Mental Health and Wellness Program Meeting the Policy and Requirement Handbook (PRH) Requirements for Documentation Valerie Cherry, PhD

Mental Health and Wellness Program Chapter 6.10, R3 General Emphasis (a) Assessment (b) Promotion, Prevention, and Education (c) Treatment (d) .

Mental Health and Wellness Program (a) General Emphasis Early identification and diagnosis Basic mental health care Mental health promotion, prevention and education Employee assistance program approach Short-term counseling with focus on employability Referral to center support groups Crisis intervention The general emphasis of the mental health and wellness program shall be on the early identification and diagnosis of mental health problems, basic mental health care, and mental health promotion, prevention, and education designed to help students overcome barriers to employability.

Mental Health and Wellness Program Documentation (b) Assessment Social Intake Form Most recent was released via Information Notice 12-31- November 16, 2012 Bottom date - October 2012 Review within 1 week Signed by CMHC Completed Copy or Original in SHR Question: Does the CMHC have to review and sign every SIF? Yes No Review of Social Intake Form (SIF) or intake assessment performed by counseling staff of students who indicate mental health history, current mental health problems, or who request to see the center mental health consultant within one week of arrival.

Mental Health and Wellness Program Documentation (b) Assessment Con’t Assessments and Recommendations for Referred Students What should the Intake include? Reason for Referral Presenting Problem Mental Health History Chemical Health History Mental Status Exam Barriers to Employability and Strengths DSM Diagnosis, if applicable Education and Recommendations Referral to Reasonable Accommodation Committee Provide student with MHCCMP Fact Sheets and note in SHR in progress note or on intake form.

Mental Health and Wellness Program Documentation (b) Assessment Con’t Intake Assessments should be placed in MH section of SHR Progress Note Mental Health Intake Forms (DRG) Provide student with Mental Health Chronic Care Management Plan (MHCCMP) Student Fact Sheets and note in SHR Job Corps Information Notice 13-51 “Updated Chronic Care Management Plans”, dated April 10, 2014 Flow Sheets for recording periodic monitoring visits for students with Schizophrenia, Bipolar Mood Disorder, and Depression Provide student with MHCCMP Fact Sheets and note in SHR in progress note or on intake form.

Mental Health and Wellness Program Documentation (b) Assessment Con’t MSWR or Medical Separations Progress Note in MH section What should be included? Clinical justification for the separation due to health needs beyond what can be managed on center. Sometimes you may be asked for a recommendation on mode of transportation and if an escort is needed. Resource: Medical Transfer, Separation, and Referral; Management of Student Injury and Death Under FECA/OWCP TAG Administrative Report of Functional Evaluation Notification of Medical Separation (Regional Office) Separation and Referral Instructions to Student/Parent/Legal Guardian

Mental Health and Wellness Program Documentation (c) Mental Health Promotion and Education 1-hour CPP Presentation Curriculum Standing day of the week for new inputs CDP and CTP Presentations Maintain a folder/binder, or computer file with days and topics Annual Center Wide Activity Maintain a folder/binder or computer file with information CDP and CTP Hints: For the CDP presentations, how should these be structured and are we expected to provide all of the activities in the curriculum? The CDP curriculum is a resource with various activities to support social emotional learning and it is probably not possible for you to conduct all of the activities for each cohort of students. Select activities from the curriculum and consider providing monthly presentations by trade or dorm for students or if at a large center quarterly. If counselors have active groups already set up for students you may be able to work with them and enhance the groups with activities from the CDP curriculum. Another idea is to integrate this presentation with the required Wellness Education class during CDP.   What is the best way to do presentations during CTP? Some centers have what is called a "Career Readiness" group for students preparing to exit the program. If your center has this group, collaborate and provide activities from the CTP curriculum. If not, talk with your career transition counselor on center and see when would be a good time to set up a group for students preparing to exit where you can present an activity from the CTP curriculum. Question: Can any other staff help with the presentations? A. Yes B. No We strongly recommend that the CMHC provide the CPP presentation to all new students. For CDP and CTP, if there is a counselor or intern who wants to assist with your supervision, that is not a problem. However, remember the requirement is for the MHWP and ultimately the responsibility of the CMHC.

