Region 1 South Crisis Care SystemRegion 1 South Crisis Care SystemSystem of Care OverviewSystem of Care Overview

Policy and ProceduresPolicy and Procedures

Illinois Department of Human Services Division of Mental Health

Jackie Manker, LCSWAssociate Director

Community ServicesJune 6, 2012

6/6/20121

Materials for todayMaterials for today

Region 1 South Crisis Care System Policies and Procedure Chapter of Provider Manual

Calendar

Presentation Slides

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Objectives of OVERVIEWObjectives of OVERVIEW

Understand the flow of new Crisis Care System Understand key policies Understand procedures

Understand any interim policies and procedures

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ACCESSAuthorization

DMHCrisis

Residential

DMHHospital

DMHAcute

CommunityServices

DASAResidential

CrisisStabilzation

13 EDs NoBehavioral Health

Assessment Capacity

YES

NO

Post dischargereferral and linkage

Region 1 SouthUninsuredCommunityPopulation

CMHCED-based

Eligibility & DispositionAssessment

Community Stabilization

CRISIS CARE SYSTEM15 Community Hospitals

Emergency Department Presentation

ClinicalDisposition

Region1 SouthCrisisCare

System

NonMedicaidBenefit

Package

Psychiatric Crisis

Is Consumer eligibleCrisis Care

Alternatives?

2 EDs withBehavioral Health

Assessment Capacity

CHIPS

DHS/DMH IntentDHS/DMH Intent

To replace services previously provided by Tinley Park Mental Health Center with a re-balanced system and services that are:

Community-based Recovery oriented Trauma informed Outcome validated

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ServicesServices

Eligibility and Disposition Assessments (EDA)Community Hospital Inpatient Psychiatric

Services (CHIPS)Mental Health Crisis ResidentialDASA Residential Crisis StabilizationAcute Community Services (ACS)Transportation

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EligibilityEligibility

Individual presents in Region 1 South E.D.

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Region 1 South Area

City of Chicago South of 67th Street

South Suburban Cook County

Kankakee County

Will County

Grundy County

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Region 1 South Area Community Hospitals to be Served

City of Chicago South of 67th Street Roseland Community HospitalSt. Bernard Hospital

South Suburban Cook County Franciscan St. James HealthMetro South Medical CenterAdvocate South Suburban Hospital

Palos Community HospitalLittle Company of Mary Hospital

Advocate Christ Medical Center

Ingalls Memorial Hospital

Kankakee County Riverside Medical CenterProvena St. Mary’s Hospital

Will County Provena St. Joseph Medical CenterSilver Cross HospitalAdventist Bolingbrook Hospital

Grundy County Morris Hospital

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General Eligibility determined by E.D.General Eligibility determined by E.D.

Uninsured with no other resources

Preliminary diagnosis of mental illness or mental illness and substance use disorder

No acute medical illness or excluded medical condition

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When all criteria are met,E.D. calls for an

Eligibility and Disposition Assessmentconducted by a

DMH funded evaluatorassigned to that E.D.

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Region 1 South Area

Community Hospitals to be Served

Assigned Eligibility & Disposition Assessment

Agency

City of Chicago South of 67th Street

Roseland Community Hospital Human Resource Development Institute

St. Bernard Hospital To Be Determined (TBD)

South Suburban Cook County

Franciscan St. James HealthMetro South Medical CenterAdvocate South Suburban Hospital

Grand Prairie Services

Palos Community HospitalLittle Company of Mary Hospital

TBDTBD

Advocate Christ Medical Center Advocate Christ Medical Center

Ingalls Memorial Hospital Ingalls Memorial Hospital

Kankakee County Riverside Medical CenterProvena St. Mary’s Hospital

Helen Wheeler Mental Health Center

Will County Provena St. Joseph Medical CenterSilver Cross HospitalAdventist Bolingbrook Hospital

Will County Behavioral Health

Grundy County Morris Hospital Grundy County Health Department

EDA EVALUATORS

Minimum credential of Qualified Mental Health Professional (QMHP)

Available 24/7

Respond within (1) hour of call

Confirms general eligibility

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EDA EVALUATOR

Conducts clinical evaluation and documents on DMH Uniform Screening and Referral Form (USARF)

