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Welcome and Introductions

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Title: Welcome and Introductions


1
Welcome and Introductions
Presented by MHSACM, DMH, DPH/BSAS
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Assessments
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(No Transcript)
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Thank you!
  • DMH
  • DPH/BSAS
  • MHSACM
  • MBHP
  • CHD
  • Presenters
  • Countless volunteers

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Morning Agenda
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MSDP - Overview
  • Terms -

8
Terms
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More terms
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Paradigm Shift
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New Language
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How did we get here
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Benefits of Participating
  • Quality of Care Benefits
  • Promotes consistent assessment, planning
    service documentation
  • Person-Centered and Strengths focus
  • Recovery/Resiliency focus
  • Promotes Information Sharing
  • Promotes effective collaboration with other
    providers shared terminology for use by
    different disciplines
  • Less room for error Decision support

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Benefits of Participating
  • Business Benefits
  • Compliant with Federal Mandate for Electronic
    Health Records by 2014 a wide variety of
    regulatory and payer requirements
  • Protection against federal audits
  • Wide array of funders/payers support this
    initiative
  • Enhances Measurement Outcomes Focus

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Benefits of Participating
  • Financial Benefits
  • Free training and forms
  • Compliant with a wide variety of regulatory and
    payer requirements
  • Some protection against federal audits
  • Saves time and money
  • Reduces redundancy in collecting information
  • Concurrent documentation possible
  • Standardized revisions and updates in future

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MSDP Initiative Operational Structure
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MSDP Scope of Work
  • The identified scope of work for the MSDP
    includes documentation requirements for services
    identified below
  • All Department of Mental Health community
    services
  • Medicaid Mental Health acute services, regardless
    of health plan, carve out or Fee For Service
    status
  • Services purchased by the Bureau of Substance
    Abuse Services
  • Substance Abuse services purchased by Medicaid
  • EATS, CBATS and Supported Education and
    Employment Services are included in the scope of
    work for the project.
  • Programs that do not have an individual record
    will not be included in the scope of work (i.e.,
    Disaster Response, Training, Trauma Response,
    Consultation Programs, etc.)

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MSDP Forms and Manual Website
  • Each of the MSDP 2009 version of the paper forms,
    e-forms and manuals can be downloaded by program
    type at the website
  • http//www.mtmservices.org/MSDP/2009forms.html  
  • MSDP UPDATE Website http//www.mtmservices.org/MS
    DP-Update.html
  • Technical Assistance will be provided by the MSDP
    Leadership Team. Email at MSDPHelp_at_Earthlink.net

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Compliance?
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List of Regulators / Licensers / Accrediting
Bodies - MSDP
  • Beacon Health
  • Documentation Review Tool
  • BHS FCHP Manual
  • BHS NHP Manual
  • DHHS Regs
  • DHHS Program Memo AB03037 MH
  • DHHS SMD Letter Rehab Option
  • DMA Regs
  • DMA 130CMR429.400 MH Center Manual
  • 130450-275 Resident Regs
  • 130CMR433-428 Docs
  • 130CMR418-400
  • 130CMR417 Day Tx
  • 130CMR450.100

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List of Regulators / Licensers / Accrediting
Bodies - MSDP
  • DMH Regs
  • DMH 104CMR28.00 Licensing and Operations for
    Community Programs
  • 104CMR29.00 Service Planning
  • Risk Management Policies Informed Consent for
    Psychotropic Medications/ECT Therapy
  • Comprehensive Assessment Requirements
  • DPH Regs
  • DPH 104CMR27
  • 105CMR140.000
  • 105CMR160 Detox
  • 105CMR161 STIIT
  • 105CMR162 SA/OT/PT
  • 105CMR750 Drug Tx Programs

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List of Regulators / Licensers / Accrediting
Bodies - MSDP
  • DPH Regs (cont)
  • 105CMR165 Halfway House
  • Family Substance Abuse Shelter Guidelines
  • Transitional Support
  • MBHP
  • MBHP Audit Tool
  • OT/PT Perf Specs
  • SOAP Documentation Requirements
  • CBATICBAT Performance Specs
  • Inpatient Acute Mental Health Performance Specs
  • Level 4 Detox for Co-occuring Disorders
    Performance Specs
  • Medically Monitored Detox ATS Performance Specs

