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Community Psychiatric Rehabilitation

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Title: Community Psychiatric Rehabilitation


1
Community Psychiatric Rehabilitation
  • Presented by Susan Blume, M.Ed.
  • Certification Coordinator
  • Department of Mental Health
  • Division of Comprehensive Psychiatric Services

2
The goal of todays presentation is to answer
questions such as
  • What is the community psychiatric rehabilitation
    (CPR) program?
  • What is the philosophy of this program?
  • Who is eligible for services?
  • What services are available through CPR?
  • What is the funding stream for services?

3
Community Psychiatric Rehabilitation
  • was established in Missouri in 1989
  • is funded by both the Missouri Department of
    Mental Health (DMH) and by Medicaid
  • is part of the rehabilitation option to the
    Missouri State Medicaid Plan

4
Community Psychiatric Rehabilitation
  • is administered jointly by the DMH Division of
    Comprehensive Psychiatric Services (CPS) and the
    Division of Medical Services, which is part of
    the Department of Social Services
  • the development and implementation of the
    Community Psychiatric Rehabilitation program is
    an important component of the DMH community-based
    system of care

5
Community Psychiatric Rehabilitation
  • CPR programs provide a range of mental health
    services to adults with serious and persistent
    mental illness and children and youth with
    serious emotional disturbances

6
Services are designed to
  • maximize independent functioning
  • promote the recovery and self-determination
    process
  • increase interagency coordination and
    collaboration in all aspects of the treatment
    planning process and
  • reduce inpatient hospitalizations and out-of-home
    placements

7
The core services that must be provided in order
for an agency to be certified by DMH as a CPR
program are
  • Evaluation
  • Community Support
  • Crisis Intervention
  • Medication Administration
  • Medication Services
  • Consultation and
  • Psychosocial Rehabilitation

8
Evaluation
  • Assessment and evaluation are crucial to the
    delivery of quality services since the findings
    of the assessment provide a foundation for
    determining service delivery needs and developing
    strategies for intervention and level of care
  • Evaluation occurs at intake and annually after
    that

9
The intake evaluation focuses on
  • presenting problems
  • history of treatment
  • history in areas such as family, vocation,
    education and community
  • current functional strengths and weaknesses
  • physical and medical complaints and
  • recommendations for treatment

10
Annual evaluations focus on
  • changes over the past year in all areas of
    assessment
  • update of diagnostic formulation and
  • recommendations for treatment

11
Treatment Planning
  • Treatment plans and treatment plan reviews are
    part of the evaluation package
  • Treatment plans are developed from the assessment
    and in partnership with the consumer in order to
    have goals that are individualized and realistic
  • Treatment plan reviews summarize progress toward
    goals for a three month period

12
Community Support Services
  • Many individuals with mental illness experience
    difficulty being included in the community and
    accessing community resources
  • This is due in part to the segregation and
    isolation that they may have experienced, and in
    part to the disabilities associated with their
    mental illness

13
Community Support Services
  • Is defined as those activities designed to ease
    an individuals immediate and continued community
    adjustment

14
Community support activities include
  • teaching community living skills
  • advocating for individuals and families
  • coordinating delivery of mental health services
    with services provided by other agencies
  • providing individualized guidance and support and
  • monitoring progress in organized treatment
    programs

15
Community Support Services
  • Community support workers (CSW) are responsible
    to assure that appropriate resources are
    available to individuals and to support them in
    attaining their highest level of functioning in
    their families and in the community

16
Community Support Services
  • In order to be included in the community,
    individuals are assisted in filling legitimate,
    valued social roles such as worker, student,
    neighbor, voting citizen, church member,
    volunteer, spouse and parent

17
A typical day for a team of CSWs might include
  • helping a person with a medical or psychiatric
    appointment
  • monitoring a persons mental health
  • developing or reviewing a treatment plan
  • providing support to someone in the hospital and
    participating in hospital discharge planning

18
A typical day (continued)
  • training/coaching in daily living skills such as
    housekeeping, cooking, grooming, budgeting
  • training/coaching in community living skills such
    as paying bills, taking the city bus, shopping
    for groceries within a budget or within special
    dietary constraints
  • helping someone with an appointment at DFS, the
    housing authority or vocational rehabilitation

19
A typical day (continued)
  • For example, with vocational rehabilitation,
    CSWs can help their client remember and keep
    appointments, complete paper work, and understand
    what is required when receiving services

20
Crisis Intervention
  • Crisis intervention services include telephone
    access and face-to-face emergency response.
    Interventions are available to the consumer 24
    hours a day, 7 days a week
  • Services are provided by Access Crisis
    Intervention (ACI) providers regionally (see
    handout) with back-up by program staff locally