For individuals with suspected substance use, also assesses using ASAM Patient Placement Criteria

Completes level of care assessment using the Level of Care Utilization System (LOCUS)

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EDA EVALUATOR

Determines if individual meets 2 clinical criteria for Region 1S CCS

Diagnosis of: Schizophrenia (295.xx) Schizophreniform Disorder (295.4)

Schizo-affective Disorder (295.7) Delusional Disorder (297.1)Shared Psychotic Disorder (297.3) Brief Psychotic Disorder (298.8)Psychotic Disorder NOS (298.9) Cyclothymic Disorder (301.13)Major Depression (296.2x, 296.3x) Obsessive-Compulsive Disorder (300.30)Anorexia Nervosa (307.1) Bulimia Nervosa(307.51)Post Traumatic Stress Disorder (309.81)Bipolar Disorders (296.0x, 296.4x, 296.5x, 296.6x, 296.7, 296.80, 296.89, 296.90)

LOCUS Score of 4 or greater

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EDA EVALUATOR

Individual does NOT meet clinical criteria

Inform ED physician/staff

Provide any alternative treatmentor service recommendatione.g. DMH Non-Medicaid benefit package

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EDA EVALUATOR

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EDA EVALUATOR Is the individual willing?

Individual is NOT willing to engage?Does he/she meet criteria for involuntary

hospitalization?

Yes – proceed with processNo – explain outcome of assessment, recommend level of care to individual,

ED physician/staff and others of individual’s choice

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EDA EVALUATORIndividual is willing to Engage

Inform ED physician/staff of recommended level of care

ED physician/staff concur

Evaluator calls the ACCESS line for• Authorization• Available services• Authorization number

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Service Authorization

Illinois Mental Health Collaborative for Access and Choice• DMH’s Administrative Service Organization

(ASO)

Toll free ACCESS Line (866) 359-7953

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Service Authorization

Clinical Care Managers (CCM) available 24/7

Evaluator provides information • Demographics• Clinical presentation• Recommended disposition

CCM reviews for medical necessity

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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

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EDA EVALUATOR

Evaluator• Contacts service provider to make referral.• Makes needed transportation arrangements using

authorization number.• Ensures required documentation is complete and

copy to ED and accepting service provider (USARF, LOCUS, ASAM, disposition and recommendations).

• Confirms linkage occurred within 24 hours.• Registers individual in DHS/DMH consumer

registration system.

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Hospital-Based EDA Evaluator (Advocate Christ and Ingalls Memorial)

All previous elements required PLUS

• Physician conducts evaluations• May provide active treatment if applicable (e.g. extended

observation, Medication administration/monitoring, crisis intervention)

• DMH will provide training on registration

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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 ED

physician/staff• If in agreement, authorization and referral process

is initiated

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Service AuthorizationIf Not in agreement: Collaborative CCM provides clinical presentation,

treatment recommended and capacity to Madden Intake.

Madden Intake physician reviews information and discusses with ED physician.

Madden Intake physician considers option and determines most appropriate level of care and informs both CCM and ED physician.

CCM contacts Evaluator with determination and authorizes services as appropriate.

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Disposition Options

Community Hospital Inpatient Psychiatric Services (CHIPS)

DMH funded, short-term (less than 6 days), inpatient at community hospital.

Serve those experiencing psychiatric crises and exhibit acute behaviors or symptoms requiring inpatient setting.

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CHIPS

Individual has symptoms consistent with a diagnosis of one of the following mental illnesses:

Schizophrenia (295.xx) Schizophreniform Disorder (295.4)Schizo-affective Disorder (295.7) Delusional Disorder (297.1)Shared Psychotic Disorder (297.3) Brief Psychotic Disorder (298.8)Psychotic Disorder NOS (298.9) Cyclothymic Disorder (301.13)Major Depression (296.2x, 296.3x) Obsessive-Compulsive Disorder (300.30)Anorexia Nervosa (307.1) Bulimia Nervosa(307.51)Post Traumatic Stress Disorder (309.81)Bipolar Disorders (296.0x, 296.4x, 296.5x, 296.6x, 296.7, 296.80, 296.89, 296.90)

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Hospitals with CHIPS Contracts

Advocate Christ Medical Center, Oak LawnIngalls Memorial Hospital, HarveyMacNeal Hospital, BerwynMt. Sinai Hospital, ChicagoRiverside Hospital, KankakeeSt. Anthony’s Hospital, ChicagoSt. Bernard Hospital & Health Care Center, ChicagoProvena St. Mary’s, KankakeeUniversity of Illinois Hospital, Chicago

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Mental Health Crisis Residential

DMH funded, short-term 24/7 continous supervision and treatment in a provider controlled facility.• Grand Prairie Services is the current provider.

