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Region 1 South Crisis Care System System of Care Overview Policy and Procedures

Region 1 South Crisis Care System System of Care Overview Policy and Procedures. Illinois Department of Human Services Division of Mental Health Jackie Manker , LCSW Associate Director Community Services June 6, 2012. Materials for today.

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Region 1 South Crisis Care System System of Care Overview Policy and Procedures

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  1. Region 1 South Crisis Care SystemSystem of Care OverviewPolicy and Procedures Illinois Department of Human Services Division of Mental Health Jackie Manker, LCSW Associate Director Community Services June 6, 2012

  2. Materials for today • Region 1 South Crisis Care System Policies and Procedure Chapter of Provider Manual • Calendar • Presentation Slides

  3. Objectives of OVERVIEW • Understand the flow of new Crisis Care System • Understand key policies • Understand procedures • Understand any interim policies and procedures

  4. DHS/DMH Intent To replace services previously provided by Tinley Park Mental Health Center with a re-balanced system and services that are: • Community-based • Recovery oriented • Trauma informed • Outcome validated

  5. Services • Eligibility and Disposition Assessments (EDA) • Community Hospital Inpatient Psychiatric Services (CHIPS) • Mental Health Crisis Residential • DASA Residential Crisis Stabilization • Acute Community Services (ACS) • Transportation

  6. Eligibility • Individual presents in Region 1 South E.D.

  7. General Eligibility determined by E.D. • Uninsured with no other resources • Preliminary diagnosis of mental illness or mental illness and substance use disorder • No acute medical illness or excluded medical condition

  8. When all criteria are met, E.D. calls for an Eligibility and Disposition Assessment conducted by a DMH funded evaluator assigned to that E.D.

  9. EDA EVALUATORS • Minimum credential of Qualified Mental Health Professional (QMHP) • Available 24/7 • Respond within (1) hour of call • Confirms general eligibility

  10. EDA EVALUATOR • Conducts clinical evaluation and documents on DMH Uniform Screening and Referral Form (USARF) • For individuals with suspected substance use, also assesses using ASAM Patient Placement Criteria • Completes level of care assessment using the Level of Care Utilization System (LOCUS)

  11. EDA EVALUATOR Determines if individual meets 2 clinical criteria for Region 1S CCS • Diagnosis of: Schizophrenia (295.xx) Schizophreniform Disorder (295.4) Schizo-affective Disorder (295.7) Delusional Disorder (297.1) Shared Psychotic Disorder (297.3) Brief Psychotic Disorder (298.8) Psychotic Disorder NOS (298.9) Cyclothymic Disorder (301.13) Major Depression (296.2x, 296.3x) Obsessive-Compulsive Disorder (300.30) Anorexia Nervosa (307.1) Bulimia Nervosa(307.51) Post Traumatic Stress Disorder (309.81) Bipolar Disorders (296.0x, 296.4x, 296.5x, 296.6x, 296.7, 296.80, 296.89, 296.90) • LOCUS Score of 4 or greater

  12. EDA EVALUATOR Individual does NOT meet clinical criteria • Inform ED physician/staff • Provide any alternative treatment or service recommendation e.g. DMH Non-Medicaid benefit package

  13. EDA EVALUATOR • Individual does meet clinical criteria • Evaluator determines individual is a resident of Region 1 South geographic area No – refer to Madden Intake Yes – recommend level of care and service needs • CHIPS • Mental Health Crisis Residential • DASA Residential Crisis Stabilization • ACS • Transportation

  14. EDA EVALUATOR • Is the individual willing? • Individual is NOT willing to engage? Does he/she meet criteria for involuntary hospitalization? Yes – proceed with process No – explain outcome of assessment, recommend level of care to individual, ED physician/staff and others of individual’s choice

  15. EDA EVALUATOR Individual is willing to Engage • Inform ED physician/staff of recommended level of care • ED physician/staff concur • Evaluator calls the ACCESS line for • Authorization • Available services • Authorization number

  16. Service Authorization • Illinois Mental Health Collaborative for Access and Choice • DMH’s Administrative Service Organization (ASO) Toll free ACCESS Line (866) 359-7953

  17. Service Authorization • Clinical Care Managers (CCM) available 24/7 • Evaluator provides information • Demographics • Clinical presentation • Recommended disposition • CCM reviews for medical necessity

  18. Service Authorization • When medical necessity is present for recommended level of care, the CCM: • Provides authorization number • Provides location and contact information for service provider

  19. EDA EVALUATOR • Evaluator • Contacts service provider to make referral. • Makes needed transportation arrangements using authorization number. • Ensures required documentation is complete and copy to ED and accepting service provider (USARF, LOCUS, ASAM, disposition and recommendations). • Confirms linkage occurred within 24 hours. • Registers individual in DHS/DMH consumer registration system.

  20. Hospital-Based EDA Evaluator (Advocate Christ and Ingalls Memorial) • All previous elements required PLUS • Physician conducts evaluations • May provide active treatment if applicable (e.g. extended observation, Medication administration/monitoring, crisis intervention) • DMH will provide training on registration

  21. Service AuthorizationAlternative Level of Care • If the CCM would propose a different level of care based on medical necessity or capacity • Evaluator discusses alternatives with ED physician/staff • If in agreement, authorization and referral process is initiated

  22. Service Authorization If Not in agreement: • Collaborative CCM provides clinical presentation, treatment recommended and capacity to Madden Intake. • Madden Intake physician reviews information and discusses with ED physician. • Madden Intake physician considers option and determines most appropriate level of care and informs both CCM and ED physician. • CCM contacts Evaluator with determination and authorizes services as appropriate.

