California Department of Corrections and Rehabilitation

1. California Department of Corrections and Rehabilitation RELEASE PLANNING CONTINUITY OF MENTAL HEALTH AND MEDICAL CARE

2. California Department of Corrections and Rehabilitation Presented by The CDCR Division of Correctional Health Care Services

3. Benefit Entitlements Division of Adult Parole Operations • Uses contracted staff within prisons to apply for federal and state benefit entitlements prior to inmate’s return to the community • Benefits applied for: • Social Security • Medi-Cal • Veterans benefits

4. Benefit Entitlements Division of Adult Parole Operations • Prioritize inmates by acuity and need • Long-term medical care and inpatient mental health care. • Board & care/assisted living, in-home health care, and hospice. • Chronic illness requiring life sustaining assistance (i.e., dialysis, continuous oxygen).

5. Benefit Entitlements Division of Adult Parole Operations • Prioritize inmates by acuity and need • Inmates with mental illness designated Enhanced Outpatient Program (EOP) or above • HIV/AIDS (if qualified) • Developmentally disabled or other qualifying disabilities • Inmates with mental illness designated Correctional Clinical Case Management System (CCCMS)

6. Benefit Entitlements Division of Adult Parole Operations • Current funding do not allow applications for benefits for all potentially eligible releasing inmates • So, focus remains on first four priorities of which not all receive the service

7. Benefit Entitlements Division of Adult Parole Operations • Transitional period of offender realignment and budget reductions • Efforts will continue to provide benefit application assistance to releasing inmates within criteria 1-4, regardless of parole supervision status

8. Benefit Entitlements Division of Adult Parole Operations • Funding and staffing levels may change from FY to FY • If level services changes counties will be notified • Counties should consider alternatives to the CDCR benefits program

9. Benefit Entitlements Division of Adult Parole Operations For additional information on the Division of Adult Parole Operations’ Transitional Case Management Program, please contact: Patricia Lujan (916) 323-0152 Patricia.Lujan@cdcr.ca.gov.

10. Benefit Entitlements Additional Efforts California Correctional Health Care Services • Implementing program to obtain Medi-Cal eligibility for inmates receiving inpatient medical treatment outside of the prisons • May result in increase of inmates releasing with Medi-Cal established which can continue upon release from prison

11. Patient Information Sharing • Will attempt to obtain signed authorization to release information from inmates as part of release planning for continuity of care • Not all inmates will sign a release

12. Patient Information Sharing • Both the California Medical Instrumentation Association (CMIA) and the federal Health Insurance Portability and Accountability Act (HIPAA) provide for the privacy and security of protected health information.

13. Patient Information Sharing • CMIA and HIPAA permit the use and disclosure of protected health information by health care providers without an authorization by the individual to whom the information pertains when that information is used or disclosed for treatment, payment or health care operations.

14. Patient Information Sharing HIPAA • Covered entity may obtain the consent of an individual to use or disclose protected health information • Consent is not required by the individual whose medical information is being disclosed to another health care provider for treatment

15. Patient Information Sharing HIPAA • Arrangement for the continuity of care is a form of treatment. • HIPAA defines “treatment” to mean, “the provision, coordination, or management of health care and related services by one or more health care providers”

16. Patient Information Sharing CMIA • CMIA does not define treatment but authorizes use or disclosure of medical information for each of the purposes in the HIPAA definition of treatment

17. Patient Information Sharing • An inmate’s refusal to sign an authorization is not a barrier to the disclosure of his or her medical information from provider to provider to arrange for treatment

18. Community Based Medical and Mental Health Care Release Planning • Planning and preparation for release of inmates who need continued mental health or medical care is essential to successful transition to the community

19. Community Based Medical and Mental Health Care Release Planning • CDCR staff attempt to arrange community-based care prior to an inmate-patient’s release when inmate: • Needs acute or sub acute care • Is unable to arrange for care due to disability • Needs dialysis • Is unable to handle Activities of Daily Living

20. Community Based Medical and Mental Health Care Release Planning • For all AB109/PRCS mental health and dental related questions contact:  DCHCS Operations – Mental health and dental questions only: • Email: AB109MHdentalhelp@cdcr.ca.gov • Phone: (916) 324-9482, Pamela Michel 

21. Community Based Medical and Mental Health Care Release Planning • For all AB109/PRCS medical related questions contact:  CCHCS Field Operations – Medical questions only: • Email: Renel.Alford@cdcr.ca.gov • Phone: (916) 648-8281

22. Community Based Medical and Mental Health Care Release Planning • All questions will be logged and forwarded to appropriate personnel for timely response

23. Transitional Protocol Workgroup Mental Health and MedicalSubcommittees • The CDCR Office of Communications and External Affairs established Transitional Protocol Workgroup • Co-hosted by the California State Association of Counties

24. Transitional Protocol Workgroup Mental Health and MedicalSubcommittees • Representatives from several organizations • Various CDCR Divisions • California Correctional Health Care Services • California Hospital Association • California Mental Health Directors Association • Chief Probation Officers of California • County Counsels • County Health Executives • Public Guardians • County Welfare Directors Association