21
Crisis Intervention
  • Crisis personnel have access to a physician for
    consultation purposes 24 hours a day
  • Crisis personnel assist clients in utilizing
    natural supports or perhaps, if needed, in
    admission to an inpatient psychiatric facility

22
Crisis Intervention
  • The goals of crisis service are to
  • Provide immediate response, intervention and
    referral for persons experiencing mental health
    crisis, whether in a rural, urban or metropolitan
    area
  • Respond to crisis by providing community-based
    intervention in the least restrictive
    environment, e.g. home, school

23
Crisis Intervention
  • Avert the need for hospitalization to the
    greatest extent possible
  • Stabilize persons in crisis and refer them to
    appropriate services to regain an optimal level
    of functioning and
  • To mobilize and link individuals with services,
    resources and supports needed for ongoing care
    following a crisis, including natural support
    networks

24
Medication Services
  • Psychiatrists or Advanced Practice Nurses assess
    individuals in the need for medication as well as
    e ongoing management of the medication regimen.
  • Services also include reviewing for side effects
    and providing education about medications

25
Medication Administration
  • Medication administration services provide for
  • coordination with pharmacies and indigent drug
    programs
  • setting up medication boxes
  • monitoring of medication compliance
  • consumer and family education
  • therapeutic injection of medication

26
Consultation Services
  • CPR personnel often consult with human service
    and other government agencies as well as natural
    and professional supports
  • The goals of consultation services are to
  • provide direction to treatment
  • promote effective working relationships
  • heighten awareness of the characteristics and
    needs of the population
  • advocate for an individual or group

27
Psychosocial Rehabilitation Services
  • Psychosocial rehabilitation services (PSR) are
    defined as a combination of goal-oriented
    rehabilitative services provided in a group
    setting as outlined in the persons treatment
    plan

28
Psychosocial Rehabilitation Services
  • Services focus on development of behaviors and
    abilities that allow the person to
  • fully participate in community living
  • maximize independence
  • enhance interpersonal relationships
  • develop support systems
  • Participate in meaningful recreation and
    socialization activities that are appropriate to
    the age and interest of the person

29
Psychosocial Rehabilitation Services
  • Some agencies may include pre-vocational
    services as part of PSR. These services are
    designed to assist a person in preparing for
    employment, including
  • interview and job application skills
  • therapeutic work opportunities
  • temporary employment opportunities
  • referral to a community-based agency that
    specializes in the provision of vocational
    services

30
CPR Program Philosophy
  • The CPR program is based on the following ten
    specific principles and values
  • Persons with mental illness should be active
    participants in program planning as well as
    individualized treatment planning, consistent
    with individual abilities. In the case of
    children, the child and parent(s) are an integral
    part of the treatment team and have ownership of
    the plan.

31
CPR Program Philosophy
  • 2. To the extent possible, community
    integration, inclusion, recovery and
    self-determination shall be goals for service
    delivery.
  • 3. Outreach, engagement and ease of service
    access are essential characteristics of
    successful programs serving adults with serious
    mental illness and children with serious
    emotional disturbance.

32
CPR Program Philosophy
  • 4. Continuity and coordination of care are
    essential to the delivery of quality mental
    health services.
  • 5. Services shall be available in varying levels
    of intensity based on the individuals need.
  • 6. An interdisciplinary and interagency team
    approach to service delivery is a model which
    best assures the quality and continuity of care.

33
CPR Program Philosophy
  • 7. Services and programs shall be responsive to
    the needs of those it serves and sensitive to the
    individuals community, ethnic and cultural
    context.
  • 8. Natural supports existing within the
    community shall be utilized whenever possible.

34
CPR Program Philosophy
  • 9. The focus of the CPR program is on the
    strengths of the individual.
  • 10. Services are community-based.

35
Service Linkages
  • Consistent with the principles of coordination
    and continuity of care, the CPR program must
    establish linkages with service/government
    agencies and natural supports that interact with
    individuals served by the program

36
Service Linkages
  • Key service functions in brokering a range of
    services to individuals include
  • developing working relationships with other
    service providers
  • possessing knowledge of access to and operation
    of other service providers
  • identifying interventions to support or enhance
    the quality of services received through other
    service providers

37
Service Linkages
  • These types of activities must take place to
    assure that individuals are referred to other
    service providers as necessary to meet their
    needs and to maximize the benefit of those
    services

38
Standards for mental health programs further
state that the CPR provider shall
  • provide services and liaison activities to state
    and local public assistance/housing agencies and
    employment/training agencies in order to provide
    assistance to persons with serious mental illness
    in seeking public benefits
  • work closely with the staff of state and local
    public assistance/housing and employment/
    training agencies, within the limits of
    confidentiality, to expedite the application
    process and continuation of the clients
    eligibility

