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

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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

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Materials for today

• Region 1 South Crisis Care System Policies and
  Procedure Chapter of Provider Manual
• Calendar
• Presentation Slides

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Objectives of OVERVIEW

• Understand the flow of new Crisis Care System
• Understand key policies
• Understand procedures
• Understand any interim policies and procedures

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(No Transcript)
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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

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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

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Eligibility

• Individual presents in Region 1 South E.D.

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Region 1 South Area

City of Chicago South of 67th Street
South Suburban Cook County
Kankakee County
Will County
Grundy County
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Region 1 South Area Community Hospitals to be Served

City of Chicago South of 67th Street Roseland Community Hospital St. Bernard Hospital
South Suburban Cook County Franciscan St. James Health Metro South Medical Center Advocate South Suburban Hospital
Palos Community Hospital Little Company of Mary Hospital
Advocate Christ Medical Center
Ingalls Memorial Hospital
Kankakee County Riverside Medical Center Provena St. Marys Hospital
Will County Provena St. Joseph Medical Center Silver Cross Hospital Adventist Bolingbrook Hospital
Grundy County Morris Hospital
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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

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• 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.

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Region 1 South Area Community Hospitals to be Served Assigned Eligibility Disposition Assessment Agency

City of Chicago South of 67th Street Roseland Community Hospital Human Resource Development Institute
St. Bernard Hospital To Be Determined (TBD)
South Suburban Cook County Franciscan St. James Health Metro South Medical Center Advocate South Suburban Hospital Grand Prairie Services
Palos Community Hospital Little Company of Mary Hospital TBD TBD
Advocate Christ Medical Center Advocate Christ Medical Center
Ingalls Memorial Hospital Ingalls Memorial Hospital
Kankakee County Riverside Medical Center Provena St. Marys Hospital Helen Wheeler Mental Health Center
Will County Provena St. Joseph Medical Center Silver Cross Hospital Adventist Bolingbrook Hospital Will County Behavioral Health
Grundy County Morris Hospital Grundy County Health Department
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EDA EVALUATORS

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

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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)

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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-Compu
  lsive 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

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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

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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

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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
  individuals choice

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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

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Service Authorization

• Illinois Mental Health Collaborative for Access
  and Choice
• DMHs Administrative Service Organization (ASO)
• Toll free ACCESS Line [phone]

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Service Authorization

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

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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

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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.

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• 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

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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

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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.

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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.

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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-Compu
  lsive 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)

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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. Anthonys Hospital, Chicago
• St. Bernard Hospital Health Care Center,
  Chicago
• Provena St. Marys, Kankakee
• University of Illinois Hospital, Chicago

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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.

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Mental Health Crisis Residential

• Individuals 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-Compu
  lsive 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)

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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.

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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 Womens Treatment Center, Chicago

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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.

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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

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Acute Community Care Service Providers
Region 1 South Area Region 1 South Area Acute CCS Provider
City of Chicago South of 67th Street City of Chicago South of 67th Street Human Resource Development Institute Metropolitan Family Services
South Suburban Cook County Township Bremen, Thornton, Rich, Bloom Grand Prairie Services
South Suburban Cook County Township Lemont, Calumet, Palos, Worth, Orland Metropolitan Family Services
Kankakee County Kankakee County Helen Wheeler Mental Health Center
Will County Will County Will County Behavioral Health Cornerstone Services
Grundy County Grundy County Grundy County Health Department
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Madden Mental Health Center Services

• Will serve as safety net when other services are
  not appropriate or available.

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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

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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

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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

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Region 1 South Crisis Care SystemSystem of Care
OverviewPolicies and Procedures

• Thank you!!
• Questions??