Welcome and Introductions

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Welcome and Introductions
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Assessments Group
Name Affiliation
Sherry Davis, Lead Bay Cove Human Services
Susan Abbott Vinfen
Steve Chisholm CAB Health Recovery
Dave Selden SDT Co-Facilitator North Suffolk Mental Health
Porter May Advocates
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Individualized Action Plan Group
Name Affiliation
Stephanie Sladen, Lead Health Education Services
Rita Barrette Department of Mental Health
Jan Feingold High Point Treatment Center
Jordan Oshlag SDT Co-Facilitator Community Healthlink
Michael Stuart Spectrum Health Systems
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Progress Note Group
Name Affiliation
Nancy Carlucci, Lead Network Health
Dallas Gulley Riverside Community Care
Joe Passeneau MBHP
Anne Priestley Wayside Youth Family
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Thank you!

• DMH
• DPH/BSAS
• MHSACM
• MBHP
• CHD
• Presenters
• Countless volunteers

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Morning Agenda
The MSDP Goals, Origins, Where we are today, The Golden Thread
Assessment Group of MSDP Processes - Form by Form, Section by Section Review
Break
IAP Group of MSDP Processes - Form by Form, Section by Section Review with an Application Work Session
Lunch
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Terms
MSDP Massachusetts Standardized Documentation Project
EMR/EHR Electronic Medical Record / Electronic Health Record
QMC Quality Management Team
SDT Standardized Documentation Team
CRT Compliance Review Team
CFAAC Consumers, Families, and Advocates Advisory Committee Membership on CFAAC
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More terms
CBFS Community Based Flexible Supports
Recovery Orientated
Person Centered
LPHA Licensed Practitioner of the Healing Arts
RAC Recovery Audit Contractor Program
OIG Office of the Inspector General
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Paradigm Shift
OLD NEW
Comprehensive Assessment CA - Comprehensive Assessment
Program Specific Treatment Plan IAP Individualized Action Plan
Patient, Client, Consumer Person Served
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How did we get here
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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
• Enhances measurement outcomes focus

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Benefits of Participating

• 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 Forms and Manual Website

• 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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Documentation Linkage The Golden Thread
Assessment Data
Diagnoses - Assessed Needs Service
Recommendations
Individualized Action Plan Goals
Individualized Action Plan Objectives
Rehabilitative Services and Interventions
Progress Notes
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Medical Necessity
The type, intensity and duration of an
intervention as provided by a qualified
practitioner and ordered by a qualified
practitioner in the current action plan is needed
to prevent worsening and/or produce improvement
of symptoms, behaviors and/or functioning level
related to an approved diagnosis and assessed
needs
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Medical Necessity Auditor View

• Provided Service
• Appropriately Qualified Practitioner
• Clinically Appropriate and Allowed Services
• At appropriate Intensity and Duration
• As Prescribed in
• Individualized Action Plan
• Designed to
• To improve functioning, symptoms and/or behaviors
  or prevent their worsening
• Based on

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CBFS STANDARDS

• A. Screening Enrollment
• B. Assessment
• C. Individual Action Plan (IAP)
• D. Notes
• E. Client Records

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CBFS STANDARDS Screening and Enrollment

• Timelines for completion
• Cultural and linguistic considerations
• Documentation
• Purpose
• LPHA responsibility
• Critical Needs Plan
• Client orientation

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CBFS STANDARDS Assessment

• Timelines for completion
• Cultural and linguistic considerations
• Strength based and person centered
• Includes additional assessments as indicated
• The Golden Thread
• LPHA responsibility
• Signatures
• Who receives the completed assessment
• Reviews and modifications

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Adult Comprehensive Assessment (CA)

• Standard format to assess mental health,
  substance use and functional needs
• Summary of assessed needs serves as the basis of
  Individualized Action Plan Goals and Objectives
• Completed by the LPHA after interviewing the
  person served, face to face

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Adult Comprehensive Assessment (CA)

• Personal Information
• Captures essential demographic, contact and
  insurance/billing information

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Adult Comprehensive Assessment (CA)

• Living Situation
• Only need to complete one check off box
• Family and Social Support History
• Legal, Education, Employment, Military, etc.
• 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 (CA)

• 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 not addressed during initial comprehensive
  assessment, Trauma Addendum is available for
  completion in future sessions

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Adult Comprehensive Assessment (CA)

• 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
• 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 (CA)

• Was outcomes tool used?
• CBFS providers may choose to use an outcomes tool
• If outcomes tool is used important to include
  findings when completing CA
• Inclusion of Person Served
• Important to include person/family response to
  recommendations
• Give person option to read and sign assessment

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Adult Comprehensive Assessment (CA)

• Addenda
• Addenda Education, Employment, Legal, Military,
  Trauma, Substance Use
• Addenda created to shorten the length of the CA
• Allows for capture of information relevant to
  each person served

