Practical Application of PCPC Rev. 11/2015

DDAP’s Mission The Department of Drug and Alcohol’s mission is to engage, coordinate and lead the Commonwealth of Pennsylvania’s effort to prevent and reduce drug, alcohol and gambling addiction and abuse and to promote recovery, thereby reducing the human and economic impact of the disease. Gary Tennis, First Secretary of DDAP

Goals To review PCPC criteria, providing an opportunity for problem solving To increase knowledge and skills of the PCPC through practical application exercises **reminder: PCPC and Confidentiality trainings are prerequisites for Practical Applications course** To review confidentiality issues relevant to the PCPC

Objectives By the end of the training, participants will: Increase knowledge of the practical application of the PCPC. Increase skill of the practical application of the PCPC Identify confidentiality issues pertaining to the PCPC summary sheet. Demonstrate proficiency in administration of the PCPC

The PCPC Set of guidelines designed to provide clinicians with a basis for determining the most appropriate treatment setting for individuals with Substance Use Disorders (SUD) Sequence: screening, assessment, interpretation through 6 dimensions, Level of Care (LOC) and Type of Service (TOS) placement determination

Importance of Level of Care and Length of Stay –Under treating can lead to treatment resistance or increased progression of the disease What happens if you take a half dose of antibiotic? What happens if you take a half dose of insulin? What happens if you take a half dose of treatment? –Answers: It doesn’t work Individuals get sicker Individuals and providers “give up” believing that there is no hope, and therefore become resistant to change. PCPC

PCPC Levels of Care *based on service descriptions Types of Service Tx Contact/ Staff Ratio Structure*Medical*Setting Level.5Early InterventionNoneLowNoneCommunity Level I Outpatient 1A Low (<5hr/35:1) LowNoneCommunity Intensive Outpatient 1B Medium LowNoneCommunity (5-10 hr./15:1) Level II Partial Hospitalization 2A Medium NoneCommunity (10+ hr./10:1) Halfway House 2B Low (<5 hr./8:1) High (24 hr.)Low (phys. exam) Community/ Residential Level III Med Monitored Detox 3AHigh (7:1)High (24 hr.)Medium (exam in 24h)Residential Short Term Residential 3BHigh (8:1)High (24 hr.) Medium (physical exam) Residential Long Term Residential 3CHigh (8:1) High (24 hr.) Medium(phys. exam 48h) Residential (Longer tx) Level IV Med Managed Detox 4AVery High (5:1)High (24 hr.)Very High (24h Doc)Hospital Med Managed Tx 4BHigh (7:1)High (24 hr.)High (24h Nurs.)Hospital

Initial Placement Determination What type of help (medical, structure, contact) does the client need? Medication-Assisted Treatment Co-Occurring SUD and Mental Health Women/Women with Children Criminal Justice Cultural/Ethnic Sexual Orientation/ Gender Identity Co-Occurring SUD and Gambling Disorder Level of CareType of Service Special Considerations Provider Which Type of Service is designed to meet those needs? (TOS Placement ) Which Provider meets the needs?

Role of Assessor/SCA Case Manager –Complete a comprehensive assessment –Identify key assessment and placement issues –Advocate for individual to receive the care that is appropriate based on PCPC. –Use techniques to motivate the individual to engage in the appropriate LOC (e.g., Motivational Interviewing) Role of Payer Care/Case Manager –Coordination of care –Quality assurance of collaborative review of case –Financial authorization for appropriate LOC according to PCPC Role of SCA Case Manager –Coordination of care –Case management to link to ancillary supports such as employment services, Medicaid, etc. LOC determinations are made based on meeting the criteria of the PCPC. Discussion on the LOC placement is to center on which criteria are met. Recommendations may not be denied solely because the assessor was not able to provide information due to confidentiality limits. PCPC Collaboration for Authorization of Care

As in the past, only information compliant with state and federal regulations may be included in the Summary Sheet or shared with funders. Relevant confidentiality regulations include but are not limited to 42CFR Part 2 and 4 Pa Code § –42 CFR Part 2 provides protections on redisclosure of client information, as well as protects the information from being used for legal and other sanctions –4 Pa Code § 255.5: Limits the information that may be shared to: 1)Whether the client is or is not in treatment. 2)Client’s prognosis. 3)The nature of the project. 4)A brief description of the client’s progress. 5)A short statement as to whether the client has relapsed into drug or alcohol abuse and the frequency of such relapse. Authorization of care is not to be limited as a result of confidentiality protections. PCPC Summary Sheet Information

PCPC & Confidentiality Applying confidentiality regulations to PCPC Summary Sheet –See confidentiality guidelines handout While the clinical record will contain relevant clinical information, only information that complies with 4 Pa Code § is to be written on the PCPC Summary Sheet. Verbatim quotes from PCPC matrix are insufficient without supporting individualized information

Determining Level of Care/Type of Service Be aware of your biases –Are you trying to make someone fit? –Stretching criteria? Maintain integrity of your work by always recommending the clinically appropriate LOC –Don’t assume what a client’s response will be to your placement recommendation. –Don’t assume what the funder will and won’t pay for. –Individuals can choose a lower level of care if they are not in agreement with your recommendation. Note: reason for not receiving recommended LOC must be documented on the Summary Sheet

Case Study 1 WANDA

Case Study 2 ALAN

Case Study 3 MONIQUE

Wrap up Questions & Comments