Understanding the community mental health system

1. CHILDREN, YOUTH, and FAMILIES Understanding the community mental health system August 25, 2010 Julie de Losada, Angela Fraser, & Pat Morris Adapted from Children’s Mental Health Services, by Judy Gosney, 2003.

2. CMHA CMHA CMHA Centers for Medicare & Medicaid Services Federal Government Mix of State Mental Health and Federal $$ DSHS DDD ADSA JRA other other CA MAA • Pearl Street • McGraw • CSTC • Tamarack DBHR CLIP WSH ESH North Sound Mental Health Administration RSN • Catholic Community Services NW • Whatcom, Skagit, Snohomish • Compass Health • Skagit, Snohomish, San Juan • SeaMar Behavioral Health • Skagit, Snohomish, Whatcom • Whatcom Counseling & Psychiatric Clinic • Region 3 • NSMHA From Washington to Washington…

3. 39Counties Groupedinto13 RSNs

4. Role of VOA • 24/7/Phone Crisis Intervention (800-584-3578) • 24/7/ Triage Clinician Line (800-747-8654) • Linkage to Regional (Five-County) Integrated • Crisis Response System • Regional Lifeline call center (1-800-273-8255) • ACCESS to Outpatient counseling (888-693-7200) • Inpatient Certification & Authorization (800-707 • 4656 • Offers ASIST and safeTALK community trainings

5. Access to Care 4 Ways to Enter the Community Mental Health System Crisis Services Outpatient Services Inpatient Services* CLIP* Volunteers of America (VOA) *Neither NSMHA nor our Providers deliver inpatient or CLIP services. NSMHA may authorize for these levels of care.

6. Accessing Crisis Services • 24/7 Phone Crisis Intervention Services @ 800-584-3578 • 100,000 Annual Total Calls • Serving Five North Sound Counties • Self-Defined Crisis • Mental Health Professional Staff • Consultation with Crisis Intervention • Access to Consumer Info Database • Crisis Appointments • Crisis Planning • Crisis Respite • Dispatch for voluntary Outreach • Dispatch for Involuntary Evaluations

7. Accessing Outpatient Services • MUST meet Medicaid Financial Eligibility • Established by Community Service Office (CSO) • MUST have a covered “Access to Care” diagnosis • MUST meet “medical necessity” • MUST call ACCESS to Mental Health Services @ 888-693 7200

8. Access to Care “B” Diagnosis

9. RSN/ CMHA Service • Outpatient services offered by NSMHA contracted Community Mental Health Agencies • Catholic Community Services NW • Compass Health • SeaMar • Whatcom Counseling and Psychiatric Services

10. ALL Providers Offer… • Assessment/ Evaluation • Individual Therapy • Group Therapy • Family Therapy • Medication Management • Case Management • Coordination with formal systems • Coordination with natural supports

11. SOME Providers Offer… • CHAP – Children’s Hospitalization Alternative Program • Co-Funded by Children’s Administration for 16 yrs. • Individualized/ intensive care • In-home & out-of-home • Respite • 24/7 Crisis Response Compass Health: Snohomish/ Island Catholic Community Services: Whatcom

12. SOME Providers Offer… • Wraparound • Family-driven/ Youth-Guided • Team Based • Natural Supports • Community Based • Culturally Competent • Strengths Based • Collaboration • Persistent • Outcomes Based Compass Health: Snohomish/ Island Catholic Community Services: Whatcom/ Skagit

13. Individual and Tailored Care • Eachperson has a unique combination of strengths and needs. • Servicesshould be designed to: • utilize strengths • meet needs • Inthe least restrictive manner.

14. Plans Should… • Includea mix of formal services and informal supports. • Includeage appropriate normal activities. • Beprovided in a natural environment.

15. Family Voice and Participation • Assessments based on family strengths and needs. • Families should be included in the entire planning and treatment process.

16. Considerations for Adolescents • Youth who are thirteen and older can request mental health services without the consent of their parents. RCW 71.34.500 • Youth who are thirteen or older and who are a danger to themselves or others, and refuse treatment may be involuntarily detained and hospitalized. RCW 71.34.710

17. Accessing Inpatient Services • Two ways to access inpatient services • Voluntary • Involuntary • RCW 71.34.600 : Parent may request determination whether minor has mental disorder requiring inpatient treatment — Minor consent not required • (1) A parent may bring, or authorize the bringing of, his or her minor child to an evaluation and treatment facility or an inpatient facility licensed under chapter 70.41, 71.12, or 72.23 RCW and request that the professional person examine the minor to determine whether the minor has a mental disorder and is in need of inpatient treatment.