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Addendum Example
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How to Access CA Addenda
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Assessed Needs Checklist

• Functionally oriented
• Captures categories other than functioning as
  well (Addictive Behaviors, Family and Social
  Support, etc.)
• Allows for use of Agency specific functional
  assessment
• Combination of clinical and rehab oriented needs

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Prioritized Assessed Needs
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Adult Comprehensive Assessment (CA) Update

• Person may experience other issues/symptoms
  indicating an additional mental health and/or
  substance use concern that needs to be addressed
  by the program
• To maintain Golden Thread CA Update form must be
  completed to document need as an assessed need
  and to support Goals/Objectives in the IAP

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Adult Comprehensive Assessment (CA) Update

• Saves time and effort
• Provides an ongoing cumulative history of
  assessed needs of the person served
• Completed by LPHA after interviewing the person
  served, face-to-face
• 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 maintains the Golden
  Thread

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Form Components

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

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Diagnosis

• Official Diagnosis for the person is Housed in
  the CA or in subsequent CA Updates
• If there is a change to the existing Diagnosis or
  Diagnosis added 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 clients 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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Risk Assessment

• Optional form
• Please check your agencys risk assessment
  procedures!
• 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

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Tobacco Assessment

• Optional form
• Please check your agencys tobacco assessment
  procedures!
• Assesses current/past tobacco use and readiness
  to change

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HIV Risk Assessment

• Optional form
• Please check your agencys HIV risk assessment
  procedures!
• Assesses current/past risk behaviors as well as
  willingness for testing and treatment

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Physical Health Assessment

• Optional form
• Please check your agencys procedures!
• Required annually and as needed
• Assess current/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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BREAK
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CBFS STANDARDS Individualized Action Plan (IAP)

• Timelines for completion
• Cultural and linguistic considerations
• Meeting schedules
• Participation
• Strength based and person centered
• LPHA responsibility

• Signatures
• Who receives the completed IAP
• DMH involvement
• Additional assessments
• Reviews and modifications
• The Golden Thread

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IAP Group Documentation Processes/Forms

• Individualized Action Plan (IAP)
• Expanded
• Condensed
• Short w/ Multiple Goals

• Transfer/Discharge Summary and Plan
• IAP Review/Revision

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IAP

• To promote principles of recovery, IAP serves as
  what is now known as a treatment plan
• Name reflects the recovery concept of shared
  decision making
• Used to document collaboratively identified
  goals, objectives, and therapeutic interventions

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IAP

• Links needs identified during the assessment to
  rehabilitative interventions
• Serves as a tool to collaboratively build an IAP
  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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IAP

• To supporting a recovery focus
• transition and discharge planning is advised from
  the earliest possible point in treatment
• a section is provided on the form to assist in
  this process.

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IAP

• Multiple versions are available
• Expanded one page per goal, ample space for
  writing, page for objectives, which correspond
  with the goal
• Condensed space to document a goal with two
  objectives on one page
• Short with Multiple Goals multiple condensed
  goal pages within one document

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IAP Review/Revision

• Designed to document information from
• ongoing review(s)
• revision(s) of goals and objectives, and/or
• periodic rewrites
• Minimizes duplication
• Documents information to demonstrate evidence
  and/or rationale for revision

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IAP Review/Revision

• Used to update or modify the IAP
• 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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IAP Review/Revision

• Revision and Review
• Use both pages of the IAP Review/Revision form
• Additional IAP goal and/or objective sheets
  should be added as necessary
• If a new goal and/or objectives sheets are
  completed, they are attached to the IAP
  Review/Revision form

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IAP Review/Revision

• Rewrite
• Use page 1 of the IAP Review/Revision
• Complete a new IAP
• Attach new IAP to the IAP Review/Revision form

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IAP Review/Revision

• Anytime a new goal and/or objective is added
  during the Review/Revision
• Review the most recent Comprehensive Assessment
• Is the new goal and/or objective supported in the
  Comprehensive Assessment?
• If NO, a Comprehensive Assessment Update form
  must be completed
• Remember the Golden Thread

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Transfer/Discharge Summary and Plan

• Use at the time of transition within CBFS
• To or from a CBFS group living environment
• To or from a CBFS individual living situation
• Use at the time of discharge from CBFS
• 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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LUNCH
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Afternoon Agenda
Progress Note Group of MSDP Processes - Form by Form, Section by Section Review
Break
Interplay between forms New Goals, New Information, Updates
Implementation Strategies
Questions and Discussion
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CBFS STANDARDSProgress Notes

• Timelines for completion
• The Golden Thread
• Other documentation

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KEY ELEMENTS

• Therapeutic Interventions Provided
• Clients Response to therapeutic interventions,
  progress and functioning
• Interventions Linked to IAP interventions
• New Issues