25. Transitional Protocol Workgroup Mental Health and MedicalSubcommittees • Purpose: To bring together stakeholders to determine information needs, notification timelines, and treatment coordination roles for inmates releasing to post release community supervision

26. Transitional Protocol Workgroup Mental Health and MedicalSubcommittees • Bi-weekly meetings • Held in CDCR headquarters, Sacramento • Conference call-in available

27. Transitional Protocol Workgroup Mental Health and MedicalSubcommittees For additional information or to request to be part of the process, please contact Thy Vuong, at (916) 327-0277 or Thy.Vuong@cdcr.ca.gov.

28. Division of Correctional Health Care Services Mental Health Pre-Release Workgroup • Goals: • Redesign prison-based mental health pre-release process/services to be more effective • Meet the needs of counties in linking high risk, high need inmates to care • Focus on inmates in EOP or higher levels of care • Increase involvement of families to increase success of inmates

29. Division of Correctional Health Care Services Mental Health Pre-Release Workgroup Participants: DCHCS Pre-Release Programs California Mental Health Directors Association Chief Probation Officers of California NAMI (National Alliance on Mental Illness) Other interested stakeholders

30. Division of Correctional Health Care Services Mental Health Pre-Release Workgroup To participate contact: Michael Morrison Michael.Morrison@cdcr.ca.gov 916-323-6299

31. Accessing Health Records InformationAfter Release from Prison • After release from prison, inmate-patient Unit Health Records are stored and managed at the California Correctional Health Care Services’ Health Records Center

32. Accessing Health Records InformationAfter Release from Prison • Requests for inmate health records after release from prison: • Mail request to:         Health Records Center    P.O. Box 942883    Sacramento, CA 94283 • Fax Request to: (916) 229-0002

33. Accessing Health Records InformationAfter Release from Prison • All requests should include an Authorization for Release of Information, which can be accessed at http://www.cphcs.ca.gov/docs/resources/CDCRForm7385.pdf.

34. Accessing Health Records InformationAfter Release from Prison • For additional information on requesting Health Records after an inmate’s release from prison, please contact: The California Correctional Health Care Services’ Health Records Center • (916) 229-0475

35. CDCR’s Mental Health Program Provide services to inmates with serious mental illness or those meeting medical necessity criteria Interdisciplinary treatment teams Psychiatrists Psychologists Licensed Social Workers Recreational Therapists Psychiatric Technicians

36. CDCR’s Mental Health Program Four Basic Levels of Care Correctional Clinical Case Management System (CCCMS) Stable/functioning in the general population or Administrative Segregation Exhibit symptom control or are in partial remission Assessment by a mental health clinician Treatment team - primary clinician, psychiatrist, and correctional counselor Primary clinician contact no less than every 90 days Seen annually by treatment team If prescribed medication are seen by psychiatrist at least every 90 days

37. CDCR’s Mental Health Program Four Basic Levels of Care Enhanced Outpatient Program (EOP) Acute onset/significant decompensation and unable to function in the prison general population Inability to program in work, education, etc. Dysfunctional or disruptive social interaction or impairment in the activities of daily living Need structured therapeutic living environment but do not require inpatient care Initial clinical assessment and treatment team every 90 days Weekly clinical contact with primary clinician in individual or group Individual clinical contact at least every other week At least ten hours per week of structured therapeutic activities Seen by a psychiatrist at least once per month

38. CDCR’s Mental Health Program Four Basic Levels of Care Mental Health Crisis Bed (MHCB) - Short term (less than 10 day) inpatient treatment Marked impairment/dysfunction requiring 24 hour nursing care, danger to others due to serious mental disorder or danger to self Pre-admission screening by a psychiatrist or licensed psychologist Admission note, initial mental health assessment to begin initial treatment planning, nursing assessment, and physical examination in first 24 hours Treatment team meets within 72 hours of admission and at least every 7 days Daily assessment and monitoring by the primary clinician. Evaluation by a psychiatrist at least twice a week Twenty-four hour nursing care Brief intensive therapy as needed Rehabilitation therapy activities as needed Aftercare planning

39. CDCR’s Mental Health Program Four Basic Levels of Care Acute Care or Intermediate Care Facility (ICF) CDCR/DMH Memorandum of Understanding for inpatient psychiatric care. Provide care to patients whose conditions cannot be successfully treated in the outpatient setting or in short term MHCB placements

40. MENTAL HEALTH POPULATION AND PERCENTAGES AS OF AUGUST 24, 2011 Total Mental Health Inmate Population 37,200 % of Overall CDCR Inmate Population 23.1%

41. MENTAL HEALTH POPULATION AND PERCENTAGES AS OF AUGUST 24, 2011

42. MENTAL HEALTH POPULATION AND PERCENTAGES AS OF AUGUST 24, 2011

43. Questions?