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List of Regulators / Licensers / Accrediting
Bodies - MSDP
  • Network Health Regs
  • Network Health Chart Review Tool
  • NHIC Regs
  • NHIC (L13492) Health Behav Ass Tx
  • L3159 Diag Assess
  • L3162 Psycho Pharm
  • L3187 ECT
  • L3203 Neuro Psy Test
  • L3220 Group Tx
  • L3239 Ind Tx
  • L3242 Interactive Ind Tx
  • Article 90862
  • Transmit Psychotherapy Notes
  • Transmit Psych Tests

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List of Regulators / Licensers / Accrediting
Bodies - MSDP
  • Federal Medicaid Regs
  • Federal States Medicaid Manual 2500A Doc
  • States Medicaid Manual 4221 Psych OTPT
  • States Medicaid Manual 4320 Clinic
  • Federal Opiod Regs
  • 42CFR812 Opiod Tx
  • 42 CFR8.1221CFR291 Opiod Tx
  • JCAHO
  • CARF
  • COA
  • NCQA

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Documentation Linkage The Golden Thread
Assessment Data
Diagnoses - Assessed Needs Service
Recommendations
Individual Action Plan Goals
Individual Action Plan Objectives
Interventions and Services
Progress Notes
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Assessment Forms
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Personal Information
  • Must be completed at the time of initial contact
    with the person who is seeking services.
  • Captures essential demographic, contact and
    insurance/billing information.
  • This form can be completed by support staff or
    clinical staff.

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Adult Comprehensive Assessment
  • Complete after the Personal Information form, as
    the person enters services, in compliance with
    agency policies and funding requirements.
  • The Adult Comprehensive Assessment provides a
    standard format to assess mental health,
    substance use and functional needs of persons
    served. This Assessment provides a summary of
    assessed needs that serve as the basis of Goals
    and Objectives in the Individualized Action Plan.
  • A qualified clinician must complete or oversee
    the completion of this form after interviewing
    the person served, face to face.

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Adult Comprehensive Assessment Specifics
  • Living Situation
  • Only need to check off one box to indicate
    persons living situation
  • Family and Social Support History
  • Legal, Education, Employment, Military, etc.
  • May complete Addenda if additional information is
    needed depends on persons needs
  • Substance Use
  • Screening tool needed to determine if there is a
    substance use problem

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Adult Comprehensive Assessment Specifics
  • Health Summary
  • If Physical Health Assessment has been completed,
    do not need to complete again here
  • Advanced Directives
  • Follow your agencys protocols with regard to
    Advanced Directives
  • Trauma History
  • If Trauma is not addressed during initial intake,
    the Trauma Addendum is available for completion
    in future sessions

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Adult Comprehensive Assessment Specifics
  • Strengths/Abilities/Resiliency
  • Key component of the assessment
  • Important shift in assessment process
  • Strengths-based assessments increasingly more
    common used to generate goals and objectives
  • Interpretive Summary
  • This is a summary, not meant to repeat data
    already gathered
  • Answers the question How does the data gathered
    in the assessment fit together and how will it be
    used to create an action plan?

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Adult Comprehensive Assessment Specifics
  • Was outcomes tool used?
  • Different funders require use of different
    outcomes tools
  • May not apply to everyone
  • Example CANS used for MBHP members
  • Inclusion of Person Served in assessment process
  • Important to include person/family response to
    recommendations
  • Give person option to read and sign assessment

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Assessment Addenda
  • Addenda Education, Employment, Legal, Military,
    Trauma, Substance Use (Substance Use screening
    must be completed)
  • Addenda created to shorten the length of the CA
  • Allows for capture of information relevant to
    each person served
  • Meets regulatory requirements of variety of
    funders

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Addendum Example
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Assessment Addenda
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Assessed Needs Checklist
  • Functionally oriented
  • Captures categories other than functioning as
    well (Addictive Behaviors, Family and Social
    Support, etc.)
  • Combination of clinical and rehab oriented needs
    to fit a variety of service models

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Prioritized Assessed Needs
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Adult CA Update
  • While receiving services persons may experience
    other issues or have symptoms indicating an
    additional mental health and/or substance use
    need or concern that needs to be addressed
    through treatment
  • Important to complete a CA Update form to make
    sure that new need is documented as an assessed
    need and incorporated into support for
    Goals/Objectives in the IAP

