Specialized Children’s Services

Specialized Children’s Services

Operations Manual

District 19 Community Services Board

Effective Jan. 31, 2007 Updated March 31, 2021

2

Table of Contents Section I: General Information Page 3-12 Mission Statement 4 Program Purpose 4 Consumers Served 4 Definitions 4-12 Section II: Program Descriptions and Treatment Process 13-52 Mental Health Case Management Program 14-26 Juvenile Corrections Treatment Program 27-32 Adolescent Substance Use Disorders Treatment Program 33-40 Court Service Unit Program 41-47 Mental Health Initiative Funding 48-51 Section III: Policy and Procedures 52-58 Policy and Procedures Overview 53 Required Reporting, Confidentiality, Human Rights 54 Consumer Records 55 Emergencies 56 Management of Infectious Diseases 57 Use of Program Vehicle 58

3

SECTION I: GENERAL INFORMATION

MISSION STATEMENT PROGRAM PURPOSE CONSUMER SERVED DEFINITIONS

4

Mission Statement

The mission of District 19 Specialized Children’s Services is to provide a comprehensive range of quality mental health and substance use disorder services to children and their families in the community. Specialized Children’s Services includes the Juvenile Corrections Treatment Program, the Adolescent Substance Use Disorder Outpatient Therapy and Outreach Program, the Court Service Unit Program, Children’s Mental Health Case Management and oversight of Mental Health Initiative Funds. We provide our services in the clinic, in their home, school, the community or while incarcerated in the Crater Youth Care Commission.

Program Purpose

The purpose of Specialized Children’s Services is to offer mental health and substance use assessment, treatment, counseling, and case management services to seriously emotionally disturbed and at-risk youth and their families.

Consumers Served

District 19 Specialized Children’s Services is a non-discriminatory agency and accepts consumers without regard to race, color, religion, sex or national origin. Definitions Please note that all definition from this section are directly from, or in conjunction, with the regulations from the Department of Behavioral Health and Developmental Services (DBHDS), and the DMAS Community Mental Health Rehabilitation Services Manuals.

Admission - the process of acceptance into a service as defined by the provider's policies.

Adolescent or Child - the individual receiving the services described in this manual. For these purposes, the use of the term adolescent means an individual 12-20 years of age; a child means an individual from birth up to 12 years of age.

5

Assessment - face-to-face interaction in which the provider obtains information from the individual, and parent, guardian, or other family member or members, as appropriate, about the individual’s mental health status. It includes documented history of the severity, intensity, and duration of mental health problems and behavioral and emotional issues. At Risk of Hospitalization - one or more of the following: (i) within the two weeks before the Comprehensive Needs Assessment (CNA), the individual shall be screened by an LMHP, LMHP-R, LMHP-S or LMHP-RP for escalating behaviors that have put either the individual or others at immediate risk of physical injury such that crisis intervention, crisis stabilization, hospitalization or other high intensity interventions are or have been warranted; (ii) the parent/guardian is unable to manage the individual's mental, behavioral, or emotional problems in the home and is actively, within the past two to four weeks, seeking an out-of-home placement; (iii) a representative of either a juvenile justice agency, a department of social services (either the state agency or local agency), a community services board/behavioral health authority, the Department of Education, or an LMHP, as defined in 12VAC35-105-20, or LMHP-R, LMHP-S, or LMHP-RP and who is neither an employee of nor consultant to the intensive in-home (IIH) services or therapeutic day treatment (TDT) provider, has recommended an out-of-home placement absent an immediate change of behaviors and when unsuccessful mental health services are evident; (iv) the individual has a history of unsuccessful services (either crisis intervention, crisis stabilization, outpatient psychotherapy, outpatient substance abuse services, or mental health skill building) within the past 30 calendar days; (v) the treatment team or family assessment planning team (FAPT) recommends IIH services or TDT for an individual currently who, within the past thirty calendar days, is either: (a) transitioning out of residential treatment services, either psychiatric residential treatment facility (PRTF) or therapeutic group home (TGH), (b) transitioning out of acute psychiatric hospitalization, or (c) transitioning between foster homes, mental health case management, crisis intervention, crisis stabilization, outpatient psychotherapy, or outpatient substance abuse services. Care Coordination - locating and coordinating services across multiple providers to include collaborating and sharing of information among health care providers, who are involved with the individual’s health care, to improve the restorative care and align service plans.

6

Case management service - services that can include assistance to individuals and their family members in assessing needed services that are responsive to the person's individual needs. Case management services include identifying potential users of the service; assessing needs and planning services; linking the individual to services and supports; assisting the individual directly to locate, develop, or obtain needed services and resources; coordinating services with other providers; enhancing community integration; making collateral contacts; monitoring service delivery; discharge planning; and advocating for individuals in response to their changing needs. "Case management service" does not include maintaining service waiting lists or periodically contacting or tracking individuals to determine potential service needs.

Clinical experience - providing direct services to individuals with mental illness or the provision of direct geriatric services or special education services. Experience may include supervised internships, practicums, and field experience.

Comprehensive Needs Assessment - the face-to-face interaction, in which the provider obtains information from the individual, and parent or other family member or members, as appropriate, about the individual’s mental health status. It includes documented history of the severity, intensity, and duration of mental health care problems and issues and shall contain all of the following elements: (i) the presenting issue/reason for referral, (ii) mental health history/hospitalizations, (iii) previous interventions by providers and timeframes and response to treatment, (iv) medical profile, (v) developmental history including history of abuse, if appropriate, (vi) educational/vocational status, (vii) current living situation and family history and relationships, (viii) legal status, (ix) drug and alcohol profile, (x) resources and strengths, (xi) mental status exam and profile, (xii) diagnosis, (xiii) professional summary and clinical formulation, (xiv) recommended care and treatment goals, and (xv) The dated signature of the LMHP, LMHP-supervisee, LMHP-resident, or LMHPRP. Counseling - the application of principles, standards, and methods of the counseling profession in (i) conducting assessments and diagnoses for the purpose of establishing treatment goals and objectives and (ii) planning, implementing, and evaluating treatment plans using treatment interventions

7

to facilitate human development and to identify and remediate mental, emotional, or behavioral disorders and associated distresses that interfere with mental health. Counseling must be provided by an LMHP, LMHP-S, LMHP-R or LMHP-RP acting within their scope of practice. Crisis - a deteriorating or unstable situation often developing suddenly or rapidly that produces acute, heightened, emotional, mental, physical, medical, or behavioral distress or any situation or circumstance in which the individual perceives or experiences a sudden loss of the individual's ability to use effective problem-solving and coping skills.

