Community Support Services Training Session 5 Rutgers, The State University of New Jersey School of Health Professions Department of Psychiatric Rehabilitation and Counseling Professions
Review from Session 4 Person-First Language Rehabilitation Needs Assessment Knowledge, Skills, Resources Form -successes and challenges with completing the form SMART Documentation
Learning Objectives Review Knowledge, Skill, Resource (KSR) and its connection to the rehabilitation plan. Practice developing an Individualized Rehabilitation Plan. Describe the critical components of a progress note. Evaluate agency documentation. Understand the impact of burnout.
Rehabilitation Plan Process CRNA: Identifies goals. KSR Form: Helps identify the critical components needed to achieve the goal. Once prioritized to 3 to 5 identified areas, written in S-M-A-R-T format, becomes the objectives in the Rehabilitation Plan. Rehabilitation Plan: Incorporates the CRNA with the KSR form. Adds S-M-A-R-T interventions to match objectives and drives the intentional billable services.
Rehabilitation Plan Preliminary Individualized Rehabilitation Plan (PIRP) Individualized Rehabilitation Plan (IRP) Completed upon admission based on medical necessity. Serves as authorization for first 60 days. Completed within the first 60 days of admission Review/Revise within 3 months of development A new IRP should be completed and submitted to the IME every 6 months
Why Individualized Rehabilitation Planning? Links the steps to achieve the goal with the interventions Interventions aim to eliminate the deficits Identifies who is responsible for doing what, by when, for how long, and where Increases sense of accountability Operationally defines the rehabilitation team approach (Anthony, Cohen, Farkas, Gagne, 2002)
Individualized Rehabilitation Plan (IRP) Valued life roles / Rehabilitation and recovery goals Objectives Strategy/intervention to be employed Anticipated outcomes Expected frequency and duration of each activity Type (credential) of practitioner to provide the service Location of service ( 47 N.J.R. 1827(a); Larosiliere, 2011)
Interventions… What is the intended service that you are providing? Medicaid is paying for the intervention that you are providing
Individualized Rehabilitation Plan Example
IRP Checklist and Red Flags Review IRP checklist and IRP red flags form - As a larger group, practice using the IRP checklist on the example provided Break up into groups, practice using the IRP checklist on the sample IRP’s that were brought in
Individualized Rehabilitation Plan – Activity Part 1 Step 1: Find a partner Step 2: Choose a goal from one of your sample IRP’s Step 3: Work with your partner to brainstorm a list of possible steps to achieve the goal. Step 4: Take that list and break the items into knowledge, skills, or resource on the KSR form
Individualized Rehabilitation Plan – Activity Part 2 Step 1: Identify strengths and areas for improvement by checking off the appropriate boxes on the KSR form. Step 2: Talk with your partner; prioritize 3 to 5 areas of need that you want to work on first. Step 3: Break down the 3 to 5 prioritized items into S-M-A-R-T format.
Individualized Rehabilitation Plan – Activity Part 3 Transfer the information from the KSR Form to your Individualized Rehabilitation Plan Keep in mind: Strengths, Valued Life Role, Wellness Dimension S-M-A-R-T objectives Develop S-M-A-R-T interventions to match each objectives Calculate the units Select another sample IRP at the buzzer
Rehabilitation Plan Process CRNA: Identifies goals. KSR Form: Helps identify the critical components needed to achieve the goal. Once prioritized to 3 to 5 identified areas, written in S-M-A-R-T format, becomes the objectives in the Rehabilitation Plan. Rehabilitation Plan: Incorporates the CRNA with the KSR form. Adds S-M-A-R-T interventions to match objectives and drives the intentional billable services.
Rehabilitation Plan Revisions Goal (s) have been accomplished Consumer no longer wants to work on chosen goal (s) Unforeseen events Disengagement Incarcerations/Hospitalizations
Documentation Progress note for each encounter Must relate to a service on the rehabilitation plan There is adequate content for time billed Should reflect the intervention(s) being addressed during the visit Medicaid Regulations (10:79B-2.5) Date of the service Type of service provided Duration of the service Name, credential, and title of the employee providing the service Specific location service was provided
Data Data Linkage to the rehabilitation goal Review of consumers follow-up activities Specific interventions Consumer report
Assessment Consumer response to the intervention Assessment of progress towards IRP goals, objectives, and interventions Assessment of change in consumer behavior
Plan Staff/Consumer next steps Date and time of next service delivery
Golden Thread of Documentation CRNA Rehabilitation Plan Progress Note
D-A-P Checklist
D-A-P Format Data Assessment Plan
Progress Note Exercise Review your sample progress note Use the DAP checklist to evaluate if the key components of a progress note are present
Burnout A psychological syndrome that involves a prolonged response to chronic interpersonal stressors on the job. Burnout consists of three components: Emotional exhaustion Cynicism Personal efficacy (Ray et al., 2013; Thompson, Amatea, & Thompson, 2014)
Burnout Six areas of work life where mismatches between the person’s expectations and the job are considered to be predictive of burnout: Workload Control Rewards Community Fairness Values (Ray et al., 2013; Thompson et al., 2014)
Factors that Trigger Burnout Caring for patients System problems High census Heave patient assignments High acuity Overtime Extra work days Personal issues (Ray et al., 2013; Thompson et al., 2014)
Activity: Self-Care How do you practice self-care?
Learning Application Use the IRP checklist on two IRP’s at your agency.
Q&A and Evaluations
Zakia Clay, MSW, LCSW, CPRP Anthony Zazzarino MA, LPC, ACS, CPRP Contact Information Zakia Clay, MSW, LCSW, CPRP Zakia.Clay@shp.rutgers.edu Ann Reilly MA, LSW, CPRP Reillya2@shp.rutgers.edu Anthony Zazzarino MA, LPC, ACS, CPRP ASZ28@shp.rutgers.edu
References Alexander, M. J., & Haugland, G. (2000). Integrating services for co-occurring disorders. Final report prepared for the New York State Conference of Local Mental Hygiene Directors. Orangeburg, NY: Center for the Study of Issues in Public Mental Health, Nathan S.Kline Institute for Psychiatric Research. Retrieved from \http://www.clmhd.org/UploadedFiles/Resources/Integrating% Services%20for%20CoOccurring%20Disorders_1283591 33052805216.pdf. Anthony, W., Cohen, M., Farkas, M., & Gagne, C. (2002).Psychiatric rehabilitation. (2nd ed., pp. 141-151). Boston: Center for Psychiatric Rehabilitation. Larosiliere, V (2011). Community Support Services [memo]. Retrieved from http://www.state.nj.us/humanservices/dmhs/info/CSS_Notice_t o_provi ders.pdf.
References (continued) New Vitae. (2014). Documentation, the D.A.P. Format, and Writing Incident Reports [Module #5]. Quakertown, PA: Human Resources. Pratt, C. W., Gill, K. J., N.M, & Roberts, M. M. (2014). Psychiatric Rehabilitation. (3rd ed.) San Diego, CA: Elsevier Inc. Ray, S. L., Wong, C., White, D., & Heaslip, K. (2013). Compassion satisfaction, compassion fatigue, worklife conditions, and burnout among frontline mental health care professionals. Traumatology, 19(4), 255-267. Thompson, I.A., Amatea, E.S., & Thompson, E.S. (2014). Personal and contextual predictors of mental health counselors’ compassion fatigue and burnout. Journal of Mental Health Counseling, 36(1), 58-77.