Northwest Crisis Care System System of Care Overview Policy and Procedures

1. Northwest Crisis Care SystemSystem of Care OverviewPolicy and Procedures Illinois Department of Human Services Division of Mental Health September 12, 2012: Dan Wasmer, MS Associate Director, Regional Services

2. Materials for today • Calendar • Presentation Slides

3. Objectives of OVERVIEW • Understand the flow of new Crisis Care System • Understand key policies • Understand procedures • Understand any interim policies and procedures

4. DHS/DMH Intent To enhance the existing Crisis Care system in Regions 2W and 3N by providing equivalent access to necessary levels of care that are: • Community-based • Recovery oriented • Trauma informed • Outcome validated These services have historically been provided by Singer Mental Health Center.

5. Services • Enhanced Crisis Response • Community Hospital Inpatient Psychiatric Services (CHIPS) • Mental Health Crisis Residential • Acute Community Services (ACS) • Transportation

6. Enhanced Crisis Response • DHS/DMH expects that community providers in Region 2W and 3N will continue to respond to mental health crisis situations within their communities • DHS/DMH is funding enhancements to this system to ensure timely access.

7. Eligibility Disposition Assessment (EDA)EVALUATORS • Minimum credential of Qualified Mental Health Professional (QMHP) • Available 24/7 • Respond within (1) hour of call • Determines financial and clinical eligibility

8. EDA EVALUATOR • Conducts clinical evaluation and documents on DMH Uniform Screening and Referral Form (USARF) • Completes level of care assessment using the Level of Care Utilization System (LOCUS)

9. EDA EVALUATOR Determines if individual meets 2 clinical criteria for Region NCCS • Diagnosis of: Schizophrenia (295.xx)SchizophreniformD/O(295.4) Schizo-affective D/O (295.7) Delusional D/O (297.1) Shared Psychotic D/O (297.3) Brief Psychotic D/O (298.8) Psychotic D/O NOS (298.9)Cyclothymic D/O (301.13) Major Depression (296.2x, 296.3x) Obsessive-Compulsive D/O (300.30) Anorexia Nervosa (307.1) Bulimia Nervosa (307.51) Post Traumatic Stress D/O (309.81) Bipolar Disorders(296.0x, 296.4x, 296.5x, 296.6x, 296.7, 296.80, 296.89, 296.90) • LOCUS Level of Care Recommendation of 4 or greater

10. EDA EVALUATOR Individual does NOT meet clinical criteria • Inform referral source as appropriate • Provide any alternative treatment or service recommendation e.g. DMH Non-Medicaid benefit package

11. EDA EVALUATOR • Individual does meet clinical criteria • Evaluator determines individual is a resident of Region 2W/3N No – refer to Elgin/McFarland Yes – recommend level of care and service needs • CHIPS • Mental Health Crisis Residential • ACS • Transportation

12. 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, referral source and others of individual’s choice

13. EDA EVALUATOR Individual is willing to Engage • Inform referral source as appropriate of recommended level of care • If individual is in Emergency Department, assure that ED physician/staff concur • Evaluator calls the ACCESS line for • Authorization • Available services • Authorization number

14. Service Authorization • Illinois Mental Health Collaborative for Access and Choice • DMH’s Administrative Service Organization (ASO) Toll free ACCESS Line (866) 359-7953

15. Service Authorization • Clinical Care Managers (CCM) available 24/7 • Evaluator provides information to ACCESS CCM • Demographics • Clinical presentation • Recommended disposition • CCM reviews for medical necessity

16. 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

17. EDA EVALUATOR • Evaluator • Contacts service provider to make referral. • Makes needed transportation arrangements using authorization number. • Ensures required documentation (USARF, LOCUS, disposition and recommendations) is complete; distributes copies to ED (if involved) and accepting service provider (USARF, LOCUS, disposition and recommendations). • Confirms linkage occurred within 24 hours. • Registers individual in DHS/DMH consumer registration system.

18. 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 the individual and ED physician/staff (if in an ED) • If in agreement, authorization and referral process is initiated

19. Service Authorization If Not in agreement: • Collaborative CCM provides clinical presentation, treatment recommended and capacity to Elgin/McFarland • Elgin/McFarland physician reviews information and discusses with ED physician (if involved). • Elgin/McFarland considers option and determines most appropriate level of care and informs both CCM and ED physician (if involved). • CCM contacts Evaluator with determination and authorizes services as appropriate.

20. Disposition Options Community Hospital Inpatient Psychiatric Services (CHIPS) • DMH funded, short-term inpatient treatment at community hospital. • Serve those experiencing psychiatric crises and exhibiting acute behaviors or symptoms requiring inpatient setting.

21. Hospitals with CHIPS Contracts • Swedish American Hospital, Rockford • Rockford Memorial Hospital, Rockford • OSF St. Elizabeth’s, Ottawa • Trinity Medical Center, Moline • Provena Mercy Center, Aurora

22. Mental Health Crisis Residential • DMH funded, short-term 24/7 continuous supervision and treatment in a provider controlled facility. • Rosecranceis the current provider.

23. 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 the EDA • Services must be initiated within 48 hours of discharge CHIPS, crisis residential, or SOH.

24. Acute Community Service (ACS) • Individual eligible for services up to 12 months of initial assessment • Provider agrees to serve all referred/enrolled 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

25. Elgin and McFarland Mental Health Centers • Will serve as safety net when other services are not appropriate or available.

26. Elgin/McFarland Mental Health Centers • When an individual presents with the following, Elgin/McFarland may be consulted for consideration of DMH admission. • History indicating need for extended inpatient treatment • Presents challenges in discharge from inpatient setting, such as experiencing homelessness.

27. Transportation • DMH will purchase transportation services between site of EDA, CHIPS hospitals, and MH Crisis Residential • Individual must meet all eligibility criteria • The Authorization number received from the Collaborative will serve as authorization for transportation • Transportation provider must respond within 90 minutes of request

28. Phone Contacts Complaint Resolution/Help Line • 312-814-0930 McFarland Mental Health Center • 217-786-6857 Elgin Mental Health Center • 847-847-6239 • Alternate Phone: 847-742-1040 – have operator connect you to the Admissions staff person. • Questions can also be sent to: • Dhs.R2ccs@illinois.gov

29. Northwest Crisis Care SystemSystem of Care OverviewPolicies and Procedures • Thank you!! • Questions??