Department - the Virginia Department of Behavioral Health and Developmental Services. Discharge - the process by which the individual's active involvement with a service is terminated by the provider, individual, or authorized representative.

Discharge plan - the written plan that establishes the criteria for an individual's discharge from a service and identifies and coordinates delivery of any services needed after discharge.

Early and Periodic Screening, Diagnostic and Treatment (EPSDT) - Medicaid’s comprehensive and preventive child health program for individuals under the age of 21. Federal law (42 CFR § 441.50 et seq) requires a broad range of outreach, coordination, and health services under EPSDT distinct from general state Medicaid program requirements. EPSDT is geared to the early assessment of children’s health care needs through periodic screenings. The goal of EPSDT is to assure that health problems are diagnosed and treated as early as possible before the problem becomes complex and treatment more costly. Examination and treatment services are provided at no cost to the member. Any treatment service which is not otherwise covered under the State’s Plan for Medical Assistance can be covered for a child through EPSDT as long as the service is allowable under the Social Security Act Section 1905(a) and the service is determined by the Department of Medical Assistance Services (DMAS) or its agent as medically necessary.

8

Emergency service - unscheduled and sometimes scheduled crisis intervention, stabilization, and referral assistance provided over the telephone or face-to-face, if indicated, available 24 hours a day and seven days per week. Emergency services also may include walk-ins, home visits, jail interventions, and preadmission screening activities associated with the judicial process. Individual - the Medicaid-eligible person receiving these services and for the purpose of this section includes children from birth up to 12 years of age or adolescents ages 12 through 20 years. Individuals may also be referred to as a member. Individualized Service Plan or ISP - a comprehensive and regularly updated written plan that describes the individual's needs, the measurable goals and objectives to address those needs, and strategies to reach the individual's goals. An ISP is person-centered, empowers the individual, and is designed to meet the needs and preferences of the individual. The ISP is developed through a partnership between the individual and the provider and includes an individual's treatment plan, habilitation plan, person-centered plan, or plan of care, which are all considered individualized service plans.

Licensed Mental Health Professional or LMHP - the same as defined in 12VAC35-105-20. It is currently defined as a physician, licensed clinical psychologist, licensed professional counselor, licensed clinical social worker, licensed substance abuse treatment practitioner, licensed marriage and family therapist, certified psychiatric clinical nurse specialist, licensed behavior analyst, or licensed psychiatric/mental health nurse practitioner. LMHP-Resident or LMHP-R - the same as "resident" as defined in (i) 18VAC115-20-10 for licensed professional counselors; (ii) 18VAC115-50-10 for licensed marriage and family therapists; or (iii) 18VAC115-60-10 for licensed substance abuse treatment practitioners. An LMHP-resident shall be in continuous compliance with the regulatory requirements of the applicable counseling profession for supervised practice and shall not perform the functions of the LMHP-R or be considered a "resident" until the supervision for specific clinical duties at a specific site has been preapproved in writing by the Virginia Board of Counseling. For purposes of Medicaid reimbursement to their supervisors for services provided by such residents, they shall use the title "Resident" in connection with the applicable profession after their signatures to indicate such status.

9

LMHP-Resident in Psychology or LMHP-RP - the same as an individual in a residency, as that term is defined in 18VAC125-20-10, program for clinical psychologists. An LMHP-resident in psychology shall be in continuous compliance with the regulatory requirements for supervised experience as found in 18VAC125-20-65 and shall not perform the functions of the LMHP-RP or be considered a "resident" until the supervision for specific clinical duties at a specific site has been preapproved in writing by the Virginia Board of Psychology. For purposes of Medicaid reimbursement by supervisors for services provided by such residents, they shall use the title "Resident in Psychology" after their signatures to indicate such status. LMHP-Supervisee in Social Work, LMHP-supervisee, or LMHP-S - the same as "supervisee" as defined in 18VAC140-20-10 for licensed clinical social workers. An LMHP-supervisee in social work shall be in continuous compliance with the regulatory requirements for supervised practice as found in 18VAC140-20-50 and shall not perform the functions of the LMHP-S or be considered a "supervisee" until the supervision for specific clinical duties at a specific site is preapproved in writing by the Virginia Board of Social Work. For purposes of Medicaid reimbursement to their supervisors for services provided by supervisees, these persons shall use the title "Supervisee in Social Work" after their signatures to indicate such status. Marketing Materials - any material created to promote services through any media including, but not limited to, written materials, television, radio, websites, and social media. Outpatient service - treatment provided to individuals on an hourly schedule, on an individual, group, or family basis, and usually in a clinic or similar facility or in another location. Outpatient services may include diagnosis and evaluation, screening and intake, counseling, psychotherapy, behavior management, psychological testing and assessment, laboratory and other ancillary services, medical services, and medication services. "Outpatient service" specifically includes:

1. Services operated by a community services board or a behavioral health authority established pursuant to Chapter 5 (§ 37.2-500 et seq.) or Chapter 6 (§ 37.2-600 et seq.) of Title 37.2 of the Code of Virginia;

https://law.lis.virginia.gov/vacode/37.2-500/


10

2. Services contracted by a community services board or a behavioral health authority established pursuant to Chapter 5 (§ 37.2-500 et seq.) or Chapter 6 (§ 37.2-600 et seq.) of Title 37.2 of the Code of Virginia; or

3. Services that are owned, operated, or controlled by a corporation organized pursuant to the provisions of either Chapter 9 (§ 13.1-601 et seq.) or Chapter 10 (§ 13.1-801 et seq.) of Title 13.1 of the Code of Virginia.

Progress Notes - individual-specific documentation that contains the unique differences particular to the individual's circumstances, treatment, and progress that is also signed and contemporaneously dated by the provider's professional staff who have prepared the notes. Individualized and member-specific progress notes are part of the minimum documentation requirements and shall convey the individual's status, staff interventions, and, as appropriate, the individual's progress, or lack of progress, toward goals and objectives in the ISP. The progress notes shall also include, at a minimum, the name of the service rendered, the date of the service rendered, the signature and credentials of the person who rendered the service, the setting in which the service was rendered, and the amount of time or units/hours spent in the delivery of service. The content of each progress note shall corroborate the time/units billed. Progress notes shall be documented for each service that is billed. Provider - an individual or organizational entity that is appropriately licensed as required by the Department of Behavioral Health and Developmental Services and/or the Department of Health Professions and credentialed with the BHSA and/or MCO as a Medicaid provider of community mental health and rehabilitation services. Psychoeducation - (i) a specific form of education aimed at helping individuals who have mental illness and their family members or caregivers to access clear and concise information about mental illness and (ii) a way of accessing and learning strategies to deal with mental illness and its effects in order to design effective treatment plans and strategies. Qualified Mental Health Case Manager - the same as defined in 12VAC30-50-420 and 12VAC30-50-430 and as described in Chapter II of this manual.