39
Service Linkages
  • Additionally, standards (also known as the code
    of state regulation) indicate that a key service
    function of the community support service is to
    assist the client in accessing and utilizing a
    variety of community agencies and resources to
    provide ongoing social, educational, vocational
    and recreational supports and activities

40
Service Linkages
  • As a result, consultation with these agencies can
    significantly influence the quality and quantity
    of services provided to individuals
  • Consultation and education by CPR program staff
    with criminal justice, juvenile courts, public
    assistance, housing and employment agencies,
    schools and DFS is critical

41
Department Oversight
  • Community Mental Health programs that provide CPR
    services must be certified by the Department of
    Mental Health
  • Each agency is reviewed on an annual basis to
    determine compliance with the code of state
    regulation as defined by the CPS division

42
Department Oversight
  • Certification activities may consist of a team
    going to an agency for four or five days to
    review governing authority, environmental safety,
    policy and procedure guidelines, quality
    assurance systems, fiscal management, personnel
    qualifications/background/training, as well as,
    clinical review of client records for service
    provision and documentation

43
DMH Visions and Values
  • In addition to being in compliance with the code
    of state regulation, agencies are expected to
    fall in line with the Department of Mental
    Healths vision and values
  • These values should be recognized and reflected
    in the operation of the CPR program

44
Eligibility
  • To be eligible for CPR program services,
    individuals must be determined to be seriously
    and persistently mentally ill, or, for children,
    have a serious emotional disturbance, as measured
    against diagnostic, disability and duration
    criteria.

45
Disability
  • There is clear evidence of serious and/or
    substantial impairment in the ability to function
    at an age or developmentally appropriate level in
    each of the following two areas of behavioral
    functioning

46
Disability
  • 1. Social role functioning/family life the
    ability to sustain functionally the role of
    worker, student, homemaker, family member or a
    combination of these.
  • For children, consider their play and
    leisure activities, ability to establish or
    maintain satisfactory relationships with peers
    and adults, capacity to live in a family or the
    equivalent of a family, learning ability, self
    expression or ability to communicate effectively
    with others, and their ability to function in
    school.

47
Disability
  • 2. Daily living skills/self-care skills the
    ability to engage in personal care (grooming,
    personal hygiene, etc.) and community living
    (handling individual finances, using community
    resources, performing household chores,
    interacting with peers, etc.), learning
    ability/self-direction and activities appropriate
    to the individuals age and social role
    development.

48
Diagnosis
  • A physician, advanced practice nurse, or
    licensed psychologist shall certify a primary
    diagnosis of any of the following, which may
    coexist with other psychiatric or medical
    diagnoses

49
Diagnosis
  • Schizophrenia (7 types)
  • Delusional disorder
  • Bipolar I disorders (4 types)
  • Bipolar II disorders
  • Psychotic disorders NOS
  • Major Depressive disorder recurrent
  • Obsessive-Compulsive Disorder
  • Post Traumatic Stress Disorder
  • Borderline personality disorder
  • Anxiety disorders (5 types)

50
Diagnosis(for children and youth only)
  • Major depressive disorder, single episode
  • Bipolar disorder, not otherwise specified
  • Reactive attachment disorder of infancy or early
    childhood

51
Duration
  • is evidenced by one or more of the following
    occurrences
  • Psychiatric treatment more intensive than
    outpatient and received more than once in a
    lifetime (crisis services, alternative home care,
    partial hospital, inpatient)

52
Duration
  • Continuous residential care other than
    hospitalization, for a period long enough to
    disrupt the normal living situation
  • Psychiatric disability has been present for one
    year or more and/or
  • Treatment of a psychiatric disorder has been or
    will be required for longer than six months

53
Funding Stream
  • CPR program services have multiple funding
    sources, including Medicaid for Medicaid eligible
    individuals, Division of Comprehensive
    Psychiatric Services general revenue Purchase of
    Service (POS) funds for those providers who have
    a POS contract, and individual fee for services

54
Funding Stream
  • Because CPR is a Medicaid supported program, the
    federal government pays approximately 60 percent
    of the costs for clients with Medicaid
    eligibility
  • The departments of Mental Health and Social
    Services assume responsibility and accountability
    for administration and reimbursement of service
    delivery consistent with requirements

55
Funding Stream
  • The Department of Mental Health monitors each CPR
    provider through an annual billing audit, that
    coincides with the certification survey, to
    review for adequate service provision and
    compliance with Medicaid requirements

56
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