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Publications & Documents

Block Grant

Title	Type	Posted Date
FFY2020 Combined SA/MH Application with Notice for Comment	PDF	07/30/2019
2019 SABG Annual Report	PDF	06/12/2019
FFY 2019 SAMH Mini Block Grant Application with Notice	PDF	07/31/2018
FFY 18-19 Combined Substance Abuse and Mental Health Block Grant Application	PDF	08/01/2017

Brochures

Title	Type	Posted Date
Senior Medicaid Patrol Brochure	PDF	05/08/2019
Diabetes Brochure	PDF
MDS Section Q Brochure	PDF
Diabetes Brochure - Spanish	PDF

Directories

Title	Type	Posted Date
DASEP DWI County Directory	DOC	12/02/2019
DASEP DWI Staff Directory	PDF	12/02/2019
Community Mental Health Center Directory by County	PDF	08/22/2019
Community Mental Health Center Directory	PDF	08/22/2019
DASEP Map	PDF	08/08/2019
SFY19 Arkansas Prevention Services Providers List	PDF	02/22/2019
Licensed Substance Abuse Treatment Providers	PDF	08/02/2018
Psychology Internship Supervisors	PDF	07/13/2017

Forms

Title	Type	Posted Date
AAS-9511 Change of Client Status Form	PDF	08/01/2019
24 Hour Contact Information Form	PDF	05/12/2019
DHS-4000 Authorized to Disclose Health Info-Release of Info Form	PDF	05/11/2019
DHS-4000 Release of Info Authorization - Spanish Edition	PDF	05/11/2019
DHS-8504 Start Service Form	PDF	05/10/2019
DHS-8505 Informed Consent	PDF	05/09/2019
DHS-8506 MFP Assessment and Personal History Form	PDF	05/08/2019
DHS-8507 Checklist of Clients Rights Form	PDF	05/07/2019
DHS-8508 Statement of Rights & Responsibilities of MFP Participants Form	PDF	05/06/2019
DHS-8510 Demonstration Services Freedom of Choice Form	PDF	05/05/2019
DHS-8511 Transition Risk Plan Form	PDF	05/04/2019
DHS-8512 Risk Mitigation Monthly Form	PDF	05/03/2019
DHS-8520 General Professional Recommendations Form	PDF	05/02/2019
DHS-8521 Demonstration Services Plan of Care Form	PDF	05/01/2019
DHS-8523 Housing Information Form	PDF	04/30/2019
MediMaide Checklist (Need copy of Prescriptions) Form	PDF	04/29/2019
Consent to Discuss Form	PDF	04/28/2019
Tier Level Request Form	PDF	04/27/2019
Transition Goods and Services Form	PDF	04/26/2019
Helping Hands Respite Programs form	PDF	02/19/2019
APS-0001 Request for Adult Maltreatment Registry Information	DOC	09/12/2016

General Information

Title	Type	Posted Date
Mental Health Committment - Immediate Confinement	DOC	09/20/2018
Mental Health Commitment - Involuntary Committment	PDF	09/20/2018
Forensic Seminar Schedule	DOC	05/11/2016
Arkansas Money Follows the Person Demonstration Operational Protocol	PDF	01/30/2014
DASEP Guidelines	PDF	10/30/2012

Manuals

Title	Type	Posted Date
Regional Alcohol and Drug Detoxification (RADD) Manual	PDF	10/01/2019
Peer Support, Family Support Partner, and Youth Support Specialist Standards Manual and application 09/06/2019	PDF	09/09/2019
Licensure Standards for Alcohol and other Drug Abuse Treatment Programs	PDF	04/26/2019
Alcohol and Drug Prevention Rules of Practice and Procedure Manual	PDF	04/26/2019
Infant Mental Health Therapist Standards Manual with application 09.06.19	PDF	09/07/2018
ADMIS Manual Revised Oct 2017	PDF	10/13/2017

Physician Certification Forms

Title	Type	Posted Date
PHYSICIAN CERTIFICATION OF SERIOUS EMOTIONAL DISTURBANCE	PDF	02/08/2018
PHYSICIAN CERTIFCATION OF ADULT WITH A SERIOUS MENTAL ILLNESS	DOC	02/08/2018

Procedures

Title	Type	Posted Date
Provider Reconsideration Submission Instructions	PDF	03/28/2019
Provider Reconsideration Registration Instructions	PDF	03/28/2019
Physician Certification of Adults with a Serious Mental Illness Policy and Procedure Instructions	PDF	10/12/2011

Publications

Title	Type	Posted Date
ICD-10 Training Fall 2015	PDF	09/24/2015
ICD-10 Training 6/17/2015	PDF	07/08/2015

Reports

Title	Type	Posted Date
Arkansas Strategic Prevention Plan	PDF	02/22/2019
Mental Health Commitment - Involuntary Committment	PDF	09/20/2018
Infant Mental Health Therapist Provider Training slide deck	PDF	02/15/2018
Special Services Program Report SFY 2015	PDF	02/03/2016
Resource Summary Report SFY 2016	PDF	02/02/2016
Adult Protective Services (APS) Taskforce Report	PDF

Resources

Title	Type	Posted Date
Senior Medicaid Patrol Brochure	PDF	05/08/2019
Infant Mental Health Training Information	PDF	02/20/2019
PSS FSP and YSS posting	PDF	09/07/2018
PSS, FSP & YSS Provider Training slides		02/15/2018
Peer Support, Family Support Partner, and Youth Support Specialist Training Information	PDF	02/14/2018
Implementing Trauma-Informed Approaches in Access to Recovery Programs	PDF	08/01/2012
Dealing with the Effects of Trauma	PDF

Rules

Title	Type	Posted Date
HIPAA Notice of Privacy Practices	PDF	10/13/2010

Staff

Title	Type	Posted Date
Psychology Staff List	PDF

State Plan

Title	Type	Posted Date
Aging State Plan - Fiscal 2016 - 2019	PDF	05/08/2016

Synar Report

Title	Type	Posted Date
2019 Arkansas Annual Synar Report	PDF	06/27/2019
2018 Arkansas Annual Synar Report	PDF	11/08/2017
2017 Arkansas Annual Synar Report	PDF	11/06/2016
2015 Arkansas Annual Synar Report	PDF	12/09/2015
2016 Arkansas Annual Synar Report	PDF	12/08/2015
2014 Arkansas Annual Synar Report	PDF	10/16/2014
2013 Arkansas Annual Synar Report	PDF	01/24/2013
2012 Arkansas Annual Synar Report	PDF	11/29/2011
2011 Arkansas Annual Synar Report	PDF	12/31/2010
2010 Arkansas Annual Synar Report	PDF	12/31/2009
2009 Arkansas Annual Synar Report	PDF	12/31/2008
2008 Arkansas Annual Synar Report	PDF	01/01/2008
2007 Arkansas Annual Synar Report	PDF	01/02/2006
2006 Arkansas Annual Synar Report	PDF	01/01/2006