11

Qualified Mental Health Professional-Child or QMHP-C - the same as defined in 12VAC35-105-20 and consistent with the requirements of 18VAC115-80-10. A QMHP-C may only provide services to individuals under the age of 22 in accordance to 18VAC115-80-10. A qualified mental health professional-child shall provide such services as an employee or independent contractor of the Department of Behavioral Health and Developmental Services or the Department of Corrections, or as a provider licensed by the Department of Behavioral Health and Developmental Services. Qualified mental health professional-trainee - a person who is receiving supervised training to qualify as a qualified mental health professional and is registered with the board. Qualified Paraprofessional in Mental Health or QPPMH - the same as the term is defined in 12VAC35-105-20 and consistent with the requirements of 12VAC35-105- 1370. Qualified Mental Health Professional-Adult or QMHP-A - the same as defined in 12VAC35-105-20. A qualified mental health professional who provides collaborative mental health services for adults. A qualified mental health professional-adult shall provide such services as an employee or independent contractor of the Department of Behavioral Health and Developmental Services or the Department of Corrections, or as a provider licensed by the Department of Behavioral Health and Developmental Services.

Referral - means the process of directing an applicant or an individual to a provider or service that is designed to provide the assistance needed.

Screening -the process or procedure for determining whether the individual meets the minimum criteria for admission. Substance Abuse (Substance Use Disorders) - the use of drugs enumerated in the Virginia Drug Control Act (§ 54.1-3400 et seq.) without a compelling medical reason or alcohol that (i) results in psychological or physiological dependence or danger to self or others as a function of continued and compulsive use or (ii) results in mental, emotional, or physical impairment that causes socially dysfunctional or socially disordering behavior; and (iii), because of such substance abuse, requires care and treatment for the health of the individual. This care and treatment may include counseling, rehabilitation, or medical or psychiatric care.


12

Treatment - means the individually planned therapeutic interventions that conform to current acceptable professional practice and that are intended to improve or maintain functioning of an individual receiving services delivered by a provider.

13

SECTION II:

PROGRAM DESCRIPTIONS AND

TREATMENT PROCESS

Program Descriptions & Treatment Process

• Mental Health Case Management Program

• Juvenile Corrections Treatment Program

• Adolescent Substance Use Disorder Outpatient Therapy Program

• Court Service Unit Program • Mental Health Initiative Funding

14

Program Descriptions Mental Health Case Management Program Purpose The Children’s Mental Health Case Management Program offers targeted case management services to children ages birth-7 identified as at-risk for serious emotional disturbance and ages 8-17 identified as seriously emotionally disturbed. The goal of the Children’s Mental Health Case Management Program is to assist children, adolescents, and their families with accessing needed medical, psychiatric, social, educational, and vocational services and other supports essential to meeting the basic needs for successful recovery. Children’s Mental Health Case Management services are offered throughout the D19 catchment area. Consumers Served The Children’s Mental Health Case Management Program offers targeted case management services to children ages birth-7 identified as at risk for serious emotional disturbance and ages 8-17 identified as seriously emotionally disturbed. Persons eligible for case management services through District 19 should be residents of one of the nine jurisdictions of the agency. Medicaid consumers are protected by their Freedom of Choice rights and are not restricted to receive case management services within their respective localities. Prospective consumers may refer themselves or be referred by collateral resources, hospitals, schools, treatment facilities, family members or legal guardians. Eligible Targeted Case Management Population Definitions 1. Serious Emotional Disturbance Serious emotional disturbance in children ages birth through 17 is defined as a serious mental health problem that can be diagnosed under the DSM, or the child must exhibit all of the following:

a. Problems in personality development and social functioning that have been exhibited over at least one year’s time; and

15

b. Problems that are significantly disabling based upon the social functioning of most children that age; and c. Problems that have become more disabling over time; and d. Service needs that require significant intervention by more than one agency.

Children diagnosed with Serious Emotional Disturbance and a co-occurring substance abuse or developmental disability diagnosis are also eligible for Case Management for Serious Emotional Disturbance. 2. At-Risk of Serious Emotional Disturbance Children aged birth through 7 are considered at-risk of developing serious emotional disturbances if they meet at least one of the following criteria:

a. The child exhibits behavior or maturity that is significantly different from most children of that age and which is not primarily the result of developmental disabilities; or b. Parents, or persons responsible for the child’s care, have predisposing factors themselves that could result in the child developing serious emotional or behavioral problems (e.g., inadequate parenting skills, substance abuse, mental illness, or other emotional difficulties, etc.); or c. The child has experienced physical or psychological stressors that have put him or her at risk for serious emotional or behavioral problems (e.g., living in poverty, parental neglect, physical or emotional abuse, etc.).

Service Eligibility Criteria The Medicaid eligible individual shall meet the DBHDS criteria of serious mental illness, serious emotional disturbance in children and adolescents, or youth at-risk of serious emotional disturbance. • There must be documentation of the presence of serious mental illness for an adult individual or of serious emotional disturbance or a risk of serious emotional disturbance for a child or adolescent. • The individual must require case management as documented on the ISP, which is developed by a qualified mental health case manager and based on an appropriate Comprehensive Needs Assessment and supporting documentation. • To receive case management services, the individual must be an “active client,” which means that the individual has an ISP in effect which requires regular direct or client-related contacts and communication or activity with

16

the client, family, service providers, significant others, and others, including a minimum of one face-to-face contact every 90 calendar days. Persons eligible to receive case management services must have documented evidence in the clinical record to support such services. Documentation may include, but is not limited to, the following:

A. A psychiatrist’s diagnosis B. Copies of hospital discharge summaries C. Reports, referrals, or information from other agencies

involved with the client/family D. A social or medical history E. An employment history

Persons eligible to receive case management require initial and annual health and physical exams. The case manager is responsible for coordinating as well as securing copies of physical exams. All eligible MHCM consumers require primary screenings by the CSB. Staffing Staffing of all Specialized Children’s Services programs is done in accordance with 12VAC35-105-590 and§ 37.2-203 of the Code of Virginia.

Specialized Children’s Services Manager: The Manager is responsible for the overall administrative and clinical functioning of Specialized Children’s Services Program and staff. The Manager provides direct clinical supervision to all Specialized Children’s Services staff. Clinical supervision occurs at a minimum of once per month. The Manager must be a Licensed Mental Health Professional (LMHP).

