be the central goal of our work with people experiencing homelessness; and 2) Providing housing assistance and follow-up case management services after a family or individual is housed can significantly reduce the time people spend in homelessness. Case management ensures individuals and families have a source of income through employment and/or public benefits, identifies service needs before the move into permanent housing, and works with families or adults after the move into permanent housing to help solve problems that may arise that threaten their tenancy including difficulties sustaining housing or interacting with the landlord and to connect families with community-based services to meet long term support/service needs.



A federal department active in a variety of national housing programs including urban renewal and public housing.



Income at or below 80% of the area median income.



A health insurance program administered by the United States government, covering people who are either age 65 and over, or who meet other special criteria, such as a disabling illness (i.e. severe mental illness). It was originally signed into law on July 30, 1965 by President Lyndon B. Johnson as amendments to Social Security legislation.



This generally refers to people who have chronic alcohol and/or other drug use problems and/or a serious mental illness and/or are HIV-positive. The terms "dually diagnosed" and "triply diagnosed" are also used.



Housing which is intended to be the tenant's home for as long as they choose. In the supportive housing model, services are available to the tenant, but accepting services cannot be required of tenants or in any way impact their tenancy. Tenants of permanent housing sign legal lease documents.



(HUD Definition) Long-term, community-based housing that has supportive services for homeless persons with disabilities. This type of supportive housing enables special needs populations to live as independently as possible in a permanent setting. The supportive services may be provided by the organization managing the housing or coordinated by the applicant and provided by other public or private service agencies. Permanent housing can be provided in one structure or several structures at one site or in multiple structures at scattered sites. There is no definite length of stay.



HUD's Section 8 program defines a "person with a disability" as: a person who is determined to: 1) have a physical, mental, or emotional impairment that is expected to be of continued and indefinite duration, substantially impedes his or her ability to live independently, and is of such a nature that the ability could be improved by more suitable housing conditions; or 2) have a developmental disability, as defined in the Developmental Disabilities Assistance and Bill of Rights Act.


The process of sending a patient/client from one social service agency to another health care or social service agency. Agencies may require written documentation for referral.



Federal agency which administers various programs related to SAMHSA within the Department of Mental Health. SAMHSA also refers to block grant funding received from SAMHSA to pay for certain services.



A long term subsidized housing program, which allows qualified individuals to pay 30% of their income towards rent.



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.



Is a program that provides rental assistance for homeless persons with disabilities. This program is designed to provide long-term housing for a homeless person with disabilities, (primarily those with serious mental illness, chronic problems with alcohol and or drugs, and acquired immunodeficiency syndrome (AIDS) or related diseases, and their families who are living in a place not intended for human habitation (e.g. street) or in emergency shelters.



The charge for services based upon the income and family size of the individual or family requesting services.



(HUD Definition) A residential property that includes multiple single room dwelling units. Each unit is for occupancy by a single eligible individual. The unit need not, but may, contain food preparation or sanitary facilities, or both.



Is a government supported accommodation for people with low to moderate income. To meet these goals many governments promote the construction of affordable housing. Forms of subsidies include direct housing subsidies, non-profit housing, public housing, rent supplements and some forms of co-operative and private sector housing.



The problems resulting from a pattern of using substances such as alcohol and drugs. Problems can include: a failure to fulfill major responsibilities and/or using substances in spite of physical, legal, social, and interpersonal problems and risks.



(HUD Definition) Services that assist a client in the transition from the streets or shelters into permanent or permanent supportive housing, and that assist persons with living successfully in housing.



(HUD Definition) Transitional housing as a project that is designed to provide housing and appropriate support services to homeless persons to facilitate movement to independent living within 24 months. For purposes of the HOME program, there is not a HUD-approved time period for moving to independent living. Very Low Income: Income at or below 50% of the area median income.



An individual in need who receives no services.



A Voucher generally refers to a Section 8 Voucher provided by a local Housing Authority to a low or moderate income person but can also refer to an emergency voucher for short-term motel voucher for a homeless person. The Section 8 Voucher issued by Housing Authority makes up, in payment directly to the landlord, the difference between what a low or moderate income tenant can pay for rent (roughly 30% of their income) and the Fair Market Rent (more or less an average rent). Most Section 8 Vouchers are "tenant-based" meaning that the voucher holder can shop for an apartment or house rental on the private market, while others are "project based", meaning that they are not portable, but can only be used in a specific building.

Reports

July 2018 – June 2019

Assertive Community Treatment

Consumer Operated Services

Permanent Supportive Housing

  • Coming soon.

Supported Employment