Mental Health and Wellness Program Documentation (c) Mental Health Promotion and Education Con’t Clinical Consultation with CD (monthly), Mgt. Staff, and HWM Minutes Coordination with other departments Keep file on specific trainings for Counselors and/or Residential Advisors. Include SGA, HEALs and other center departments with center wide activities and document in your file their participation in developing the activity.

Mental Health and Wellness Program Documentation (d) Treatment Short term with employability focus Document on progress note in MH section of the SHR How do we document employability focus in a note? Sample Progress Notes in DRG MHCCMP Student Fact Sheet

Employability Focus Student was referred by counselor for acting out behavior in the classroom. Student has history of anxiety and expressed feeling stressed out on center and difficulty with peers. Refer for medication evaluation and return in 1 week. Student was referred by counselor for acting out behavior in the classroom. Student has history of anxiety and expressed feeling stressed out on center and difficulty with peers. Introduced distress tolerance activity to increase awareness of feelings and how to express them in a more positive way. Student agrees to journal and will return in 1 week.

Sample Employability Progress Note S = Student reports having difficulty sleeping in the dorm along with feelings of sadness and disinterest in center activities over past two weeks. Student states he is becoming increasingly irritable during the day. O = Student was generally anxious throughout the session with a flat affect. At one point became tearful and slightly agitated. Able to verbalize how current symptoms could become barriers to employment if not resolved. Denied any suicidal thoughts or past suicidal behavior. A = Student has been on center for two months and is experiencing adjustment issues which may be triggering an episode of depression. Shows moderate level of motivation to address symptoms, identify, and remain in program. P = Schedule next appointment for 5/10/2014 @ 3:30pm to begin short-term cognitive behavior therapy to address symptoms on center and provide strategies on how to handle emotions on center and in future work environment. Gave student sleep hygiene brochure and instructed to return to wellness if problems do not get better before next appointment. Refer to Counselor’s adjustment group, alert RA and Counselor to watch for behavioral changes over the week and refer back to health and wellness, if needed. Lastly, student given mindfulness exercises to practice over next week. CMHC, Ph.D. # 1010

Sample Progress Note INTERVENTIONS FOR EMPLOYABILITY Indicate primary types of interventions utilized (Check all that apply). Describe in summary of session. Assess/Info Gather Psycho-education Motivational Interviewing Crisis Intervention Stress Management CBT/ACT Empathic Exploration Social Skill Training DBT/Mindfulness Decision Making Psychodynamic/Relational Other SUMMARY (Include how the session ties into employability or the work environment for the student) Session Phone contact Case Management/Consultation Other __________________________________________________ _____________________________________________________________________________________

Mental Health and Wellness Program Documentation (d) Treatment Con’t Collaboration with TEAP Minutes of meetings Collaboration with CP - Psych Meds Note on chronological record or note in MH section of SHR Standing meeting with CP and/or Wellness staff Collaboration with Counseling staff in developing and/or leading psycho-educational groups Schedule of groups on center provided by counseling If you referred student to group, should be indicated in the SHR- MH section If you are conducting a group, should be indicated in the SHR HINT: Chapter 2.8 Personal Development Skill R1. Conflict Resolution Skills Centers shall provide each new student with instruction in basic conflict resolution techniques within the first 60 days of enrollment. At a minimum, instruction shall include: HINT: Chapter 2.4 Personal Counseling Services Centers shall provide intensive ongoing personal counseling services early within the first 60 days of the student’s stay on center. These services will continue as needed (see Chapter 3, Section 3.3, Personal and Career Counseling) throughout the student’s enrollment, with the following features: b. Ongoing structured, scheduled, and documented individual social development and adjustment counseling. c. Group support sessions designed to identify and address specific issues, such as abuse, relationships, child care, homesickness, language and cultural barriers, etc. d. Identification of students who need more intensive services and referral to such services. e. Intervention, implementation, and documentation of strategies to address personal issues, including mental health, medical issues, and English Language Learners.