Children’s Mental Health Case Manager: Children’s Mental Health Case Managers provide mental health case management services to children ages 0-7 who are at risk for serious emotional disturbance and children ages 8-17 who meet criteria for serious emotional disturbance. Services include identifying potential users of the service; assessing needs and planning services; linking the individual to services and supports; assisting the individual directly to locate, develop, or obtain needed services and resources; coordinating services with other providers; enhancing community integration; making collateral contacts; monitoring service delivery;


17

discharge planning; and advocating for individuals in response to their changing needs. Office Associates: The Office Associates provides administrative support to clinical and case management staff and the manager. Duties include monitoring admissions for billing purposes and processing data for internal and external requirements. The Office Associates are members of the Child and Adolescent Services Support Staff with assigned duties.

Student Interns: Specialized Children’s Services staff are encouraged to be field instructors for student interns. All student interns will be supervised according to agency policy. Assessment Process& Intake Protocols District 19’s Same Day Access Program (SDA) is the initial point of contact for information and referrals for all services offered at District 19 CSB. No appointment is required. Potential consumers can walk into a District 19 CSB office and see a clinician on the same day during specified days and times. Initial paperwork, consent to treatment, releases of information, insurance information and a signed financial contract are all completed during the Same Day Access appointment. SDA clinicians will complete a comprehensive needs assessment and make recommendations for services. Mental health case management may be included as a recommended service on a comprehensive needs assessment. All treatment records will include the health history of the consumer and the general condition of the consumer. Also included will be gender assigned at birth on the birth certificate, gender identity and preferred pronouns. The emergency information for the consumer will include significant communication information, as well as notice of advance directives. Treatment records will be reviewed for accuracy and information added as appropriate. All treatment records will be completed in accordance with current District 19 Policies and Procedures. Same Day Access staff will schedule a follow-up case management appointment with a case manager in the locality the consumer resides in within 10 days of the completion of the comprehensive needs assessment.

18

The SCS case manager is responsible for completing the admission process and developing the final case management ISP within thirty (30) days of the date of the initial comprehensive needs assessment/admission assessment. The admission process includes the completion of all applicable admission forms.

Once the admission process is completed, the SCS case manager must register for targeted case management services per service population criteria for Medicaid reimbursement via applicable Medicaid MCO electronic submissions (please see DMAS/Medallion 4.O instructions). It is the case manager’s responsibility to complete the Program Enrollment, secure the MCO registration and ensure data entry no later than twenty-four (24) hours from date of completion for billing purposes. The primary service provider must notify or document the attempts to notify the primary care provider or pediatrician of the individual’s receipt of Community Mental Health Rehabilitative Services, specifically mental health case management. Federal regulation 42CFR441.18 prohibits providers from using case management services to restrict access to other services. An individual cannot be compelled to receive case management if he or she is receiving another service, nor can an individual be required to receive another service if they are receiving case management. For example, a provider cannot require that an individual receive case management if the individual also receives medication management services. Treatment Process The continuum of primary services begins following intake and assessment. The consumer’s case is opened to the District 19 system and assigned a primary clinician for case management services. The case manager will make recommendations regarding specific program placement consistent with the consumer’s condition. Case consultation across District 19 programs and services is utilized as needed. Each consumer enrolled in Specialized Children’s Services has his or her case clinically staffed in individual supervision. Cases may also be staffed at monthly case staffings. Each consumer’s signed individualized service plan is reviewed for progress no less than every ninety days and modified as

19

needed. Updates and addendums to the treatment plan reflect goals accomplished as well as new problems that have emerged. The consumer and the case manager are mutually involved in the ongoing process of defining treatment goals. During regular business hours, clinicians are available to respond in person, electronically, or by telephone to preadmission screening evaluators of individuals with open cases at the CSB, to provide relevant clinical information to help facilitate appropriate dispositions related to the civil involuntary admissions process. In situations where the preadmission screening evaluator would like additional clinical information, they will attempt to contact the primary clinician first, but if unsuccessful, then they will contact the Manager and/or Supervisor of the program. During regular business hours, Managers/Supervisors are available by email, if they are not available in person or by phone. Case Management Functions

1. The case manager will meet with the consumer to verify that they do meet the criteria for case management. If the consumer does qualify for case management, the case manager will complete the Person-Centered Individual Service Plan (ISP) with the consumer at the next appointment following their comprehensive needs assessment.

2. All consumers receiving case management services within District 19 must have a completed initial ISP within twenty-four hours of admission/program enrollment and a comprehensive Person-Centered Individualized Service Plan (ISP) within 30 days of the initiation of service. The ISP must include the following:

- Consumer’s name and case identification number - Consumer’s treatment and training needs - Goals and measurable objectives to meet the consumer’s identified need - Services to be provided with recommended frequency to accomplish the measurable goals/objective - The person who is responsible for the service intervention.

3. All assessments and ISPs shall be updated as necessary as the needs of the

individual change and/or if the individual meets a different service population definition due to a change in age, diagnosis, level of disability, duration of illness, etc.

20

4. All ISPs must be updated every 365 days at a minimum.

5. The case manager will conduct a person-centered planning meeting and

develop a new ISP with the consumer at the annual update. The consumer and/or legal guardian must sign the updated service plan as verification that the case manager has discussed changes in the plan with her/him.

6. At the annual update, the case manager shall include information provided

from essential service providers and significant individuals who are involved in the overall treatment of the consumer. This information can be obtained by phone, face-to-face meetings, or fax.

7. The case manager and consumer shall review the ISP every 3 months, or 90

days, and complete the Quarterly Progress Review (QPR). The QPR is an evaluation of the consumer’s progress towards the identified treatment goals. The first review is due by the last day of the 3rd month from the effective date of the ISP. A grace period of the last day of the following month will be given to complete the review. Subsequent reviews, however, are due based on the original due date of the previous review(s); not on the date(s) the previous review(s) had been completed within the grace period.

8. Case managers should meet face-to-face with consumers once a month;

however, a face-to-face meeting must occur at least once every ninety (90) days. The purpose of the face-to-face meeting is for the case manager to observe the consumer’s condition, to verify linked services, to determine if there are any unmet needs at that time, and to determine if the current treatment plan should be continued or revised. Community outreach, home and program site visits are also encouraged to better assess consumer’s current living situation, as well as to better determine appropriateness of community resources and ancillary services.

