Response to the VACBP Action Alert.  Comments concerning the initial protocol for new MHSB clients, we often spend numerous hours (most not being billed due to the time constraints) establishing trust and rapport, facilitating needed services, and re-emphasizing the needed physical or psychiatric care.  In rural areas this is very difficult due to the limited resources and/or the extended travel components for services.  Instructions are primarily to operate within the 2-Unit Block (3 Hours) as a maximum of daily services, anything over 2-Units (3 hours) must follow the SIR requirements and be associated with the client's physical and/or mental health and safety.  The instructions given concerning emergency care have been to facilitate the 9-1-1 call and relinquish our CBC service once "Higher Care" is involved in the care of the client.  The frequency needed to manage a MHSB case becomes problematic and restrictive, clients often will began to reject the number of times per week the CBC Worker is required to see them.  If the time limits for daily sessions was extended past the current 2-Unit (3-hour), I believe we would experience a very positive response form both the CBC Workers and the clients.  Utilization efficients would also increase per client and allow the CBC Workers to better time-manage their case loads.