1. Third Time Is A Charm PRESENTERS APPENDIX 609 AND 610 Valerie Cherry, PhD- Lead and Region 2 Mental Health Specialist Helena Mackenzie, PhD- Region 5 Mental Health Specialist September 4, 2013

2. Brief Relevant Background  Only Potential Application Outcomes  Enrollment  Applicant Withdrawal  Recommendations for Denial New Information Direct Threat (DT) Cannot Meet Basic Health Care Needs (HCN) Refer to more appropriate provider/program Consider for alternate center Appendix 609 Individualized Direct Threat Assessment Appendix 610 Individualized Health Care Needs Assessment

3. Appendices 609 and 610 History  December 11, 2007 – Direct Threat Assessment Form via Program Instruction 07-16.  July 27, 2011- Updated and added “Appendix 609 Individualized Assessment of Possible Direct Threat” to PRH via Job Corps PRH Change Notice No. 11-03.  November 16, 2011- Added new “Appendix 610 Health-Care Needs Assessment” to PRH via Job Corps PRH Change Notice No. 11-09.  July 1, 2013 –Revised Appendices 609 and 610 via Job Corps PRH Change Notice No. 13-02.

4. Why Use Appendices 609 and 610 Forms?  Ensure recommendation for denial process is standardized and less likely to appear discriminatory.  Includes consideration of reasonable accommodation for applicants with disabilities.  Required forms in the Policy and Requirement Handbook (PRH).

5. Recommendations for Denial Center Level  Two Primary Reasons to Recommend Denial:  Concern applicant is at significant risk of harming self or others Complete Direct Threat Assessment (Appendix 609)  Believe Job Corps can not meet applicant’s health care needs Complete Health Care Needs Assessment (Appendix 610)  Third Reason to Recommend Denial:  New Information Revisit specific EAR

6. 609 Direct Threat Assessment  A direct threat assessment should be completed whenever center believes that an applicant poses a direct threat to the health or safety of himself or others.  Poses a significant risk of substantial harm to the health or safety of the individual or others; and  Cannot be eliminated or reduced by reasonable accommodation or modification.  Assessment conducted by licensed clinician. 6

7. 610 Health Care Needs Assessment  The Health Care Needs Assessment should be completed if there is a concern that the center cannot meet the basic health care needs of the applicant.  The applicant’s health-care needs exceed those of basic care and cannot be met by the center.  The applicant’s health-care needs are manageable at Job Corps as defined by basic health-care services in Exhibit 6-4, but require community supports and services which are not available near center. The center must document efforts to arrange for less frequent treatment in home state and/or to secure community support near center and include this information in the health-care needs assessment  Assessment conducted by licensed clinician. 7

8. 610 Health Care Needs Assessment  Health care needs beyond Job Corps basic health care responsibilities (PRH Exhibit 6-4)  Red Flags:  Frequent recent ER visits  Newly diagnosed or uncontrolled health issue  Symptoms/condition not well managed in similar environment as Job Corps  Require extensive resources/intervention

9. 609 Direct Threat Assessment Versus 610 Health Care Needs Assessment  609-Direct Threat  Imminence: Immediate safety concern Suicidal behavior Homicidal behavior Paranoid thinking Threat of assault  610-Health Care Needs  May have safety issues related to health needs, but threat is not imminent Mood swings Impulsive behavior Impaired judgment

10. Revisions to 609 and 610 Forms More User Friendly  New section 1(a) provides examples of potential harm to be selected in a check-box format.  Question 5 was expanded to consolidate information from the “Center Recommendation of Denial Form for Health-Care Needs, Direct Threat or Disability Status” to reduce redundancy and provide specific reasonable accommodation examples in a check-box format.  New Question 3 has been added to identify the functional limitations (specific symptoms/behaviors) of the applicant that are barriers to enrollment in a check box format.  Question 5 was expanded to consolidate information from the “Center Recommendation of Denial Form for Health Care Needs, Direct Threat or Disability Status” and provide specific reasonable accommodation examples in a check box format.  New Question 7 was added for centers to document their efforts to arrange less frequent treatment in home state and/or secure community support near center if recommending an applicant for a different center. Appendix 609-Individualized Assessment of Possible Direct Threat Appendix 610-Individualized Health-Care Needs

11. Mental Health Example of Appendix 610- Health Care Needs Assessment Scenario

12. Appendix 610: Mental Health Example “Derrick D”  20-year-old male  In reviewing health documentation, the HWM identifies concerns on the applicant’s Health Questionnaire (6-53) and associated medical documentation  History of significant mental illness: psychiatric hospitalization five months ago, ongoing symptoms  HWM forwards the file to the CMHC for review and completion of a Health Care Needs Assessment (Appendix 610), if indicated.

13. Health Care Needs Assessment Appendix 610

14. History and Present Functioning

16. File Review Team Meeting

17. Functional Limitations/Symptoms

18. Health Care Management Needs

26. If Recommending Different Center...

27. Direct Threat Assessment Appendix 609  History of suicide attempts and expresses current suicidal thoughts with imminent risk.  Active hallucinations and/or delusional thinking which places them or others at imminent risk.  Significant history of sexual assaults in recency or increased violent episodes. Non- compliant with tx.  Homicidal thoughts SAMPLE AVAILABLE FOR DOWNLOAD

28. Resources Available Downloads  PowerPoint presentation  Word versions of appendices 609 and 610  Sample of completed appendix 609 and 610  Appendix 107-applicant file review guidance – center process