9. Monthly consumer-related contacts, communication, or activities with

family, other D19 and community service providers or significant others (as authorized) are allowed as long as the 90– day face-to-face contact requirement is met. There must be at least two consumer-related case management activities conducted (which can include phone calls with consumers) for billing to occur; a single telephone call is not sufficient. Required case management activities include monitoring service delivery, linking and service coordination, education and counseling, enhancing

21

community integration, direct assistance in developing/obtaining needed community resources. 10. All case management services shall be documented in the consumer’s medical record. Progress notes are to convey the consumer’s status, staff interventions, and the consumer’s progress towards the goals and objectives stated in the consumer’s ISP. At a minimum, a progress note should outline the following:

Name of service rendered Date of service

Signature and credentials of person rendering the service Amount of time or units required to deliver the service Detailed notes outlining the precise nature of the service(s) rendered (e.g., assessing needs, linking, collateral contacts, counseling). Operating Procedures for SCS Staff Assigned to Outlying Clinics

Assessment Process& Intake Protocols District 19’s Same Day Access Program (SDA) is the initial point of contact for information and referrals for all services offered at District 19. No appointment is required. Potential consumers can walk into a District 19 CSB office and see a clinician on the same day during specified days and times. Initial paperwork, consent to treatment, releases of information, insurance information and a signed financial contract are all completed during the Same Day Access appointment. SDA clinicians will complete a comprehensive needs assessment and make recommendations for services. Mental health case management may be included as a recommended service on a comprehensive needs assessment. Same Day Access staff will schedule a follow-up case management appointment with a case manager in the locality the consumer resides in within 10 days of the completion of the comprehensive needs assessment. Financial Information All initial financial information will be obtained at the Same Day Access appointment. Annual, updated financials and extended payment contracts will be completed by SCS support staff. SCS staff in the clinics should only

22

conduct financial assessments in emergency situations. It is therefore advised that all annual financial assessments (and updates, as applicable) be conducted in the clinics to ensure timely/accurate completion of financial assessments. Notifications of any critical financial matters will also be forwarded to the SCS administrative support staff, who are responsible for routine insurance verifications, insurance pre-authorizations, extension requests, resolving insurance denials, etc. All extended payment contracts will be forwarded to be signed by the SCS Manager. The SCS administrative support staff will be responsible for gathering data regarding billable services to ensure that all insurance claims are accurately made within established billing time frame(s). This includes running case management reports for all localities to track monthly case management contacts. All adjustment requests regarding financial/reimbursement data elements need to be forwarded to the SCS administrative support staff ASAP if errors are discovered after the billing deadlines. Records Management Clinic administrative support staff will assist SCS staff with records management in accordance with existing RM 001 (Medical Record Creation, Content Order, Thinning and Closing) RM 002 (Medical Records - Active and Closed Record Storage and Transport) and RM 004 (Medical Records - Closed Record Retention and Disposition) guidelines (please see applicable Policies & Procedures). The SCS Case Manager Supervisor is the SCS Manager’s designee/primary contact person for all records management issues regarding area clinics. SCS administrative support staff are also available for questions, concerns or requests for assistance with records management protocol regarding SCS medical records of all minors (persons under age 18) and/or of all persons under a disability (defined as declared incompetent by a court). Clinic Coverage It is expected that all SCS staff assigned to outlying clinics maintain a routine work schedule to ensure appropriate clinic coverage. Schedules should be updated weekly in the electronic health record scheduler. Any requests for planned leave should be submitted in advance to prevent coverage problems. It is advised that SCS staff continue to communicate leave matters with Adult Services Clinic Managers. Decisions/final approval of requests for leave, changes in work schedules, etc., that may

23

result in potential clinic coverage problems will be determined by the SCS Manager after consultation with the Adult Services Clinic Managers. In the event of unplanned leave, SCS staff assigned to outlying clinics must contact the clinic administrative support staff and/or leave a voice mail message regarding their absence after contacting SCS Manager/designee, per agency guidelines. Medical Services Psychiatric Services are available to those eligible SCS consumers age 5 and older who meet the DMAS criteria for SED and At-Risk for SED. Psychiatric services will offer appointments via Telemedicine Services. *SCS consumers and their parents/legal guardians have the option to receive medical services from any psychiatrist in the community or from a D19 psychiatrist. There will be no preferential scheduling; support staff will fill all available telemedicine slots chronologically; preferences will be given only to those who can verify their school or work schedules. Consumers recently discharged from hospitals/residential treatment facilities must be scheduled for aftercare appointments with the psychiatrist ASAP to ensure timely receipt of D19 medication orders upon discharge. SCS administrative support staff will contact the parents/guardians of SCS consumers to remind them of their scheduled telemedicine psychiatric appointments 48 hours before and on the date of the scheduled appointments. SCS staff need to continuously address medication management issues with consumers and families; and help educate them of the importance of keeping appointments with the telemedicine psychiatrist to prevent any delay in securing necessary medication orders/prescriptions. Case Transfers

The SCS Manager must approve all SCS transfer requests. It is the responsibility of the transferring case manager/D19 service provider to ensure that all forms are updated and current in the consumer’s medical record prior to case transfer. If the consumer’s medical record has not been updated, the receiving D19 Program Manager reserves the right to deny the transfer until the necessary information has been updated. Once the receiving manager has obtained notification of the transfer,

24

she/he has three (3) working days to review the medical record and approve the transfer. Before a case is accepted for transfer, the D19 case manager/service provider must complete a Transfer Summary to close the case to its program prior to the actual case transfer. Once notice of the transfer is received, the receiving D19 case manager/service provider must then open the case to its site/program. If a D19 case is transferred to SCS case management services from a D19 outpatient service provider, an assessment for case management services and ISP must be completed within 30 days of the date of the transfer. * This includes the updated assessment to determine eligibility criteria for continued case management services if the child ages out of SED and/or AT-RISK populations. The SCS case manager is responsible for coordinating case management services for consumers who move outside the D19 catchment area. To ensure continuity of care guidelines are met, the case manager must follow up with the VACSB case manager (or out-of-catchment service provider) within the first thirty (30) days of the date of the transfer to ascertain status/progress. Such service activity should be noted in the consumer’s record.

DISCHARGE PROTOCOLS

Discharge planning for the consumer begins with the comprehensive needs assessment and is addressed throughout the treatment process. Planned discharge is discussed with the consumer and his family in greater detail as he or she nears program completion. Additional referrals are clarified and facilitated, as needed, and a written discharge plan is developed. Discharge status is usually characterized as successful or unsuccessful, based on the clinical assessment of the individual at the time of termination of services. With a signed consent form, the referral source will be notified of the discharge status and recommendations. Successful completion of treatment indicates that the goals for the individualized treatment plan have been substantially met. The consumer’s prognosis may be clinically evaluated as “good”, “fair”, “guarded” or “poor.”