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Mental Health Crisis Residential

Individual’s symptoms require psychiatric stabilization services. Individual has symptoms consistent with a diagnosis of one of the

following diagnosis.

Schizophrenia (295.xx) Schizophreniform Disorder (295.4)Schizo-affective Disorder (295.7) Delusional Disorder (297.1)Shared Psychotic Disorder (297.3) Brief Psychotic Disorder (298.8)Psychotic Disorder NOS (298.9) Cyclothymic Disorder (301.13)Major Depression (296.2x, 296.3x) Obsessive-Compulsive Disorder (300.30)Anorexia Nervosa (307.1) Bulimia Nervosa (307.51)Post Traumatic Stress Disorder (309.81)Bipolar Disorders (296.0x, 296.4x, 296.5x, 296.6x, 296.7, 296.80, 296.89, 296.90)

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DASA Residential Crisis Stabilization Short term (5-10 days) residential treatment that targets:

• Stabilization of problems related to biomedical, emotional, behavior, or cognitive conditions as described in ASAM Dimensions 1-3.

• Diagnosis of mental illness and substance use disorder.• Planned regimen of care of at least 3 hours of treatment

services per day.• Must link with Acute Community Service provider upon

discharge.

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DASA Residential Crisis Stabilization Providers

The Haymarket Center, Chicago

Healthcare Alternative Systems, Chicago

The South Suburban Council on Alcoholism & Substance Abuse, East Hazel Crest

The Women’s Treatment Center, Chicago

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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 discharge from ED

Services must be initiated within 48 hours of discharge CHIPS, crisis residential, or SOH, and those discharged from DASA residential with co-occurring disorder.

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Acute Community Service (ACS)

Individual eligible for services up to 12 months of initial assessment

Provider agrees to serve all referred individualsProvider required to assist individual with application for

medical assistanceProvider required to register each individual through

DHS/DMH information systemIndividuals will be referred to provider in their geographic

proximity but will have choice if requested

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Acute Community Care Service ProvidersRegion 1 South Area Acute CCS Provider

City of Chicago South of 67th Street Human Resource Development InstituteMetropolitan Family Services

South Suburban Cook County Township

Bremen, Thornton, Rich, Bloom Grand Prairie Services

Lemont, Calumet, Palos, Worth, Orland Metropolitan Family Services

Kankakee County Helen Wheeler Mental Health Center

Will County Will County Behavioral HealthCornerstone Services

Grundy County Grundy County Health Department

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Madden Mental Health Center Services

Will serve as safety net when other services are not appropriate or available.

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Madden Mental Health Center Services

When an individual presents with the following, Madden may be consulted for consideration of DMH admission.

• History indicating need for extended inpatient treatment•Presents challenges in discharge placement from inpatient setting, such as being homeless • Co-occurring substance use disorder requiring medical observation that exceeds the capability of available community inpatient psychiatric services

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Madden Mental Health Center Intake

Responsible for managing the referrals to DMH hospitals to ensure available capacity

For individuals from Region 1 Central who presents at one of the four DMH contracted CHIPS hospitals, Madden Intake may choose to utilize CHIPS, Mental Health Crisis Residential or SA Residential Crisis Stabilization beds when appropriate and needed to manage DMH hospital capacity

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TransportationDMH will purchase transportation services

between Emergency Departments, CHIPS hospitals, MH Crisis Residential and DASA Residential Crisis Stabilization

Individual must meet all eligibility criteriaThe Authorization number received from the

Collaborative will serve as authorization for transportation

Transportation provider must respond within 60 minutes of request

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Region 1 South Crisis Care SystemSystem of Care OverviewPolicies and Procedures

Thank you!!Questions??

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