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Adult CA Update
  • This form saves time and effort
  • Provides an ongoing cumulative history of
    assessed needs of the person served
  • A qualified clinician must complete or oversee
    the completion of this form after interviewing
    the person served, face-to-face
  • CA Update should be placed in date order on top
    of the CA in the chart to provide the appropriate
    linkage to new services if information provided
    indicates new services are needed

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Form Components
  • Record the reason for the update
  • Enter the date of the last Comprehensive
    Assessment in the chart
  • ACA Sections for Update
  • Update Narrative
  • Signature/Credentials

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Diagnosis
  • Official Diagnosis for the person is located
    (Housed) in the CA or in subsequent CA Updates
  • If there is a change to the existing Diagnosis or
    addition of Diagnosis it must be recorded in the
    CA Update
  • If there is no change to the diagnosis, indicate
    that by checking the appropriate box

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Treatment Recommendations/Assessed Needs
  • Document any new treatment recommendations or
    assessed needs
  • Any new recommendations/needs should be
    considered the basis for subsequent treatment
    goals and/or objectives

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CA Update Process Linked to Treatment
Recommendations
  • If the Treatment Recommendations/Assessed Needs
    are adequately addressed by the Treatment
    Recommendations/ Assessed Needs as identified in
    the original Diagnostic Assessment or earlier CA
    Updates, then check the box for No Additional
    Recommendations Clinically Indicated in the
    appropriate section of the CA Update
  • Determine if existing Goal(s) and Objective(s)
    address the newly identified recommendations/needs
  • If yes, use the Progress Note to identify the
    appropriate Goal and Objective and provide the
    interventions ordered
  • If NO.

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CA Update Process Linked to IAP Revision
  • If existing Goals, Objectives, Interventions,
    Services, frequency and provider types will NOT
    meet the persons newly identified Treatment
    Recommendations/Assessed Needs, then link the
    newly assessed needs from the CA Update to an IAP
    Revision by checking Change In IAP Required.
    Update the IAP accordingly.

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ASAM
  • To be used for persons with identified Substance
    Use issues
  • Links to websites with more information in ACAU
    manual

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Child/Adolescent Comprehensive Assessment
  • Complete after the Personal Information form, as
    the person enters services, in compliance with
    agency policies and funding requirements.
  • The Child/Adolescent Comprehensive Assessment
    (C/A CA) provides a standard format to assess the
    mental health, substance use, legal status and
    functional needs of children. This assessment
    provides a summary of assessed needs that serve
    as the basis of goals and objectives on the
    Individualized Action Plan. The C/A CA may be
    completed in concert with the Child and
    Adolescent Needs and Strengths (CANS) assessment.

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Child/Adolescent Comprehensive Assessment
  • Follow agency policies and procedures when
    choosing to complete Child or Adult Comprehensive
    Assessment for transitional age youth (16-21)
  • Complete the Transition to Adulthood section for
    children 14.5 years and older.
  • If completing the CANs assessment, complete
    significant history sections only.

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Child/Adolescent Comprehensive Assessment
Specifics
  • Addenda
  • Same addenda are used for Child/Adolescent
    Assessment and Adult Assessment
  • Sections of the assessment mirror the CANS
  • Each section contains assessment of current and
    historical functioning
  • Covers broad age ranges specific instructions
    included in manual

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Child/Adolescent Comprehensive Assessment
Specifics
  • Transition to Adulthood
  • Applicable to mature minors opt out checkbox is
    available

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Child/Adolescent Comprehensive Assessment
  • Incorporation of CANS into Child/Adolescent
    Assessment

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Child/Adolescent Comprehensive Assessment Update
  • Same set up as the Adult Comprehensive Assessment
    Update to be used under same circumstances as
    ACAU.

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Mental Status Exam
  • Use anytime to assess symptoms and behaviors.
  • This is a data gathering tool, with multiple
    uses, to assess current symptoms and behaviors.
    This is a component of the comprehensive
    assessment, or is completed as part of a risk
    assessment. Also it is provided as a stand-alone
    document.
  • A licensed practitioner as determined by agency
    policy must complete this form after interviewing
    the person served, face to face.

