JJC HOSPITALIZATION

1. JJC HOSPITALIZATION Dr. John Cosma, JJC Psychologist

2. JJC Hospitalization Process • JJC recognizes that from time to time residents admitted may experience emotional deregulation, a psychotic break, and/or traumatic experiences that may be out of their control. • JJC is very sensitive to these experiences and once the resources are exhausted, residents may need to be hospitalized in order to become more stable, be placed on appropriate medication, and/or for their safety until the crisis is under their control. • Residents may be hospitalized for several reasons such as, psychotic behaviors (delusions, hallucinations, thought disorder, basically losing touch with reality), acting out behaviors (defecating and spreading feces), suicide and serious self harm attempts. • Once the residents are experiencing these behaviors, the JJC psychologist will assess them and if they are not able to be re-directed and their behavior persist, the JJC psychologist will pursue hospitalization.

3. Hospitalization Process • There are mainly two modalities that residents can be hospitalized • Through Medicaid • Through Insurance • Medicaid • Obtain the medicaid information • Screening, Assessment, and Support Services (SASS) • Caseworker comes and assesses the resident in crisis • Determine hospitalization • If resident meets hospitalization criteria, the caseworker makes arrangements with local hospitals and arranges transportation to the hospital DCFS Wards are being serviced by at least two types of HMO insurance Advocate HMO Harmony HMO

4. Insurance • Obtain information from the insurance company on hospitals within the network by calling the insurance card information • Obtain a precertification letter • Call hospitals for bed availability • Describe to intake worker the residents symptoms and why hospitalization in needed • Transport resident to hospital • The process can take anywhere from two to several hours to get a resident hospitalized

5. Hospitalization difficulties/challenges • Certain insurances have contracts with certain hospitals • We need to take the resident to those hospitals only • The bed availability may be full. We may need to call several hospitals before we obtain a bed. • Once we inform the hospital the resident is from the Juvenile Justice Center…almost immediately we are informed that there is no bed availability. • Certain insurances do not have contract with local hospitals. As such, we may need to transport residents into Chicago or surrounding suburbs of Chicago. Example: DCFS Wards Advocate HMO Insurance – APS- only hospital servicing this insurance is in Kankakee and Chicago (St. Elizabeth Hospital). Harmony HMO-Streamwood Hospital, Scott Nolan Center, St. Joe’s Hospital • Parent may have specialized type of insurance for psychiatric services. Example; BCBS-HMO Advocate Plan (for medical and psychiatric services) APS Plan (for Psychiatric Hospitalizations). Once again, these plans have contract with certain treatment facilities for services.

6. JJC Involvement • We follow up with the admitting hospital on status of the resident • We are involved in staffing of the resident while they are in the hospital • We are in close communication with the court, out of county probation, and SASS regarding the resident’s status • We transport resident back to JJC from the hospital upon discharge • Residents are seen and monitored by the Psychiatrist and JJC Psychologist upon resident’s return from the hospital for the duration of their admission

7. Hospitalizations and Diagnoses 2008 • Total Admissions: 1017 • Number of Residents Admitted with a Diagnosis: 369 (36%) • Top Diagnoses: Depression • ADHD • Bipolar Disorder • Number of Residents Admitted with Medication: 187 (18%) • Hospitalizations: 7

8. 2009 • Total Admissions: 686 • Number of Residents Admitted with a Diagnosis: 308 (44%) • Top Diagnoses: ADHD • Depression • Bipolar Disorder • Number of Residents Admitted with Medication: 165 (24%) • Hospitalizations: 3

9. 2010 • Total Admissions: 836 • Number of Residents Admitted with a Diagnosis: 144 (17 %) • Top Diagnoses: Bipolar Disorder • ADHD • Adolescent Antisocial Behavior • Number of Residents Admitted with Medication: 172 (20%) • Hospitalizations: 4

10. 2011 • Total Admissions: 780 • Number of Residents Admitted with a Diagnosis: 120 (15 %) • Top Diagnoses: Bipolar Disorder • ADHD • Mood Disorder • Number of Residents Admitted with Medication: 196 (25%) • Hospitalizations: 7

11. 2012 – August • Total Admissions: 854 • Number of Residents Admitted with a Diagnosis: 280 (33%) • Top Diagnoses:ADHD Bipolar Disorder • Anxiety Disorders • Number of Residents Admitted with Medication: 242 (28%) • Hospitalizations: 6

13. Questions/Comments?