Documentation of Case Conferences and CMHC Led Groups Pre-printed adhesive labels that allow enough space for brief sentence update. Signed and dated Case Management Meeting Student continues to attend anger mgt. group and is doing well. No further MH services needed at this time. 5-1-2014 CMHC, PhD Emotional Regulation Group Student was active in group and participated in deep breathing exercise. 5-1-2014 CMHC, PhD.

Mental Health and Wellness Program Documentation (d) Treatment Con’t Regular case conferences between CMHC, Counselors, and other appropriate staff- Case Management Documentation of Case Management and Feedback Form (DRG) in SHR in MH section Progress Note in MH section Referral to Off Center- Case Management Release of Information to exchange updates Work with Wellness staff to come up with system to document off center updates in the SHR Written referral and feedback system- Case Management Use of Referral and Feedback Form (DRG) Provide feedback to the referral source at the bottom of form. Copy in SHR Follow-up on feedback at next case conference and document in SHR HINT: Include TEAP specialist in regular case conference meeting.

Care Management vs. Case Management

Care Management PRH requirement [PRH-6.10: R1, 4] states “students identified as having chronic health problems during the cursory or entrance physical shall be monitored as directed by the CP or other appropriate center health provider.” What CMHC tasks are considered care management? MHCCMP

Case Management PRH requirement [PRH 6.10 R3, d5] states “Information exchange through regular case conferences between the Center Mental Health Consultant, counselors, and other appropriate staff based on individual student needs.” Case management requires communication among staff, monitoring, and follow up We do not recommend the use of CIS by CMHCS

Chapter 5 and Training

Chapter 5 - Exhibit 5-4 Centers shall include, at a minimum, the following: a. Five hours of annual training in adolescent growth and development for all staff. Topics could include effective communications, anger management, sexuality, suicide prevention, behavior management system, zero tolerance policy, appropriate staff/student boundaries, sexual assault prevention and response, sexual harassment and related social skills training, crisis intervention techniques, bullying prevention, violence prevention, and safety issues. New Staff Orientation Crisis Intervention training requirement (for 1st 90 Days and Yearly)

Best Practices that Make Assessors Happy! Document, Document, Document Smartly! Have documentation organized and available. Include discussions on how emotions and behaviors impact employability with students and document in progress notes. Include documentation in the file on students discussed and updated during meetings with counselors. Consistently provide information back to the referral source with a copy easily found in the SHR. Notation on Chronological Record in SHR “May 1, 2014 - See Note in MH Section”

In A Nutshell SHR - MH Section Social Intake Form Referral and Feedback Form Specifics for Referral Source Intake Assessment MHCCMP RAC Employability Progress Notes Case Management Notes On and Off site Med-Check in Notes Group Notes Mental Health Promotion and Education Binder CPP, CDP, and CTP Presentation Info Documentation of center wide activity Documentation of any staff trainings Chronological Record Document dates students receive services with corresponding note in MH section.

Regional Mental Health Specialists David Kraft, MD, MPH dkraft@external.umass.edu Maria Acevedo, PhD (PR Centers mmacevedo@onelinkpr.net Region 2 Valerie Cherry, PhD vcherryphd@gmail.com Region 3 Suzanne Martin, PsyD, MPH suzannempsyd@gmail.com Region 4 Lydia Santiago, PhD lydia.v.santiago@att.net Region 5 Helena Mackenzie, PhD helena.mackenzie530@gmail.com Region 6 Vicki Boyd, PhD vdelboyd@aol.com