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Mental Status Exam
  • Focus on changing commonly used clinical
    language to less clinical, more person-friendly
    language.
  • Examples of old vs. new language
  • Anhedonia ? Inability to perceive pleasure
  • Homicidal ideation ? Aggressive thoughts
  • Attitude ? Demeanor
  • Compliant ? Cooperative
  • Lack of insight ? Difficulty acknowledging
    presence of psychological problems

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Risk Assessment
  • Used to assess risk of harm to self or others as
    part of a comprehensive assessment or when
    assessing a person in crisis.
  • Gathers data on relevant risk issues and
    severity.
  • Completed by a masters level clinician or a
    paraprofessional, under the supervision of a
    licensed clinician or a licensed clinician.

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Initial Psychiatric Evaluation
  • Complete after the Personal Information form, as
    the person enters services, in compliance with
    agency policies and funding requirements.
  • Used to assess the bio-psychosocial health and
    service needs of the person served. Components of
    this evaluation are included in the comprehensive
    assessments. Also it is provided as a stand-alone
    document.
  • This form is to be completed by a psychiatrist,
    CNS or other APN with credential in psychiatry
    and prescribing privileges.

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Initial Psychiatric Evaluation
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Initial Psychiatric Evaluation Specifics
  • Designed to allow writer to indicate review of
    Comprehensive Assessment
  • Reduce redundancy for person served

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Tobacco Assessment
  • Required for some DPH licensed programs
    completed in concert with the comprehensive
    assessments.
  • Optional for other programs following agency
    policies.
  • Assesses current and past tobacco use and
    readiness to change.
  • Completed by staff following agency policy.

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HIV Risk Assessment
  • Required for some DPH licensed programs
    completed in concert with the comprehensive
    assessments.
  • Optional for other programs following agency
    policies.
  • Assesses current and past risk behaviors as well
    as willingness for testing and treatment.
  • Completed by staff following agency policy.

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Physical Health Assessment
  • To be completed by qualified Medical
    Professional. Required for JCAHO certified
    programs and some DPH services completed in
    concert with the comprehensive assessments.
  • Optional for other programs following agency
    policies.
  • Assess current and past medical issues of the
    person served that may impact current
    functioning.
  • Gathers test results that may be pertinent for
    functioning in the future.

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Emergency Services Comprehensive Assessment
  • Standardized assessment for use by
  • Emergency Service Program
  • Crisis Evaluation
  • Similar to ACA, but shorter to accommodate time
    restraints.
  • Clearly identifies
  • Core Assessment Components
  • Practical Information
  • Level of Care Determination and Justification

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Core Assessment Components
  • Presenting Concerns
  • Substance Use/MH History
  • Mental Status Exam
  • Assessed Needs Checklist
  • Prioritized Assessed Needs
  • Clinical Formulation

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Practical Information
  • Collateral Contacts
  • Current Medications

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Level of Care Determination and Justification
  • Person Served Strengths
  • Disposition

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Individualized Action Plan (IAP) Group
Documentation Processes/Forms
  • Individualized Action Plan (IAP)
  • Expanded
  • Condensed
  • Short w/ Multiple Goals
  • IAP Review/Revision
  • Psychopharmacology Plan
  • IAP Detoxification
  • Multi-Disciplinary Team Review/Response
  • Transfer/Discharge Summary and Plan

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Individualized Action Plan (IAP)
  • To promote principles of recovery, this form
    serves as what most of us have known as a
    treatment plan
  • The name reflects the recovery concept of shared
    decision making
  • Used to document collaboratively identified
    goals, objectives, and therapeutic interventions

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Individualized Action Plan (IAP)
  • Key Functions
  • Links to needs identified during the assessment
    phase or ongoing treatment
  • Serves as a tool to collaboratively build a
    treatment plan, which reflects both medical
    necessity and the desired outcomes of the person
    served in his or her own words
  • Design encourages collaboration amongst programs
    and across agencies

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Individualized Action Plan (IAP)
  • Supporting a recovery focus, transition and
    discharge planning is advised from the earliest
    point in treatment possible. A section is
    provided on the form to assist in this process.

