Standards for public agencies

2020 Edition

Integrated Care; Health Homes (PA-ICHH) 2: Personnel

Personnel have the competency and support needed to provide services and meet the needs of persons served.


Competency can be demonstrated through education, training, or experience. Support can be provided through supervision or other learning activities to improve understanding or skill development in specific areas.
2020 Edition




Adults and children who receive integrated care experience improved health care quality, an improved client care experience, and improved clinical and non-clinical outcomes.
Full Implementation, Outstanding Performance
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.  
  • All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance. 
Substantial Implementation, Good Performance
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
  • The majority of the standards requirements have been met and the basic framework required by the standard has been implemented. 
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.

Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.  

  • The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.  
  • Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.  
  • Service quality or agency functioning may be compromised.  
  • Capacity is at a basic level.
Unsatisfactory Implementation or Performance
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.  
  • The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Table of contents of training curricula
  • Procedures or other documentation relevant to continuity of care and case assignment
  • Training curricula
  • Documentation tracking staff completion of required trainings and/or competencies
  • Caseload size requirements set by policy, regulation, or contract, when applicable
  • Documentation of current caseload size per worker


  • Interviews may include:
    1. Program director
    2. Relevant personnel
  • Review personnel files

PA-ICHH 2.01

Personnel are trained on, or demonstrate competency in:
  1. coordinating and providing access to needed services; 
  2. facilitating transition planning and coordination; 
  3. applicable evidence-based interventions;
  4. physical health issues commonly associated with mental health or substance use conditions; 
  5. health conditions and treatment responses particular to the service population;
  6. chronic disease management, including promoting self-management; 
  7. developing a person- or family-centered care plan; 
  8. understanding the roles played by different child-serving systems, as applicable; and 
  9. using health information technology to link services and facilitate collaboration among providers, the person, and his or her family.

PA-ICHH 2.02

The agency maintains service continuity for persons served by:
  1. assigning the care planning team at intake or early in the contact; and
  2. avoiding the arbitrary or indiscriminate reassignment of direct service personnel.

PA-ICHH 2.03

Employee workloads support the achievement of client outcomes and are regularly reviewed.
Examples: Factors that may be considered when determining employee workloads include, but are not limited to: 
  1. the qualifications, competencies, and experience of the worker including the level of supervision needed;
  2. services provided by other professionals or team members;
  3. the work and time required to accomplish assigned tasks and job responsibilities; and
  4. service volume, accounting for assessed level of needs of persons served.