25

Unsuccessful discharge results from not completing treatment due to non- attendance or non-participation, leaving the program against staff advice or lack of compliance with the treatment plan. Prior to unsuccessful discharge, several attempts are made to contact the consumer to assure that the individual has a reasonable period of time in which to demonstrate compliance with his or her treatment plan. To be eligible for closing, cases must meet at least one of the following criteria:

A. The consumer has moved from District 19’s catchment area.

B. The consumer has decided to receive case management services from another agency. In such cases the case manager is responsible for verifying the consumer’s new service provider.

C. The consumer is sentenced to be incarcerated for six months or longer.

D. The consumer has requested in writing that his/her record be closed to District 19. In such cases the case manager shall respond via letter to the consumer or legal guardian that the request for termination has been received. The letter should also include a statement of treatment and service recommendations to prevent relapse and/or hospitalization; acknowledgement of the individual’s right to resume District 19 services in the future; and information about the availability of District 19’s Crisis Hotline/District 19 Emergency Services.

E. Consumers who are non-compliant with treatment goals and objectives can be closed upon the approval of psychiatrist and program manager following a formal staffing. In such cases an entry should be made in the progress notes regarding the decision to close the consumer’s chart.

F. The consumer’s whereabouts are unknown, and efforts have been made by staff to contact the consumer for a period of at least three (3) months consistently. All efforts to contact consumer must be documented.

26

G. The consumer has been permanently placed in a nursing care facility and this has been verified.

H. The consumer is deceased. I. The consumer has completed treatment goals/objectives. J. The consumer has not received active case management

services for a period of ninety (90) days.

Whenever services are terminated with a Medicaid consumer, the consumer must receive written notification of the pending action within ten (10) days with the following exceptions:

A. Recipient has stated in writing that he/she no longer wishes to receive the services.

B. Recipient gives information that requires the termination of Medicaid benefits and he/she knows that this action is a result of giving the information.

C. Recipient has been admitted to an institution where he/she is ineligible for Virginia State Plan for Medical Assistance Services.

D. Recipient moves to another state and has been determined eligible for Medicaid in the new jurisdiction.

E. Recipient’s whereabouts are unknown. The agency will determine the whereabouts are unknown if mail sent to recipient is returned as undeliverable.

Once it is determined that a case is eligible for closing, the following steps should be taken to disenroll a consumer:

1. Schedule a termination session (as appropriate) to review consumer’s treatment plan.

2. Indicate on the ISP whether the goals/objectives were achieved. Complete a QPR form if due.

3. Make an entry in the progress notes as to the consumer’s disenrollment.

4. Complete the D19 Program Disenrollment process in the electronic health record.

i. (consumers are not to be discharged from CSB).

27

CRATER JUVENILE DETENTION CENTER Program Purpose Juvenile Correction Clinicians provide mental health and substance use counseling to youth in Crater Youth Care Commission and their families. The clinicians provide assessment and intake services, case management as well as individual, family and group counseling. The goal of the Juvenile Corrections Treatment Program is to stabilize mental health and substance use problems, to promote communication and family functioning, to increase coping skills, to learn conflict resolution and problem-solving skills and to decrease state hospitalizations. Consumers Served The Juvenile Corrections Treatment Program provides services to juveniles ages 10-17 incarcerated in Crater Youth Care Commission, and their families. All youth are screened to determine their need for services. Staffing Staffing of all Specialized Children’s Services programs is done in accordance with 12VAC35-105-590 and§ 37.2-203 of the Code of Virginia.

Specialized Children’s Services Manager: The Manager is responsible for the overall administrative and clinical functioning of Specialized Children’s Services Program and staff. The Manager provides direct clinical supervision to all Specialized Children’s Services staff. Clinical supervision occurs at a minimum of once per month. The Manager must be a Licensed Mental Health Professional (LMHP). Juvenile Corrections Clinicians: The Juvenile Corrections Clinicians provide mental health and/or substance use services to incarcerated adolescent at Crater Youth Care Commission, and their families. Juvenile Corrections Clinicians are Qualified Mental Health Professionals-Child (QMHP-C) with a minimum of a master’s degree in a human service field and at least one year of clinical experience with children and adolescents. The staff-to-consumer ratio for Juvenile Corrections Clinicians is 1:30.


28

Office Associates: The Office Associates provides administrative support to clinical and case management staff and the manager. Duties include monitoring admissions for billing purposes and processing data for internal and external requirements. The Office Associates are members of the Child and Adolescent Services Support Staff with assigned duties.

Student Interns: Specialized Children’s Services staff are encouraged to be field instructors for student interns. All student interns will be supervised according to agency policy. Program Description The Juvenile Corrections Treatment Program provides community-based mental health and substance use disorder services to youth with serious emotional disturbance and/or substances use problems that are currently confined at Crater Youth Care Commission. The services also include working intensively with families to build and sustain family strengths and active participation. District 19 Mental Health Clinicians providing services at Crater Youth Care Commission provide Room Confinement Checks on those detainees who are serving 24 hours or more in their room for institutional infractions or behavioral problems (i.e. suicidal gestures, statements or other acting out behavior). The check is to include basic Mental Status components such as consciousness, physical appearance, mood and affect, speech and thought process. After each check is completed, a Room Confinement Check List will be completed and kept in the detainee’s file. The check will be completed Monday through Friday. The goal of the service is to stabilize mental health and substance use problems, to promote communication and family functioning, to increase coping skills, to learn conflict resolution and problem-solving skills and to decrease state hospitalizations. The program provides a multitude of mental health and substance use services including any of the following: Mental Health and Substance Use Disorder Assessment Crisis Intervention

29

Case Management Individual, Family, and Group Therapy Liaison Services Formal training for Crater Staff Referral Process The Juvenile Corrections Treatment Program accepts referrals from the consumers themselves, Crater Youth Care Commission Staff, Court Services Units, other District 19 programs and other community agencies. All new detainees are screened for services through an orientation program. Eligibility Criteria All detainees at the Crater Youth Care Commission are eligible for services in the Juvenile Corrections Treatment Program. Exclusion Criteria Individuals may be excluded from a program if, based on a comprehensive assessment, he or she has psychiatric issues, behavioral issues, or otherwise requires a level of care which is unable to be met by the program based on the supervision and other supports offered by and available to the program. This will be determined on an individual basis and if it is believed that a consumer’s needs are not able to be met by a particular program, that Program Manager must approve the decision not to serve the individual. More appropriate placement(s) must be sought, whenever possible. Juveniles not residing at the Crater Youth Care Commission are not eligible for services in the Juvenile Corrections Treatment Program. Assessment and Intake Protocol Once a referral is made to the Juvenile Corrections Treatment Program, the clinician completes a comprehensive needs assessment. All treatment