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Individualized Action Plan (IAP)
  • A walk through of the form will demonstrate how
    key fields support documentation of medical
    necessity and linkage to identified needs, as
    well as a collaborative and recovery focused tool.

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Individualized Action Plan (IAP)
  • Multiple formats are available to best meet the
    needs of various individuals and programs.
  • Expanded Version provides one page per goal
    with ample space for writing followed by a page
    of objectives, which correspond with that goal
  • Condensed Version provides space to document a
    goal with two objectives all on one page
  • Short with Multiple Goals gives a user
    multiple condensed goal pages within one document

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Individualized Action Plan (IAP) Review/Revision
  • This form/process was designed to document
    information from ongoing review(s), revision(s)
    of goals and objectives, and/or periodic rewrites
  • The IAP Review/Revision assists in minimizing
    duplication and maximizing the documentation of
    information, which demonstrates evidence and/or
    rationale for revision

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Individualized Action Plan (IAP) Review/Revision
  • Use the IAP Review/Revision form to update or
    modify the IAP in any of the following ways
  • Revisions to add a new goal change goals,
    objectives or interventions or change the
    frequency or duration of services
  • Reviews - to record the progress of the person
    served and
  • Rewrites - annually, after three interim
    revisions, or per agency protocol, a rewrite of
    the actual IAP is warranted. This will
    facilitate the identification and tracking of
    treatment goals/objectives and progress made.

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Individualized Action Plan (IAP) Review/Revision
  • Use both pages of the IAP Review/Revision form
    for either a Review or Revision Additional goal
    and/or objective sheets should be added as
    necessary. If you are adding a new goal or
    objective, attach the goal and/or objective
    page(s) from the IAP form to the IAP
    Review/Revision form.
  • When a Rewrite is being completed, page 1 of the
    IAP Review/Revision should be used and the new
    IAP should be attached.
  • If a goal/objective is new and not currently
    supported by the most recent Comprehensive
    Assessment, it is important to also complete a
    Comprehensive Assessment Update form.

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Psychopharmacology Plan
  • Used for persons receiving outpatient
    psychopharmacology services only.
  • Designed for ease of use and to capture all
    required information succinctly and accurately.

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Detoxification Plan
  • Used for persons receiving inpatient
    detoxification treatment.
  • Modeled after the standard Individualized Action
    Plan and reflective of the ASAM dimensions of
    treatment.
  • Reflects and supports the short-term nature of
    this treatment modality.

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Multi-Disciplinary Team Review/Response
  • As required, use this form to document the review
    of Individualized Action Plans and other
    necessary clinical documentation by a
    multi-disciplinary team.
  • This form is designed to be used as a tool to
    provide feedback regarding required actions by
    the primary provider.

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Transfer/Discharge Summary and Plan
  • Use at the time of transition or discharge,
    including any movement throughout the continuum
    of care both internal and external.
  • Summarize treatment, reasons for
    transition/discharge, and plans for referral to
    assist the person in following through on
    aftercare recommendations.

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Individualized Action Plan Group Processes/Forms
  • Application Exercise

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Afternoon Agenda
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Progress Notes
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State of Behavioral Health Recordsin
Massachusetts 2001
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In 2001, we found isolated examples of superior
documentation.
  • Generally, however, record keeping
  • Low Priority
  • Poor Quality
  • Confusing Forms / Terminology
  • Multiplicity of Forms.

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When Clinical Forms are Not Standardized
  • Labor-Intensive Form Revision Process
  • Staff Training
  • Difficulty Reconciling Payer Requirements
  • Existence Of Multiple Forms, Same Facility
  • Frustration

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Is it an exaggeration
  • to say that across the state, there are at least
    1,000 versions of each sheet of paper, for each
    form?

