Appendix 610 Health Care Needs Assessment

1. Appendix 610Health Care Needs Assessment Applicants with Mental Health Conditions

2. Presenter Valerie Cherry, PhD Lead and Region 2 Mental Health Specialist

3. Learning Objectives • Articulate the process steps involved in conducting a Health Care Needs Assessment • Identify the key clinical components of a Health Care Needs Assessment • Identify necessary information to support a recommendation of denial if an applicant’s mental health care needs cannot be met by Job Corps

4. Appendix 610 History • November 16, 2011 – Added new “Appendix 610 Health Care Needs Assessment” to PRH via Job Corps PRH Change Notice No. 11-09. • July 1, 2013 – Revised Appendices 609 and 610 via Job Corps PRH Change Notice No. 13-02 (superseding 11-03). At end of webinar an electronic version of current 610 will be available to be downloaded.

5. Why Use 610 Form? • Ensure recommendation for denial process is standardized and less likely to appear discriminatory. • Includes consideration of reasonable accommodation for applicants with disabilities. • Required forms in the Policy and Requirement Handbook (PRH).

6. Appendix 609: Individualized Direct Threat Assessment Appendix 610: Individualized Health Care Needs Assessment Brief Relevant Background • The only potential application outcomes are: • Enrollment • Applicant Withdrawal • Recommendations for Denial • New Information about Eligibility • Direct Threat (DT) • Cannot Meet Basic Health Care Needs (HCN) • Refer to more appropriate provider/program outside Job Corps • Consider for an alternate center Complete within 30 Days!

7. 7 Health Care Needs vs. Direct Threat Example Which scenario best fits Health Care Needs Assessment? Type answer in chat box! Scenario 2 Recent (3 months) lethal suicide attempt, did not follow discharge treatment recommendations, stopped meds from hospital, reports intermittent suicidal thoughts. Scenario 1 • Recent (3 months) lethal suicide attempt, did not follow discharge treatment recommendations, Inconsistent with meds from hospital and reports sad mood, poor sleep and recent angry outburst with significant other.

8. Appendix 610Health Care Needs Assessment • The Health Care Needs Assessment should be completed if there is a concern that the center cannot meet the basic health care needs of the applicant. • The applicant’s health-care needs exceed those of basic care and cannot be met by the center. • The applicant’s health-care needs are manageable at Job Corps as defined by basic health-care services in Exhibit 6-4, but require community supports and services which are not available near center • Assessment conducted and signed by licensed CMHC.

9. Exhibit 6-4Job Corps Basic Health Care Responsibilities • Mental Health Basic Health Care • Assessments (not psych testing) • Short-term counseling with mental health checks as needed, with a focus on retention and behaviors that represent employability barriers • Collaboration with center physician and health and wellness staff on psychotropic medication monitoring • Psycho-educational groups as needed in collaboration with counseling • Crisis intervention as needed • Off center referrals

10. When to considerHealth Care Needs Assessment • Red flags and triggers: • Frequent and recent ER visits or hospitalizations • Newly diagnosed or uncontrolled mental health issue • Symptoms/condition not well managed in similar environment as JC • Require extensive resources/intervention beyond the scope of JC Basic mental health services .

11. Julie • 19 year-old Female • ETA 6-53 • Sees a counselor • Takes medications • History of Depression, PTSD and borderline personality • IEP • Recently diagnosed, borderline intellectual functioning, takes medications most of the time, self harm behaviors in last six months (superficial cutting), and promiscuous behaviors with males

17. Do we have enough information yet? • No – We need to consider current functional limitations (symptoms/behaviors) and health care barriers to enrollment.

19. Do we have enough information yet? • No – We need to consider reasonable accommodations and/or modifications.

25. Poll Question • At this point, what would you do? • Enroll • Recommend denial based on cannot meet Basic Health Care Needs (HCN) • Not enough information to answer • Call your Regional Mental Health Specialist

27. HCNA – Alternate Center • In determining the need to consider enrollment at another center, document the following efforts in section 7: • Contact the treating provider and discuss applicant’s needs and see if treating provider (not the Health and Wellness staff) recommends less frequent treatment or monitoring. • If treating provider does not recommend changes to frequency of treatment or monitoring, consider local community services with sliding fee scales for applicants without insurance or insurance in another state. • If community services are not available, document name of local resource contacted and information provided by the resource. • The file should then be forwarded to Regional Office for final determination.