30

records will include the health history of the consumer and the general condition of the consumer. Also included will be gender assigned at birth on the birth certificate, gender identity and preferred pronouns. The emergency information for the consumer will include significant communication information, as well as notice of advance directives. Treatment records will be reviewed for accuracy and information added as appropriate. All treatment records will be completed in accordance with current District 19 Policies and Procedures. Treatment Process The continuum of primary services begins following intake and assessment. The consumer’s case is opened to the District 19 system and assigned a primary clinician for therapy and case management services. The clinician will make recommendations regarding specific program placement consistent with the consumer’s condition. Case consultation across District 19 programs and services is utilized as needed. Each consumer enrolled in Specialized Children’s Services has his or her case clinically staffed in individual supervision. Cases may also be staffed at monthly case staffings. Each consumer’s signed individualized service plan is reviewed for progress no less than every ninety days and modified as needed. Updates and addendums to the treatment plan reflect goals accomplished as well as new problems that have emerged. The consumer and the clinician are mutually involved in the ongoing process of defining treatment goals. During regular business hours, clinicians are available to respond in person, electronically, or by telephone to preadmission screening evaluators of individuals with open cases at the CSB, to provide relevant clinical information to help facilitate appropriate dispositions related to the civil involuntary admissions process. In situations where the preadmission screening evaluator would like additional clinical information, they will attempt to contact the primary clinician first, but if unsuccessful, then they will contact the Manager and/or Supervisor of the program. During regular business hours, Managers/Supervisors are available by email, if they are not available in person or by phone. Crisis, individual, and family counseling are available based on the clinician’s comprehensive assessment and the needs of the consumer.

31

Consumers are encouraged to participate in treatment and psychoeducational groups. Discharge Protocol Discharge planning for the consumer begins with the comprehensive needs assessment and is addressed throughout the treatment process. Planned discharge is discussed with the consumer and his family in greater detail as he or she nears program completion. Additional referrals are clarified and facilitated, as needed, and a written discharge plan is developed. Discharge status is usually characterized as successful or unsuccessful, based on the clinical assessment of the individual at the time of termination of services. With a signed consent form, the referral source will be notified of the discharge status and recommendations. Successful completion of treatment indicates that the goals for the individualized treatment plan have been substantially met. The consumer’s prognosis may be clinically evaluated as “good”, “fair”, “guarded” or “poor.” Unsuccessful discharge results from not completing treatment due to non- attendance or non-participation, leaving the program against staff advice or lack of compliance with the treatment plan. Prior to unsuccessful discharge, several attempts are made to contact the consumer to assure that the individual has a reasonable period of time in which to demonstrate compliance with his or her treatment plan. To be eligible for closing, cases must meet at least one of the following criteria:

A. The consumer is released from Crater Youth Care Commission.

B. The consumer has moved from District 19’s catchment area.

C. The consumer is sentenced to be incarcerated at another detention facility.

D. The consumer has requested in writing that his/her record be closed to District 19. In such cases the Juvenile Corrections Clinician shall respond via letter to the consumer or legal guardian that the request for termination

32

has been received. The letter should also include a statement of treatment and service recommendations to prevent relapse and/or hospitalization; acknowledgement of the individual’s right to resume District 19 services in the future; and information about the availability of District 19’s Crisis Hotline/District 19 Emergency Services.

E. Consumers who are non-compliant with treatment goals and objectives can be closed upon the approval of the program manager following a case staffing. In such cases an entry should be made in the progress notes regarding the decision to close the consumer’s chart.

F. The consumer has been permanently placed in a nursing care facility and this has been verified.

G. The consumer is deceased. H. The consumer has completed treatment goals/objectives. I. The consumer has not received active behavioral health








33

THE ADOLESCENT SUBSTANCE USE DISORDER TRATMENT PROGRAM Program Purpose The Adolescent Substance Use Disorder Outpatient Therapy Program provides individual and group counseling to adolescents struggling with substance use. The goal of the program is to offer support, intervention and treatment in a safe environment to help each consumer function at their highest potential. Consumers Served The Adolescent Substance Use Disorder Outpatient Therapy Program provides individual and group counseling to adolescents ages 11-18 (up to 19 years old if still in school and not on probation) struggling with substance use. Services are provided to consumers residing throughout the District 19 catchment area. Staffing Staffing of all Specialized Children’s Services programs is done in accordance with 12VAC35-105-590 and§ 37.2-203 of the Code of Virginia.

Specialized Children’s Services Manager: The Manager is responsible for the overall administrative and clinical functioning of Specialized Children’s Services Program and staff. The Manager provides direct clinical supervision to all Specialized Children’s Services staff. Clinical supervision occurs at a minimum of once per month. The Manager must be a Licensed Mental Health Professional (LMHP). Substance Use Disorders Outpatient Therapist: The Substance Use Disorders Outpatient Therapist provides individual and group therapy to adolescents in need of substance use intervention and treatment. The Substance Use Disorders Outpatient Therapist is, at a minimum, a Licensed Mental Health Professional – Resident (LMHP - R) with at least one year of clinical experience with children and adolescents and at least one year of experience providing substance use treatment. The staff-to-consumer ratio for Substance Use Disorders Outpatient Therapist is 1:40.


34


Student Interns: Specialized Children’s Services staff are encouraged to be field instructors for student interns. All student interns will be supervised according to agency policy. Program Description The Adolescent Substance Use Disorder Outpatient Therapy Program provides individual and group counseling to adolescents ages 11-18 (up to 19 years old if still in school and not on probation) struggling with substance use. Services are provided to consumers residing throughout the District 19 catchment area. All adolescents receiving substance use services from District 19 receive the SASSI-A2 assessment. They also receive a comprehensive diagnostic assessment to determine their substance use needs and any mental health needs that might be present. The ASAM level of care placement criteria are used. A comprehensive treatment plan is developed with the adolescent to address triggers, familial issues, relapse prevention and negative peer influence. Strengths and needs are also addressed. Outreach services are provided throughout the District 19 catchment area. The goal of outreach services is to educate children and adolescents about the dangers of substance use and how to access treatment. Resources are provided during presentation to groups and at health/community fairs. The goal of the service is to decrease adolescent substance use and abuse while helping adolescent return to their highest level of functioning. New and positive coping skills are taught and reinforced throughout the course of treatment. Referral Process District 19’s Same Day Access Program (SDA) is the initial point of contact for information and referrals for all services offered at District 19 CSB. No

