Denton County MHMR Center, a Certified Community Behavioral Health Clinic (CCBHC), is committed to fostering an inclusive, trauma-informed, and welcoming environment that embraces and celebrates diversity and equity. The Center strives to create a collaborative and encouraging atmosphere, where individuals of all backgrounds, abilities, and lifestyles feel respected, supported, and valued. Integrity, honesty, and kindness are core values that help create a strong and supportive organization that delivers high quality, person-centered care.
General Description
The Assisted Outpatient Treatment (AOT) Rehabilitation (Rehab) Specialist works under the leadership of the Program Manager of AOT and within federal, state, and local guidelines. The AOT Rehab Specialist provides moderately complex case management and skills training services to individuals with persistent symptoms of mental illness. Work involves developing and maintaining contact with individuals served, their family members, and other community services providers for the duration of their services with the AOT program. This position will work closely with both the justice and court systems to ensure comprehensive services and coordination of care for individuals served.
The Rehabilitation Specialist is a part of a self-contained program responsible for providing treatment, rehabilitation, case management, and support services to consumers with severe and persistent mental illness and who have a history of multiple hospitalizations, criminal history, homelessness, etc. The AOT team combines rehab and clinical staff to provide psychiatric, skills training, case management, and peer support services. The team will coordinate with other treatment providers to provide additional services such as substance use, employment and housing services. Works under moderate supervision, with limited latitude for the use of initiative and independent judgment.
This is a Substance Abuse and Mental Health Services Administration (SAMHSA) grant funded position ending in September of 2028. Continued employment in this role is contingent upon the availability of additional funding. If further funding is not secured, the position will end on September 29, 2028.
Education, Training and Experience (including licensure and certification)
- Graduation from an accredited 4-year college or university with major course work in a human services field as required to qualify as a Qualified Mental Health Professional (QMHP) required.
- Two (2) years prior experience in the mental health field required.
- Master's degree in a human services field and previous crisis experience preferred.
- English/Spanish bilingual preferred.
REGISTRATION, CERTIFICATION, LICENSURE OR OTHER QUALIFICATIONS:
- Must have and maintain a background and criminal history free from any disqualifying offenses as outlined by the Texas Administrative Code (TAC) and the Health and Human Services Commission (HHSC).
- Must possess and maintain a valid driver's license and automobile insurance.
- Individuals with an out of state driver's license must be able to obtain a driver's license in the state of Texas within thirty (30) days.
- Successful completion of all position-specific training within thirty (30) days of employment is required.
Knowledge, Skills, and Abilities
- Knowledge of community and government service delivery systems and case management delivery systems; of case guidelines, regulations, and policies; of interviewing techniques; of mental illness and the emotional components of physical illness; of rehabilitation methods; of individual needs associated with disabilities; and of community welfare resources.
- Skilled in interviewing, in listening, in providing case management/skills training services to individuals served and in the operation of computers and applicable computer software.
- Ability to screen and evaluate individuals served, to provide appropriate referrals/resources to individuals served, to prepare reports, and to communicate effectively.
- Ability to screen and evaluate individuals served, to provide appropriate referrals/resources to individuals served, to prepare reports, and to communicate effectively.
- Highly effective in working objectively with a diverse group of people and be able to demonstrate communication, organizational, administrative and office managerial skills.
- Ability to display regular and reliable (in-person, if required) attendance.
- Understanding and practice of Trauma Informed Care principles.
Essential Duties
The following list outlines key responsibilities for the position; however, it is not exhaustive and does not encompass all responsibilities. Additional duties may be assigned as needed.
- Communicates with individuals served, their families, treatment team, law enforcement officials, schools, and other community partners to obtain background information and ensure continuity of care, as needed.
- Conduct face-to-face, audio and/or video contact with individual's served, providing the above listed services.
- Meet with individual served within 2 business days of admission into the program.
- Evaluates the psychosocial, economic, and physical needs of individuals served, to provide appropriate referrals.
