Purpose Of Training: To guide Clinicians in the completion of screens and development of Alternative Community Service Plans.

Reasons For Training Appeals regarding denials for inpatient and PRTF (psychiatric residential treatment facility) treatment have identified areas for growth. Review of screens has yielded a need to address areas in the screening process. Data collected by SRS on all PRTF screens from October 07-January 08 showed a need for improvement in Diversion/Alternative Community Service Plans and clinical documentation. Data shows that limited alternative services are provided to the Member post-diversion.

Today’s Training Areas Focus on the documentation needed for a comprehensive clinically complete screen. Focus on Alternative Community Service Plans. Follow-up care after completion of the screening process.

Goals: Increase consistency in the completion of the screens. Accurate identification of necessary and needed behavioral health supportive services. Identifying elements of safe and effective diversion plans. Increase utilization of PRTF waiver services. Understand use of Clinical Care Coordination for Members with Special Health Care Needs.

Let’s begin

SRS Survey Results: SRS reviewed cases of all Kansas youth diverted from PRTF during the months of October 2007 to January (Prior to PRTF Demonstration Waiver implemented April 1, 2008) Tracking information was obtained from the TMHC screening database. Copies of the Mental Health Screening forms were obtained from TMHC for all youth in the survey.

SRS Survey Results Continued The Alternative Community Service Plans were used to identify service recommendations. MMIS and AIMS databases were utilized to track if a Member received the recommended services.

SRS Survey Results Continued 18 CMHC’s conducted screens 512 Screens were completed 406 recommended PRTF admission 106 recommended Diversion 72 of the 106 youth diverted received some form of CBS services after diversion

Results of the SRS Survey Continued The database evidence indicates that of the youth diverted: 73% of CWC referrals received CBS services 55% of JJA referrals received CBS services 86% of CMHC referrals received CBS services

Limitations of the Survey Data limitations of this survey were that services provided were based on claims filed. Children screened who were in foster care were harder to track regarding follow-up services. Children in JJA custody were also difficult to track as many may have received services that were not billed through Medicaid.

Programs Used To Prevent Readmission SED and PRTF Waiver specific: Wrap around Respite Care Professional Resource Family Care Parent Support Attendant Care Independent Living Skills training PRTF Waiver Specific: Community Transition Supports Fund Employment Support and Preparation

Services to prevent readmission Community Based Services and outpatient services: CPST TCM Individual, family and/or group therapy Medication management Psychosocial groups Respite

Services to prevent readmission Data reflected need for more services to reduce readmission. On average those diverted from hospital care received 7 services within the first 30 days. Coordination of Care ensuring that the diversion plan is being followed and providers are communicating.

UTILIZING THE SCREENING TOOL

Screen Disposition Identification of needed services and community resources to support diversion Consider diversion options such as SED Waiver or PRTF Waiver Check appropriate boxes for disposition/reimbursement authorization The clinical information throughout the screen needs to support the diagnosis and disposition of the screen

Alternative Community Services Plan Alternative Community Service Plans are to be effective intervention tools. Continuity of care decreases recidivism, improves outcomes for Members, improves quality of life and decreases costs to Members and others. Collaborative cooperative communication among all involved agencies creates beneficial outcomes.

Alternative Community Services Plan Protocols for utilizing Alternative Community Services Plan: Alternative Community Services Plan should be concrete and time limited. The goal is to put services into place quickly and efficiently to meet the immediate needs of the Member in crisis. Screener or designee should follow up within 24 hrs post diversion to ensure services are in place. Further Care Coordination-KHS will require screener to call and request Care Coordination.

Alternative Community Services Plan Recommend accurate units of service in the Alternative Community Services Plan. The service needs should be prioritized with identified service expectations. Example: Attendant Care 24-7 for the first 48 hours to be initiated within 2 hrs of completion of screen, then scheduled as necessary thereafter, a minimum of one hour daily for the first 7 days. Crisis case management by next business day Care coordination contact within 24 hrs

Alternative Community Services Plan Recommendations for long term services should be identified such as family therapy or individual therapy. Service start date should be identified. For example, Individual therapy to be initiated within 7 calendars days. Identification of naturally occurring supports and a plan to access those supports. Consider utilizing peer support.

Diversions Alternative Community Services Options: The PRTF Waiver is for Members who are currently receiving PRTF treatment or who are screened and clinically qualify for admission to a PRTF. SED Waiver is child or adolescent Members that are at risk of State Psychiatric Hospitalization. CBS Services: CPST, TCM, Attendant Care, and Psychosocial Rehabilitation Outpatient Services: Individual, family and/or group therapy, Medications

Diversions Continued The PRTF Waiver provides the six services offered by the SED Waiver, Independent Living Skills, Wrap Around Facilitation, Attendant Care, Respite Care, Professional Resource Family, Parent Support and Training. PRTF Waiver offers 2 additional services, Community Transition Support Funds and Employment Preparation and Support aimed to facilitate transition to independent living for those older youth.

Care Coordination Process A CMHC Clinician is to follow-up within the first 24 hours. KHS’s Care Coordination Department is to be contacted the next business day by the Clinician if the Clinician needs assistance in coordinating care between different service organizations and provider types. The KHS Care Coordinator will follow up at a minimum of one contact within first 24 hrs.

Care Coordination Process To include: Review of the diversion plan; Contact with Member; Assurance that medications are available as appropriate; Coordinate with all involved entities regarding Alternative Community Services Plan; Determine if Member feels diversion plan is meeting his/her needs and refer back to provider(s) as appropriate.

Care Coordination Process Continued Assure crisis appointments are scheduled; Follow up regarding outcome of appointments; If appointments not kept, follow up with Member to ensure continuity of care; Crisis Case management or other mental health service deemed appropriate to be initiated the next business day.

Care Coordination Process Continued Reassess supportive services to ensure services meet level of care needs within 72 hours; Follow-up with Member for 14 days to ensure continuity of care to decrease hospital or PRTF admission after diversion; Provide Care Coordination for up to 14 days or until crisis abates, ensuring all involved entities remain informed and refer to KHS Care Coordination if needed.

Conclusion Complete screens in a clear and concise manner, that is supported by clinical information. Diagnosis and treatment recommendations must be supported by the clinical information provided in the screen. Accurate identification of services needed to support diversion plan, with appropriate units of services requested. Consideration of waiver services, naturally occurring community supports and peer support services. Care Coordination to ensure diversion success and continuity of care with seamless information flow among all involved entities.

Desired Outcome Improved screens Effective Alternative Community Services Plan Higher post-diversion success