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Lack of Standardization, At What Cost?
  • 8 most common clinical forms per OP record
  • Personal Info. Assess. (1p)
  • Comp. Assessment (4pp)
  • Individ. Action Plan (1p)
  • Progress Note therapy (1p)
  • Progress Note group (1p)
  • MDT Review (2pp)
  • Discharge Summary (1p)
  • Psychopharm. Eval. (2pp)
  • TOTALS
  • 8 forms 13 pages _at_ 1,000 versions 13,000
    pages 26 reams 2.6 cases of paper
  • 8 MSDP Forms 1 version, 23 pages

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MSDP Forms are Tools
  • All tools take time to learn.
  • They are not substitutes for professional
    judgment and are not perfect.
  • Designed to
  • Identify Assessed Needs
  • Decrease Confusion
  • Fix Documentation Problems
  • Address Risk Management
  • Document Quality of Services

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Types of Progress Notes
  • Consultation Collateral
  • Group Psychotherapy
  • Health Care Provider Orders
  • Intensive Services
  • Monthly
  • Nursing (long short versions)
  • Outreach
  • Psychopharmacology
  • Psychopharmacology-Psychotherapy
  • Psychotherapy
  • Shift/Daily Services
  • Weekly

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Key Elements
  • Therapeutic Interventions Provided
  • Persons Response to therapeutic interventions,
    progress and functioning
  • Interventions Linked to IAP interventions
  • New Issues
  • Billing Strip

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Key elements
  • Therapeutic Interventions and
  • Persons Response to interventions
  • Insert sections Therapeutic Interventions and
    Persons response from Group psychotherapy

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Key elements
  • Linkage to specific Goal(s)/Objective(s) in IAP
  • Group Progress Note
  • Insert Goals/Object box
  • Monthly Progress Note
  • Insert Goals/Object box
  • Nursing Progress Note

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Key element - New issues
  • Four Options
  • None Reported
  • If the new issue can be resolved during the
    session, document in the Persons
    Response Section
  • 3. If the issue is already part of the Goals
    and Objectives, document the progress in the
    Persons Response Section and


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Key element New issues
  • When a new issue with a therapeutic need is not
    addressed in the IAP
  • Check CA Update Required
  • Document the new issue on a Comprehensive
    Assessment Update as instructed in the manual.
  • The newly assessed therapeutic information may
    require a new goal, objective, therapeutic
    intervention or service additionally requiring
    use of the IAP Review/Revision form

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Key element Billing strip
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Medicare Incident to
  • MSDP forms that contain the Medicare Incident
    to checkbox
  • Group Psychotherapy Progress Note
  • Psychotherapy Progress Note
  • Intensive Services Progress Note
  • Nursing Progress Notes

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Psychotherapy
  • Use to document therapeutic interventions and
    persons response to the intervention(s) during a
    specific contact.
  • Use for outpatient individual, couple, or family
    psychotherapy.

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Group Psychotherapy
  • Used to document therapeutic interventions and
    persons response to the intervention(s) during a
    specific contact.
  • Used for outpatient group psychotherapy.

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Nursing (Long or Short)
  • To be completed by a LPN, RN, BSN, or MSN
  • Use either long or short version depending on
    amount of space needed.
  • Use as a shift note by a nurse in Detox, SOAP, or
    DDART program.

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Nursing (Long or Short)
  • Nursing Progress Note Short
  • Nursing Progress Note Long
  • Insert Persons Condition No sig.
    changesNotable and changes in persons
    condition grid.

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Psychopharmacology Progress Note
  • For Pharmacological Management session by
  • Psychiatrists
  • Advanced Practiced Registered Nurses
  • Clinical Nurse Specialists
  • Key features
  • Ease of use
  • Salient information
  • Tracks status of core clinical data

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Psychopharmacology/Psychotherapy Progress Note
  • For Individual Psychotherapy with Medical
    Evaluation and Management session by
  • Psychiatrists
  • Advanced Practiced Registered Nurses
  • Clinical Nurse Specialists

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Psychopharmacology/Psychotherapy Progress Note
  • Key features
  • Ease of use
  • Salient information
  • Tracks status of core clinical data
  • Clearly indicates provision of both services

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Consultation/Collateral Contact
  • Use for billable or non-billable face-to-face or
    telephonic consultation or collateral contacts.
  • Identifies next action step and responsible
    party.

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Outreach Services
  • Use for home visits and community support
    interactions with the person and/or family.
  • Required for CRS, CSP, FST, Flex Support Programs
    and PACT.
  • Insert Goals Objective Addressed as per Ind.
    Action Plan section

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Intensive Services
  • Use for all individual and group services as part
    of CBAT, ICBAT, PHP, IOP, SOAP, and DDART.
  • Documents each therapeutic service during the
    course of the day.