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KEY ELEMENTS

• Therapeutic Interventions and
• Persons Response to interventions

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KEY ELEMENTS

• Linkage to specific Goal(s)/Objective(s) in IAP

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KEY ELEMENT - New issues

• Four Options
• None Reported
• If resolved during the session, document in the
  Persons Response Section
• If already part of the Goals and Objectives,
  document the progress in the Persons Response
  Section OR
  

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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 using the Comprehensive Assessment
  Update as instructed in the manual.
• May require an IAP Review/Revision to document
  new goal, objective, therapeutic intervention or
  service

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Nursing (Long or Short)

• Optional Form Please check your agencys
  procedures!
• To be completed by a LPN, RN, BSN, or MSN
• Use either long or short version depending on
  amount of space needed

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Consultation/Collateral Contact

• Optional Form Please check your agencys
  procedures!
• Use for face-to-face/telephonic
  consultation/collateral contacts.
• Identifies next action steps and responsible
  party.

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SHIFT/DAILY

• Optional Form Please check your agencys
  procedures!
• Document interventions that are not part of the
  IAP. Goals and Objectives N/A

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Healthcare Provider Orders

• Optional Use Please check your agencys
  procedures!
• Serves as ongoing communication tool amongst
  providers.
• Ensures thorough and current medication list.

2. Self Medication Training Plan
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CBFS STANDARDS Client Records

• Consolidated record
• Contents of record
• Confidentiality

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BREAK
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Interplay between forms
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Interplay between forms

• CA
• New Assessed Need
• IAP
• New Goal/Objective
• CBFS Progress Note
• New Information/Issue/Goal/Objective

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CBFS IMPLEMENTATION
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• Implementation of New Forms
• We acknowledge.....
• Training is needed to adapt
• Initially it can take more time to use
• May require change to internal processes
• There is a possible lack of understanding of The
  Golden Thread
• CA Update and IAP Review/Revision processes may
  not be understood
• Process focuses on the integration of services
  and documentation

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• Existing Record Keeping Systems
• We acknowledge.....
• It costs to make changes to current systems
• There are investments in current systems
• There may not be enough space to write on forms
• There are no lines in text boxes
• Forms cant be changed

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• Incorporating a Recovery Culture
• We acknowledge.....
• We are shifting from a culture of doing for
  clients to a culture of empowering clients
• There is a need for more training on recovery and
  resiliency.
• There is a need for more training on Medicaid
  Rehab Option

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• Staff Training and Supervision
• We acknowledge.....
• Staff will go through stages from denial to
  acceptance during implementation of the forms
• There may be a need to provide more frequent and
  different types of supervision during
  implementation
• There is a need, initially, for closer monitoring
  of the quality of documentation

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Focus Areas to Assist in the Implementation of
MSDP Forms

• Be proactive about training and re-training needs
• Provide coaching sessions on documentation
• Develop and provide to staff a written
  implementation plan including training, support
  and a change management strategy
• Develop post implementation monitoring tied to
  CQI efforts
• Include staff in problem solving the
  implementation
• Try the MSDP e-forms.
• Try each form at least 7 times and then keep
  track of issues, problems, suggestions for
  improvement.

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Transition

• All Clients enrolled as of July 1, 2009
• 72 hour screening is not required
• For clients enrolled with new provider an
  evaluation of immediate needs should be
  completed at first contact
• By August 1, 2009 all clients are provided with
  an orientation to the provider and its CBFS
  services according to CBFS standards.

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Transition to the MSDP Forms

• Group 1 Residential and RTC clients
• Group 1 Criteria Clients do not change provider
• Current DON
• Maintain current PSTP anniversary date
• Implement new CA and IAP forms at time of annual
  review
• Begin use of progress notes as of July 1
• Client level rehab billing based on current PSTP

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Transition to the MSDP Forms

• Group 2 Residential and RTC clients
• Group 2 Criteria Clients change provider
• Current DON
• Maintain current PSTP anniversary date
• Implement new CA and IAP forms at time of annual
  review
• Begin use of progress notes as of July 1
• Client level rehab billing based on current PSTP

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Transition to the MSDP Forms

• Group 3 CRS clients
• Group 3 Criteria All Clients who were previously
  enrolled in CRS regardless of whether or not
  provider is changing
• Prioritize clients for implementation of new CA
  and IAP forms within first 6 months
• Begin to use progress notes as of July 1
• Client level rehab billing will occur when new
  forms have been completed

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Transition to the MSDP Forms

• Group 4 Clients newly enrolled after 7/1/09
• Group 4 Criteria All Clients regardless of past
  service history who are newly enrolled in CBFS
• MSDP Forms must be used from the onset
• CBFS Standards must be followed from onset
• Client level rehab billing will occur when new
  forms have been implemented

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Technical Assistance and Support

• DMH will
• Work with each CBFS provider to develop a
  reasonable implementation schedule
• Be available to review documentation and provide
  feedback
• Be available to provide additional training and
  technical assistance as needed

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Resources

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

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Questions and Discussion