Understanding the Children’s Long-Term Inpatient (CLIP) System.

1. Understanding the Children’s Long-Term Inpatient (CLIP) System. CHILDREN, YOUTH, and FAMILIES July 27, 2011

2. What is CLIP? • The most intensive psychiatric treatment in WA for residents ages 5-18 years. • Provides inpatient treatment for youth with severe psychiatric impairment and is a resource on the continuum of care. • Services are available to both Medicaid and non-Medicaid youth. • A CLIP admission is not available as a crisis service, nor are children admitted to a CLIP Program solely because they need a safe place to live. • CLIP referrals are either via voluntary application or Involuntary commitment.

3. When is CLIP Appropriate? • When least restrictive options in the community have first been attempted / exhausted to ameliorate the concerns. (e.g. increase in hours of service in outpatient, CHAP / Wraparound, intensive services from other systems, etc.) • When youth “meets Medical Necessity” Youth must have a severe psychiatric impairment which warrants the intensity and restrictions of treatment in a CLIP program. • There must be an expected benefit from this level & type of treatment.

4. When is CLIP Inappropriate? • When less restrictive interventions have not been attempted / exhausted. • As a “placement” option or “last resort”. CLIP is a thoughtful, planned course of mental health treatment. • Any attempt to utilize as a crisis service. • It is not a residential program where youth can stay until adulthood. • Solely for “medication adjustments” or “medication vacations”. • When another system can better or more appropriately serve the child/youth (detention, Children’s Administration, primary care, etc.)

5. Accessing CLIP Treatment Regional Support Network (RSN) Voluntary Application Evaluation and Treatment Facility (E&T) Involuntary Committed Adolescents (180 MR order) CLIP Administration Less Restrictive Options CLIP Certification Team (voluntary applications only) CLIP Programs

6. Voluntary Application Process • Voluntary Application is a two tiered process: • A comprehensive application must be submitted to RSN CLIP Coordinator. (must include complete type written application found www.nsmha.org under “forms”, full 5 Axis diagnosis from an MD (e.g. psychiatrist) and all supporting documentation) • A face to face screening date is set for youth’s legal guardian and other salient team members to present to the RSN CLIP committee. (youth participation is at the discretion of the team) • The RSN CLIP committee recommends youth to the CLIP Administration by forwarding complete packet materials. • The CLIP Administration Process & Decision. • Youth 13 yrs and older must agree to the voluntary treatment. • RSN representative follows ALL CLIP youth from initial intake, through treatment and discharge / transitional planning.

7. Accessing CLIP Treatment Regional Support Network (RSN) Voluntary Application Evaluation and Treatment Facility (E&T) Involuntary Committed Adolescents (180 MR order) CLIP Administration Less Restrictive Options CLIP Certification Team (voluntary applications only) CLIP Programs

8. Medical Necessity Criteria-Federal Standards (Voluntary Referrals) • Ambulatory care resources available in community do not meet needs of youth • Proper treatment of youth’s psychiatric condition requires services on an inpatient basis under direction of a physician. • Services can reasonably be expected to improve client’s level of functioning or prevent further regression of functioning • Youth has been diagnosed as having an emotional/behavior disorder as defined by the DSM manual. • Youth has been diagnosed with a severe psychiatric disorder that warrants extended care in the most intensive, restrictive setting. • Youth agrees to treatment (unless ITA’d)

9. Certification, Waiting List & Assignment Procedures • Once voluntary application is received it gets reviewed. If all application materials are there youth gets put on wait list. • Voluntary applications are reviewed by the CLIP Certification Team based on Federal Medical Necessity Criteria. • Once approved youth are assigned to most appropriate CLIP facility in order of their place on statewide waiting list • Program assignment is based upon needs, bed availability, family/community choice, geographic proximity, age, gender, etc. • Wait times vary greatly and are dependent upon many factors.

10. Children’s Long Term Inpatient Program Waiting List7/27/11 Legal Date Name location County Assigned Program V 4/16 Jim Bob 9M home Spokane Camano 8/1 V 6/18 Jane Doe 11F hospital King Camano V 12/1 Jim Doe 14M Home Skagit Ketron8/18I 10/11 Kim Doe 15F Sacred Heart King ITA, McGraw 7/29I 10/15 Joey Doe 16M Fairfax Yakima ITA, Pearl 12/5I 10/15 Cole Doe 15M Fairfax Yakima ITA, not assignedI 10/16 Scott Doe 14M Lourdes Chelan ITA, will divertV 10/22 Mike Doe 16M Lourdes Kitsap Pending reviewInactiveV 2/7 Mikey Doe 13M Home Mason on hold I 10/31 Moe Doe 16M Fostercare Pierce LRA 11/4

11. What does CLIP cost? • CLIP is funded via State and Federal Medicaid dollars. • There is no associated costs of care to RSN’s or DCFS. • Private insurance is utilized till benefit is exhausted after which Medicaid is billed. • Some SSD/SSI payments families receive is directed differently.

12. Youth Receiving CLIP Treatment • Youth admitted into CLIP facilities all have been diagnosed with a serious psychiatric illness. • Many experience difficulties in other life domains (e.g.. School problems, social/emotional developmental delays, family conflict) • There is a high incidence of co-occurring problems such as developmental disabilities, learning disabilities, chemical dependency and delinquency. • Most of the youth have been served by multiple systems including community mental health, law enforcement, special education programs, child welfare, law enforcement and psychiatric hospitalizations. • All resources in the community have usually been exhausted or deemed inappropriate to meet needs.

13. CLIP PrOGRams 91 beds Pearl Street Center 12 beds McGraw 19 beds Tamarack 13 beds CSTC 47 beds

24. CLIP Programs Pearl Street Center State Psychiatric Hospitals Child Study & Treatment Center McGraw Center Western State Hospital Tamarack Eastern State Hospital

25. CLIP Treatment – What it is? Milieu Therapy – 24 hours/day treatment & supervision Intensive psychiatric treatment (nursing, psychiatry, psychology, social work...) Family participate to learn and practice new skills prior to the child/youth’s return to the community. Partnering with Family and Community Teams critical from begin to end.

26. Questions ??? • For more information on CLIP programs go to: www.clipadministration.org • Application requirements and materials can be found at: www.nsmha.org North Sound Mental Health Administration (NSMHA) Contact: Angela Fraser angela_fraser@nsmha.org CLIP Administration Contact: Lisa Daniels ldaniels@clipadministration.org CSTC Contact: Kristin Steinmetz SteinmetzSTEINKW@dshs.wa.gov