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Shift/Daily
  • Required for Child Day Services, Crisis
    Stabilization Unit (CSU), Detox Level III,
    Intensive Residential Treatment Program (IRTP),
    and Respite.

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Monthly
  • Use for services requiring monthly documentation
  • Required for Residential Services (DMH)
  • Summarizes progress toward the IAP goals and
    significant environmental changes
  • Insert Goal/objective Status Box

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Weekly
  • Use to document therapeutic interventions over
    the course of a week and the persons response to
    the interventions.
  • Required for Psychiatric Day Treatment and
    Transitional Support Services (TSS).
  • Insert Type of Program and Services provided this
    week boxes

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Healthcare Provider Orders
  • Use when a person is either living in a
    DMH-funded program or is receiving DMH-funded
    Supported Housing Services.
  • Serves as ongoing communication tool amongst
    providers.
  • Can be used in outpatient behavioral health
    settings as the progress note for a medication
    visit.
  • Ensures thorough and current medication list.

2. Self Medication Training Plan
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Questions for the
Progress Note Sub-Group
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Interplay Between Forms
  • Progress Notes New goals/Objectives/Issues
  • IAP Updates/Revisions
  • CA Update form

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MSDP Implementation Strategies
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The Change Rules Have Changed
  • Behavioral healthcare community providers are
    facing an increased emphasis on delivering
    services that support rehabilitation/recovery,
    outcome based quality services, compliance,
    performance based funding, and change management
    requirements like no other time in our industrys
    history.
  • The MSDP Documentation Process is a SOLUTION

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Change Challenges That Require Active Leadership
  • Quality Improvement Process Focus (QI)
    Typically Supports Lack of Forward Movement/
    Attainment Process based discussions of the
    need to change
  • Vs.
  • Continuous Quality Improvement Solution Focus
    (CQI) Implies Movement Forward/Action Has
    Happened to Provide Continuous Improvement

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Key CQI Pre-Implementation Evaluation Areas
  • How many styles/processes of Diagnostic
    Assessments, Service/Action Plans, Progress
    Notes, etc. are currently being used by staff in
    the Organization?
  • What is the level of ownership in the current
    processes/documentation models?
  • Emotional response level from staff when faced
    with change needs
  • Willingness/support of Senior Managers to move
    forward

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Key CQI Pre-Implementation Evaluation Areas
  • 5. Assess core competency levels of direct care
    staff regarding
  • Ability for staff to provide a more
    focused/objective information gathering/recording
    model/clinical formulation.
  • Level of narrative intensity in current
    documentation model versus focused check
    off/short narrative is critical through
    structured MSDP Clinical Tools
  • EHR Conversion Computer hardware and software
    skills for electronic recording of documentation

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Top Eight MSDP Implementation Challenges
  • 1. Change Itself
  • Change is hard
  • Weve always done it another way.
  • I like my way better.
  • Individualized documentation perspectives and
    professional pride
  • Lack of understanding of WHY we should change
  • Big changes might affect competencies of some
    staff
  • Concern that the MSDP forms will not keep up with
    accreditation changes

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Top Eight MSDP Implementation Challenges
  • 2. Training costs/Learning curve/Productivity
    issues
  • Initially it takes more time to use new forms
  • Dont know where to find info or where to put
    info in the forms
  • New forms might alter some internal processes
  • Training is needed to adapt to new forms system

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Top Eight MSDP Implementation Challenges
  • 3. Lack of commitment by top management
  • Perception that this is something we have to do,
    that this is being done to us, rather than
    looking for how it helps us.
  • Focus on rules, requirements and mandates
  • Lack of recognition of the changing business
    climate (increased scrutiny)
  • Focus on the perception that this will cost us
    money to implement, not seeing the potential for
    saving

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Top Eight MSDP Implementation Challenges
  • 4. Forms dont accommodate everyones current way
    of doing business
  • Asking clinicians to code billing strips on
    Progress Notes
  • Person Served name and at the top of page, not
    the bottom
  • Some info on CA weve always put on Demographic
    form or Health History form, etc.
  • At first, clinical staff disagreed with the CA