28. Process Concerns • What can you do if an applicant is being coached during the clinical interview? • Inform the parent, agency/organization representative, advocate know that the applicant needs to answer the questions as best as s/he can and then they will be welcomed to supplement the individual’s answers.

29. Any process concerns here?

30. Process Concern What is the issue here?

31. Enroll Recommend Denial Let’s Practice Consider Alternate Center Need More Info

32. 32 Mental Health ExamplesHCNA Decisions 1. Hospitalized 9 months ago for psychotic episode. Currently receiving therapy once per week in addition to specialty group for abuse survivors and monthly med checks. Compliant with treatment and meds, no acute symptoms, treating provider recommends enrollment with maintenance of services. Out of state, but has Medicaid in state of residency. Contacted community mental health center near rural JC center – sliding fee scale and 3 month waiting list. 2. Moderate intellectual disability, autism or other cognitive deficit with recent difficulties in group setting impacting behavior and personal safety without supervision. 3.Current binging or excessive use of substances which have resulted in recent risky behaviors. 4. History of superficial cutting on arm that required no medical attention. Reports last incident 4 months ago and a decrease in anxiety since beginning meds 6 months ago. Feels Job Corps will help keep her mind off cutting because she will be busy and around others. Recommend Denial Consider Alternate Center Recommend Denial Enroll

33. Mental Health ExamplesHCNA Decisions 5.Personality disorder predominately and currently characterized by chronic hostility and impulsivity, negative attitude, unresponsiveness to treatment and lack of insight. 6. Mild intellectual disability, mild autism, or other mild cognitive deficit with history of living in a group setting. Minor impairments in social judgment. Some assistance needed in relating to peers. 4th grade reading level. • 7. A non-recent (over six months ago) non-lethal suicide attempt or gesture, which was an isolated incident. • 8. Juvenile history of sexual offenses, completed treatment, talks about journal to help keep urges away. Enroll Recommend Denial Need More Info Enroll

34. What to do? • Currently in residential treatment facility • Homeless applicant with untreated MH diagnosis • Aging out of Foster Care with history of intensive in-home therapy

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36. Review(Pod Questions for Voting) • What are the three reasons that a center may recommend denial of enrollment? • What is key in determining whether to do a Health Care Needs Assessment or Direct Threat Assessment? • What are the steps required if you request that an applicant be considered to a Job Corps center in their home state due to health care needs? • If you receive an applicant file with medical conditions listed on the 6-53 with supporting documentation and the applicant gives new medical information during the interview, what do you do? • Can you recommend denial for health care needs due to non-compliance with medications or treatment?

37. ReviewPod/Poll Questions 6. If you are able to reach applicant and asks for additional information to be sent and you do not receive, what do you do?

38. Questions and Answers

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40. Contact Your Regional Mental Health Specialist (RMHS) • Anytime you are not sure what to do! • Conflicting data or lack of data – must make best guess – call and talk through options • Sample completed assessments can be requested from your RMHSs. • CMHC File Review Sheet available for download.

41. Regional Mental Health Specialists Region 1 Peter Oropeza, PsyD p.oropeza@oroconsulting.com Maria Acevedo, PhD macevedo.correa@gmail.com Region 2/Lead Valerie Cherry, PhD vcherryphd@gmail.com Region 3 Suzanne Martin, PsyD, MPH, ABBP suzannempsyd@gmail.com Region 4 Lydia Santiago, PhD lydia.v.santiago@att.net Region 5 Helena MacKenzie, PhD helena.mackenzie530@gmail.com Region 6 Vicki Boyd, PhD vdelboyd@gmail.com

42. Job Corps Health & Wellness Websitehttps://supportservices.jobcorps.gov/Health/Pages/default.aspx

43. Job Corps Disability Websitehttps://supportservices.jobcorps.gov/disability/Pages/default.aspx

44. Job Accommodation Networkhttp://askjan.org