- Communicates with individuals served, their families, treatment team, law enforcement officials, schools, and other community partners to obtain background information and ensure continuity of care, as needed.
- Obtains all appropriate release of information forms, as needed.
- Co-facilitates groups for individuals served in the AOT program.
- Assists with transportation needs of individuals served in the AOT program.
- Provides transportation as needed, adhering to the Center transportation procedures.
- Ensures that all documentation for services rendered is submitted to the Center within (2) business days.
- Documentation requirements may differ for crisis situations.
- Participates in discharge planning for everyone served in the AOT program.
- Engage in a treatment team meeting to discuss an appropriate level of care for everyone upon completion of the AOT program (end of court order).
- Attends transition appointments with newly assigned case manager/community provider as needed.
- Rehabilitation Specialists will comply with HHSC and Center guidelines and regulations for all services rendered.
- Rehabilitation Specialist will record, report and evaluate progress of individual's served utilizing Center Progress Notes through the Electronic Health Record (EHR).
- Demonstrates knowledge of grant goals and objectives, to include but not limited to:
- Reducing recidivism rates in the court and criminal justice system.
- Reducing rapid re-admission to local and state psychiatric hospitals.
- Increasing individual' participation in their mental health treatment.
- Assist with data collection as needed to aid in sustainability efforts for the AOT program.
- Participate in a stakeholder advisory group of key community stakeholders, as needed.
- Participates in status conferences with the individual's treatment team, as needed.
- Helps coordinate transportation for the individual, as needed.
- Actively participates and provides insight into the individual's progress or lack of progress.
- Completes monthly (or more frequent) status report as needed.
- Complete intake appointment for AOT program as needed.
- Complete adults needs and strengths assessment (ANSA) to determine appropriate level of care.
- Assign individual served to a rehabilitation specialist that works as a member of the AOT team.
- Develops a comprehensive recovery plan to address the unique needs of the individual served.
- Ensures completion of Nation Outcome Measure (NOM) Assessment at the intake appointment.
- Ensures continuity of care for individuals served in the program.
- Communicates with Center liaison staff such as hospital, jail, and court liaisons to ensure appropriate and uninterrupted care for individuals served.
- Ensures completion of appropriate paperwork and documentation to present to court officials.
- Communicates with local and state psychiatric hospitals to ensure appropriate aftercare for individuals being discharged from a psychiatric hospital.
- Communicates with local medical hospitals to ensure continuity of care for individuals being discharged from medical facilities.
- Communicates with Denton County and local jails to ensure continuity of care for individuals being released from jails.
- Completes aftercare appointments as needed.
- Completes Risk of harm assessments as needed with individuals served by the AOT team.
- Assists individuals in crisis by completing triages to determine the need for a full risk of harm assessment.
- Completes risk of harm assessments as needed for individuals receiving services from the AOT team.
- Facilitates least restrictive environment recommendation for individuals served.
- Utilizes XFERALL for placement at the psychiatric hospital as needed.
- Maintains compliance with all state and agency training requirements, including Service Coordination and Medicaid Reimbursement and Billing Protocol.
- Follows the agency and departmental policies and procedures in a responsible manner consistent with the Center's mission.
- Participates in the Center's Zero Suicide Initiative.
- Supports individuals experiencing a crisis by promptly connecting them with appropriate Center programs, such as the Mobile Crisis Outreach Team (MCOT), Psychiatric Triage, Crisis Prevention services, and/or other applicable resources. Ensures seamless coordination to facilitate timely intervention.
- Remains with individuals, when deemed safe, to provide support and maintain a calm environment until specialized crisis staff or emergency personnel arrive to take over intervention efforts. Adheres to safety protocols to prevent escalation of the crisis situation.
- Participates in debriefing sessions with the immediate supervisors or designated staff following a crisis event. Collaborates with the team to review the incident, identify lessons learned and ensure all HHSC guidelines and Center policies are followed.