18. When is Inpatient Appropriate? • Needs crisis stabilization in order to avoid a higher level of care. • Potential danger to self, others, or property. • Caregiver or youth are unable to ensure safety. • Needs constant supervision and adult intervention to assure safe environment • Inability to think clearly or distinguish reality. • AND other less restrictive services have been tried which were not successful or were unable to ensure the youth's safety

19. What to expect… • Time limited crisis stabilization (5-10 days) • Limited psychiatric evaluation/assessment • Possible medication assessments/ adjustments • Coordination with outpatient provider (if there is one) • Coordination with other systems (if indicated) • Discharge Planning

20. More about Inpatient Services • No child/youth psychiatric inpatient facilities in our region. • ALL child/youth psychiatric inpatient facilities in WA are private. • Fairfax (6-17) • Seattle Children’s (6-17) • Two-Rivers Landing (11-17) • Kitsap Youth Inpatient Unit (8-17)

21. When is Inpatient Inappropriate? • When less restrictive interventions have not been attempted. • Solely for “medication adjustments” or “medication vacations”. • In lieu of “placement”. • When another system can better or more appropriately serve the child/youth (detention, Children’s Administration, primary care, etc. • When the crisis and youth’s primary diagnosis are not directly related to mental health diagnosis.

22. What is CLIP? • CLIP stands for Children’s Long-Term Inpatient Program. • The highest, most restrictive, most intensive level of mental health treatment in Washington State. • Provides inpatient treatment for youth who have severe psychiatric impairment. • Services are available to both Medicaid and non-Medicaid youth. • There are 3 ways to access CLIP: Voluntary application, Involuntary commitment and RCW 10.77 competency / restoration. • A CLIP admission is not available as a crisis service, nor are children admitted to a CLIP Program solely because they need a safe place to live.

23. CLIP Facilities • There are 91 beds total divided among 4 CLIP facilities that serve the entire state: • McGraw Center in Seattle has 19 beds • Pearl Street Center in Tacoma has 12 beds • Child Study & Treatment Center (CSTC) in Lakewood has 47 beds divided in 3 cottages: • Camano Cottage youth 7 to 11 • Ketron Cottage youth 12 to 14 • Orcas Cottage youth 15 to 17 • Tamarack Center in Spokane has 13 beds • All facilities admit both male and female youth. • Region 3 youth are not typically admitted to Tamarack Center.

24. Core CLIP Services • Core CLIP Services that are generally offered by each of the 4 facilities. These may vary depending on the facility: • Individualized evaluations, assessments and care plans • 24 hour psychiatric & nursing care • Medication, as needed • Safe, structured environment • Crisis stabilization • Behavior management • Family, group and individual therapy • Full educational program on site

25. Core CLIP Services • Continued… • Social work/case management • Recreational, expressive, and leisure therapy • Social skills development • Dietary assessments & monitoring • Occupational Therapy • Parent support & advocacy • Chemical dependency assessments & treatment

26. Minimum Admission Criteria • Must be under 18 yrs. prior to admission to CLIP. • Must be legal residents of WA state or in the custody of a guardian who is a legal resident. • Applicants must have a severe psychiatric impairment. • Less restrictive treatment setting should be attempted prior to application. • Applicants will not be excluded from consideration due to intellectual functioning, physical or medical disabilities. • Applicants 13 yrs and younger vs. applicants 13 yrs. and older. (ITA).

27. Voluntary Application Two Tiered Process: • A comprehensive application must be submitted to RSN CLIP Coordinator. • Next, a screening date is set for youth’s legal guardian and other team members to present to the RSN CLIP committee. • The RSN CLIP committee refers youth to the CLIP Administration . • The CLIP Administration Process & Decision. • Again, youth 13 yrs and older must agree to the voluntary treatment.

28. Involuntary Application Involuntary Commitment (ITA) 180-day Restrictive Orders for Inpatient Treatment: • Under RCW 71.34, adolescents aged 13-17 may be committed for up to 180 days of involuntary inpatient psychiatric treatment. • Under this 180-day restrictive court order, the adolescent becomes eligible for admission to a CLIP Program. • The adolescent's name is placed on the statewide waiting list as of the date of the 180-day Restrictive ITA order. • RSN CLIP committee consults with CLIP Administration

29. RCW 10.77 Competency / Restoration • Competency / Restoration is the least common way to CLIP: • RCW 10.77 allows for children to be court-ordered, through the criminal justice system for psychiatric evaluation at CSTC and/or to regain competency to stand trial. • RCW 71.34 also permits the transfer of an adjudicated youth from a Juvenile Rehabilitation Administration (JRA) facility to CSTC for up to 14 days of psychiatric evaluation and treatment.

30. Other notes on CLIP • Length of stay can be from 6-12 months. Most youth average about 9 months. RSN CLIP Coordinator will follow the youth’s treatment throughout their stay. • Youth are returned to their home community as soon as possible. Community partners, including family, DSHS caseworkers, therapists, schools, RSN, etc., are expected to collaborate with the CLIP Program to assure appropriate discharge resources are in place prior to discharge. • Youth can be admitted to CLIP more than once as long as admission criteria has been met and there is expected benefit. • If an application is not recommended by RSN, treatment recommendations will be made by the local committee.

31. Questions? For more information, contact: NSMHA www.nsmha.org 360.416.7013 Julie de Losada, M.S. julie_de_losada@nsmha.org Angela Fraser, M.A. angela_fraser@nsmha.org Pat Morris, M.Ed pmorris@voaww.org Contacts