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Top Eight MSDP Implementation Challenges
  • 5. New processes
  • Lack of understanding of important linkages
    necessary in the documentation
  • A CA Update and IAP Review/Revision processes are
    not understood
  • Lack of recognition that new forms will require
    some processes to be changed or reinvented
  • Need to look at whole system of documentation
    rather than just pieces and focus on integration
    of services and documentation

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Top Eight MSDP Implementation Challenges
  • 6. Technology issues
  • Investments in current systems
  • Costs to make changes in current systems
  • Forms dont accommodate our existing business
    model need to be integrated into how we do
    business

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Top Eight MSDP Implementation Challenges
  • 7. Issues with the forms themselves
  • Not enough space to write on the forms
  • No lines in the text boxes
  • We cant change the forms
  • They are not in our local software which I know
    and love (They are in WORD!)

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Top Eight MSDP Implementation Challenges
  • 8. Incorporating a recovery culture
  • Shifting from a culture of doing for persons
    served to a culture of empowering persons served
  • Lack of understanding what recovery/ resiliency
    is
  • Lack of understanding the Medicaid rehabilitation
    option

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Acceptance Levels of Change Process
  • Keep in mind the stages of acceptance of change
    staff typically go through with this process
  • Denial
  • Negotiation
  • Anger (Blaming)
  • Drop Out
  • Acceptance of the need to change

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Key Challenges To Address before Implementation
of MSDP Forms Begins
  • The trainer needs to believe in the MSDP
    documentation process and come across to the
    staff that way Select Trainers that really
    believe MSDP process is a positive change.
  • Be aware of individualized documentation
    perspectives and professional pride
  • Be aware big change may affect the competency of
    some staff Plan ahead to provide core
    competency training (i.e., Motivational
    Interviewing, Objective Recording Using
    Structured Form Process, etc.)

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Key Challenges To Address before Implementation
of MSDP Begins
  • Change is hard for some to accept may need to
    provide an enhanced Coaching/Mentoring
    Supervision Model during implementation
  • Management of an agency needs to feel confident
    and support the documentation processes if the
    agency is going to implement need buy in of top
    management
  • Initially will need to do a closer review of
    quality of notes and clinical forms

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Some Identified Solution Focus Areas to Assist
  • Focus on MSDP Forms are a Tool not a rule. As
    a tool it can address compliance and audit
    concerns.
  • Focus on what MSDP documentation can do FOR staff
    instead of what it will do TO staff. Look for the
    potential benefits. Talk about the benefits.
    Continue to remind staff that MSDP documentation
  • Meets all three national accreditation standards
    (JCAHO, CARF and COA)
  • Provides available documentation solution without
    having to develop local form design efforts
  • Prepares us to move towards electronic medical
    records
  • Senior management/leadership need to be visibly
    proactive about the MSDP forms. Communicate,
    communicate, communicate. Share learnings,
    ahas and success stories

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Some Identified Solution Focus Areas to Assist in
Implementation of MSDP Forms
  • Be proactive about training and re-training needs
    (i.e., schedule additional core competency
    support). Provide coaching sessions on
    documentation.
  • Develop and provide to staff a written
    implementation plan including a change management
    strategy. Whether you decide to implement one
    form at a time or a group of forms (i.e. Progress
    notes), or all the forms at once, be planful
    about the approach. Provide training and support.
  • Develop post implementation monitoring and
    coaching plans. Tie monitoring to CQI efforts.

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Some Identified Solution Focus Areas to Assist in
Implementation of MSDP Forms
  • With staff, look at processes that could be
    improved and how the transition to MSDP forms can
    help improve them. View MSDP implementation as an
    opportunity to take a look at the things that are
    problematic in your system and perhaps make
    changes. Use MSDP data for internal process
    Improvements.
  • Try the MSDP e-forms. Talk to your software
    vendor about integrating the forms into your
    systems (Several vendors are in the process).
  • Try each form at least 7 times and then keep
    track of issues, problems, suggestions for
    improvement.

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Implementation Timeframes and Supports
  • Establish a completion date before the initiative
    begins.
  • Develop a full implementation plan with action
    work plans to ensure operational readiness.
  • Recommend a pre-announced evaluation process to
    ensure all feedback regarding implementation
    process is given consideration

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MSDP
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Resources
  • How to start
  • Integration
  • Planning
  • Help
  • MSDPHelp_at_Earthlink.net

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Questions and Discussion
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