2. UNDERSTANDING THE COMMUNITY MENTAL HEALTH SYSTEM Julie de Losada, Laura Davis Yen. July 27, 2011 CHILDREN, YOUTH, AND FAMILIES

3. Federal Government DSHS DBHR ESH WSH RSN CMHA CLIP ADSA DDD CA JRA other Centers for Medicare & Medicaid Services Mix of State Mental Health and Federal $$ Pearl Street McGraw CSTC Tamarack Catholic Community Services NW Whatcom, Skagit, Snohomish Compass Health Skagit, Snohomish, San Juan SeaMar Behavioral Health Skagit, Snohomish, Whatcom Whatcom Counseling & Psychiatric Clinic North Sound Mental Health Administration Region 2 North NSMHA From Washington to Washington…

4. 39 C ounties G rouped into 13 RSNs

5. How NSMHA works with Volunteers of America It All Starts at “ACCESS”

6. Access to Care 4 Ways to Enter the Community Mental Health System 1.Crisis Services 2.Outpatient Services 3.Inpatient Services* 4.CLIP* *Neither NSMHA nor our Providers deliver inpatient or CLIP services. NSMHA may authorize for these levels of care. Volunteers of America (VOA)

7. Role of VOA 24/7 Phone Crisis Intervention (800-584-3578) 24/7 Triage Clinician Line (800-747-8654)Regional Lifeline call center (1-800-273-8255) ACCESS to Outpatient counseling (888-693-7200) Inpatient Certification & Authorization (800-707-4656) Offers ASIST and SafeTALK community trainings

8. Accessing Crisis Services  24/7 Phone Crisis Intervention Services  100,000 Annual Total Calls  Serving Five North Sound Counties  Self-Defined Crisis  Mental Health Professional Staff

9. Accessing Outpatient Services  MUST meet Medicaid Financial Eligibility o Established by Community Service Office (CSO)  MUST have a covered “Access to Care” diagnosis  MUST meet “medical necessity”  MUST call ACCESS to Mental Health Services

10. Access to Care Standards Examples

11. Access to Care Standards Continued

12. RSN/ CMHA Service  Outpatient services offered by NSMHA contracted Community Mental Health Agencies  Catholic Community Services NW  Compass Health  SeaMar  Whatcom Counseling and Psychiatric Services

13. ALL Providers Offer…  Assessment/ Evaluation  Individual Therapy  Group Therapy  Family Therapy  Medication Management  Case Management  Coordination with formal systems  Coordination with natural supports

14. SOME Providers Offer…  CHAP – Children’s Hospitalization Alternative Program  Co-Funded by Children’s Administration for 16 yrs.  Individualized/ intensive care  In-home & out-of-home  Respite  24/7 Crisis Response  Wraparound  Family-driven/ Youth-Guided  Team Based  Natural Supports  Community Based  Culturally Competent  Strengths Based  Collaboration  Persistent  Outcomes Based INTENSIVE SESSION Systems of Care and Wraparound: An Overview D AN E MBREE 2:40 RM 565 B/C

15. Assessments and Evaluations How Long Does it Take to Get an Appointment??!?!?!

16. Time Lines 14 Calendar Days from Request to Intake 28 Calendar Days from Intake to First Ongoing 7 Calendar Days from Inpatient Discharge to Intake or First Ongoing.

17. Each person has a unique combination of strengths and needs. Services should be designed to: Utilize Strengths Meet Needs In the least restrictive / most normative manner Individual and Tailored Care

18. F amily V oice and P articipation A SSESSMENTS BASED ON FAMILY STRENGTHS AND NEEDS Needs are not Services F AMILIES SHOULD BE INCLUDED IN THE ENTIRE PLANNING AND TREATMENT PROCESS It’s not about us with out us.

19. C onsiderations for A dolescents  Y outh who are thirteen and older can request mental health services without the consent of their parents. RCW 71.34.500  Y outh who are thirteen or older and who are a danger to themselves or others, and refuse treatment may be involuntarily detained and hospitalized. RCW 71.34.710  Y outh who are thirteen and older can request mental health services without the consent of their parents. RCW 71.34.500  Y outh who are thirteen or older and who are a danger to themselves or others, and refuse treatment may be involuntarily detained and hospitalized. RCW 71.34.710

20. Planning Ahead… Transitioning to the Adult Mental Health System

21. Preparing for the transition  Discuss transitioning to an adult mental health provider with the current mental health provider:  Timing of the transition  Which agency and program can best meet the young adult’s needs?  Keep in mind, some programs take time to get into  Apply for Medicaid if appropriate:  Medical  Cash assistance  Food Benefit  Research and plan for housing:  Housing authorities’ programs including voucher programs and public housing  Some mental health agencies have limited housing resources

22. Preparing for the transition, Continued  Community Resources: research what other assistance is available in your community  Food Banks  Transportation Options  Discounted utilities  Any special needs  Develop skills for independent living  Plan for employment/education/daily activity  Teach/coach the youth how to communicate about and navigate health care; they will be driving their own care as an adult.

23. The Adult Mental Health System at a Glance

24. A Brief Overview… Inpatient MH Treatment

25. Accessing Inpatient Services 2- Ways Voluntary Involuntary RCW 71.34.600 (1) A parent may bring, or authorize the bringing of, his or her minor child to an evaluation and treatment facility or an inpatient facility licensed under chapter 70.41, 71.12, or 72.23 RCW and request that the professional person examine the minor to determine whether the minor has a mental disorder and is in need of inpatient treatment.

26. When is Inpatient Appropriate? Needs crisis stabilization in order to avoid a higher level of care. Potential danger to self, others, or property. Caregiver or youth are unable to ensure safety. Needs constant supervision and adult intervention to assure safe environment Inability to think clearly or distinguish reality. AND other less restrictive services have been tried which were not successful or were unable to ensure the youth's safety

27. When is Inpatient Inappropriate? When less restrictive interventions have not been attempted. Solely for “medication adjustments” or “medication vacations”. In lieu of “placement”. When another system can better or more appropriately serve the child/youth (detention, Children’s Administration, primary care etc.) When the crisis and youth’s primary diagnosis are not directly related to mental health diagnosis.

28. What to expect…  Time limited crisis stabilization (5-10 days)  Limited psychiatric evaluation/assessment  Possible medication assessments/ adjustments  Coordination with outpatient provider (if there is one)  Coordination with other systems (if indicated)  Discharge Planning

29. More about Inpatient Services NO child/youth psychiatric inpatient facilities in our region. ALL child/youth psychiatric inpatient facilities in WA are private. Fairfax (6-17) Seattle Children’s (6-17) Two-Rivers Landing (11-17) Kitsap Youth Inpatient Unit (8-17)

30. Contacts Questions?