  23. Disposition Options Community Hospital Inpatient Psychiatric Services (CHIPS) • DMH funded, short-term (less than 6 days), inpatient at community hospital. • Serve those experiencing psychiatric crises and exhibit acute behaviors or symptoms requiring inpatient setting.

  24. CHIPS Individual has symptoms consistent with a diagnosis of one of the following mental illnesses: Schizophrenia (295.xx) Schizophreniform Disorder (295.4) Schizo-affective Disorder (295.7) Delusional Disorder (297.1) Shared Psychotic Disorder (297.3) Brief Psychotic Disorder (298.8) Psychotic Disorder NOS (298.9) Cyclothymic Disorder (301.13) Major Depression (296.2x, 296.3x) Obsessive-Compulsive Disorder (300.30) Anorexia Nervosa (307.1) Bulimia Nervosa(307.51) Post Traumatic Stress Disorder (309.81) Bipolar Disorders (296.0x, 296.4x, 296.5x, 296.6x, 296.7, 296.80, 296.89, 296.90)

  25. Hospitals with CHIPS Contracts Advocate Christ Medical Center, Oak Lawn Ingalls Memorial Hospital, Harvey MacNeal Hospital, Berwyn Mt. Sinai Hospital, Chicago Riverside Hospital, Kankakee St. Anthony’s Hospital, Chicago St. Bernard Hospital & Health Care Center, Chicago Provena St. Mary’s, Kankakee University of Illinois Hospital, Chicago

  26. Mental Health Crisis Residential • DMH funded, short-term 24/7 continous supervision and treatment in a provider controlled facility. • Grand Prairie Services is the current provider.

  27. Mental Health Crisis Residential • Individual’s symptoms require psychiatric stabilization services. • Individual has symptoms consistent with a diagnosis of one of the following diagnosis. Schizophrenia (295.xx) Schizophreniform Disorder (295.4) Schizo-affective Disorder (295.7) Delusional Disorder (297.1) Shared Psychotic Disorder (297.3) Brief Psychotic Disorder (298.8) Psychotic Disorder NOS (298.9) Cyclothymic Disorder (301.13) Major Depression (296.2x, 296.3x) Obsessive-Compulsive Disorder (300.30) Anorexia Nervosa (307.1) Bulimia Nervosa (307.51) Post Traumatic Stress Disorder (309.81) Bipolar Disorders (296.0x, 296.4x, 296.5x, 296.6x, 296.7, 296.80, 296.89, 296.90)

  28. DASA Residential Crisis Stabilization • Short term (5-10 days) residential treatment that targets: • Stabilization of problems related to biomedical, emotional, behavior, or cognitive conditions as described in ASAM Dimensions 1-3. • Diagnosis of mental illness and substance use disorder. • Planned regimen of care of at least 3 hours of treatment services per day. • Must link with Acute Community Service provider upon discharge.

  29. DASA Residential Crisis Stabilization Providers The Haymarket Center, Chicago Healthcare Alternative Systems, Chicago The South Suburban Council on Alcoholism & Substance Abuse, East Hazel Crest The Women’s Treatment Center, Chicago

  30. Acute Community Service (ACS) • Any services and supports needed by the individual to continue stabilization from crisis. • Grant funding allows the provider ultimate flexibility in determining type, amount, frequency, etc., including medication • Services must be initiated within 24 hours of discharge from ED • Services must be initiated within 48 hours of discharge CHIPS, crisis residential, or SOH, and those discharged from DASA residential with co-occurring disorder.

  31. Acute Community Service (ACS) • Individual eligible for services up to 12 months of initial assessment • Provider agrees to serve all referred individuals • Provider required to assist individual with application for medical assistance • Provider required to register each individual through DHS/DMH information system • Individuals will be referred to provider in their geographic proximity but will have choice if requested

  32. Acute Community Care Service Providers

  33. Madden Mental Health Center Services • Will serve as safety net when other services are not appropriate or available.

  34. Madden Mental Health Center Services • When an individual presents with the following, Madden may be consulted for consideration of DMH admission. • History indicating need for extended inpatient treatment • Presents challenges in discharge placement from inpatient setting, such as being homeless • Co-occurring substance use disorder requiring medical observation that exceeds the capability of available community inpatient psychiatric services

  35. Madden Mental Health Center Intake • Responsible for managing the referrals to DMH hospitals to ensure available capacity • For individuals from Region 1 Central who presents at one of the four DMH contracted CHIPS hospitals, Madden Intake may choose to utilize CHIPS, Mental Health Crisis Residential or SA Residential Crisis Stabilization beds when appropriate and needed to manage DMH hospital capacity

  36. Transportation • DMH will purchase transportation services between Emergency Departments, CHIPS hospitals, MH Crisis Residential and DASA Residential Crisis Stabilization • Individual must meet all eligibility criteria • The Authorization number received from the Collaborative will serve as authorization for transportation • Transportation provider must respond within 60 minutes of request

  37. Region 1 South Crisis Care SystemSystem of Care OverviewPolicies and Procedures • Thank you!! • Questions??

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