35

appointment is required. Potential consumers can walk into a District 19 CSB office and see a clinician on the same day during specified days and times. Initial paperwork, consent to treatment, releases of information, insurance information and a signed financial contract are all completed during the Same Day Access appointment. SDA clinicians will complete a comprehensive needs assessment and make recommendations for services. When an adolescent is assessed through SDA and determined to be appropriate for SUD outpatient therapy services, the SDA assessor schedules an appointment with the SUD outpatient therapist during their next identified open appointment. This must occur within 10 days of the SDA assessment. The SDA assessor notifies the manager of the SUD program, the SUD therapist, and the front desk staff in the Child & Adolescent department of the date and time of the scheduled appointment. The Adolescent Substance Use Disorder Outpatient Therapy Program receives referrals from families, Court Service Units, medical professionals and other community providers. Eligibility Criteria Adolescents ages 11-18 (up to 19 years old if still in school and not on probation) struggling with substance use are eligible for services. The Adolescent Outpatient SUD program offers ASAM Level 1 outpatient treatment services. If an adolescent requires a different level of care based on their comprehensive needs assessment, SASSI-A2 and ASAM placement criteria, the SUD outpatient therapist will assist them with accessing the appropriate treatment services. Services are provided to consumers residing throughout the District 19 catchment area. Exclusion Criteria Individuals may be excluded from a program if, based on a comprehensive assessment, he or she has psychiatric issues, behavioral issues, or otherwise requires a level of care which is unable to be met by the program based on the supervision and other supports offered by and available to the program. This will be determined on an individual basis and if it is believed that a consumer’s needs are not able to be met by a particular program, that Program Manager must approve the decision not to serve the individual. More appropriate placement(s) must be sought, whenever possible.

36

Adolescents requiring SUD treatment other than ASAM Level 1 outpatient treatment services are not eligible for services with District 19’s Adolescent SUD program. If an adolescent requires a different level of care based on their comprehensive needs assessment, SASSI-A2 and ASAM placement criteria, the SUD outpatient therapist will assist them with accessing the appropriate treatment services. Adolescents not residing in the District 19 catchment area are not eligible for services. Assessment and Intake Protocol District 19’s Same Day Access Program (SDA) is the initial point of contact for information and referrals for all services offered at District 19 CSB. No appointment is required. Potential consumers can walk into a District 19 CSB office and see a clinician on the same day during specified days and times. Initial paperwork, consent to treatment, releases of information, insurance information and a signed financial contract are all completed during the Same Day Access appointment. SDA clinicians will complete a comprehensive needs assessment and make recommendations for services. All treatment records will include the health history of the consumer and the general condition of the consumer. Also included will be gender assigned at birth on the birth certificate, gender identity and preferred pronouns. The emergency information for the consumer will include significant communication information, as well as notice of advance directives. Treatment records will be reviewed for accuracy and information added as appropriate. All treatment records will be completed in accordance with current District 19 Policies and Procedures. When an adolescent is assessed through SDA and determined to be appropriate for SUD outpatient therapy services, the SDA assessor schedules an appointment with the SUD outpatient therapist during their next identified open appointment. This must occur within 10 days of the SDA assessment. The SDA assessor notifies the manager of the SUD program, the SUD therapist, and the front desk staff in the Child & Adolescent department of the date and time of the scheduled appointment. After the comprehensive needs assessment is completed, the outpatient therapist will meet with the adolescent to complete a SASSI-A2. Treatment goals will be developed with the adolescent based on the results of the assessment and the SASSI-A2. District 19’s Adolescent SUD Outpatient

37

Program offers ASAM Level 1 treatment. If an adolescent is determined to need a higher or lower level of treatment, SUD staff will coordinate the appropriate level of treatment for the individual. Treatment Process The continuum of primary services begins following intake and assessment. The consumer’s case is opened to the District 19 system and assigned a primary clinician for therapy and case management services. The clinician will make recommendations regarding specific program placement consistent with the consumer’s condition. Case consultation across District 19 programs and services is utilized as needed. Each consumer enrolled in Specialized Children’s Services has his or her case clinically staffed in individual supervision. Cases may also be staffed at monthly case staffings. Each consumer’s signed individualized service plan is reviewed for progress no less than every ninety days and modified as needed. Updates and addendums to the treatment plan reflect goals accomplished as well as new problems that have emerged. The consumer and the clinical team are mutually involved in the ongoing process of defining treatment goals. During regular business hours, clinicians are available to respond in person, electronically, or by telephone to preadmission screening evaluators of individuals with open cases at the CSB, to provide relevant clinical information to help facilitate appropriate dispositions related to the civil involuntary admissions process. In situations where the preadmission screening evaluator would like additional clinical information, they will attempt to contact the primary clinician first, but if unsuccessful, then they will contact the Manager and/or Supervisor of the program. During regular business hours, Managers/Supervisors are available by email, if they are not available in person or by phone. Crisis, individual, and family counseling are available based on the clinician’s comprehensive assessment and the needs of the consumer. Consumers are encouraged to participate in treatment and psychoeducational groups.

38

Discharge Protocol Discharge planning for the consumer begins with the comprehensive needs assessment and is addressed throughout the treatment process. Planned discharge is discussed with the consumer and his family in greater detail as he or she nears program completion. Additional referrals are clarified and facilitated, as needed, and a written discharge plan is developed. Discharge status is usually characterized as successful or unsuccessful, based on the clinical assessment of the individual at the time of termination of services. With a signed consent form, the referral source will be notified of the discharge status and recommendations. Successful completion of treatment indicates that the goals for the individualized treatment plan have been substantially met. The consumer’s prognosis may be clinically evaluated as “good”, “fair”, “guarded” or “poor.” Unsuccessful discharge results from not completing treatment due to non- attendance or non-participation, leaving the program against staff advice or lack of compliance with the treatment plan. Prior to unsuccessful discharge, several attempts are made to contact the consumer to assure that the individual has a reasonable period of time in which to demonstrate compliance with his or her treatment plan. To be eligible for closing, cases must meet at least one of the following criteria:

A. The consumer has moved from District 19’s catchment area. B. The consumer has decided to receive SUD outpatient therapy

services from another agency. In such cases the SUD therapist is responsible for verifying the consumer’s new service provider.

C. The consumer is sentenced to be incarcerated for six months or longer.

D. The consumer has requested in writing that his/her record be closed to District 19. In such cases the SUD therapist shall respond via letter to the consumer or legal guardian that the request for termination has been received. The letter should also include a statement of treatment and service recommendations to prevent relapse and/or hospitalization; acknowledgement of

39

the individual’s right to resume District 19 services in the future; and information about the availability of District 19’s Crisis Hotline/District 19 Emergency Services.




H. The consumer is deceased. I. The consumer has completed treatment goals/objectives. J. The consumer has not received active SUD outpatient therapy


Whenever services are terminated with a Medicaid consumer, the consumer must receive written notification of the pending action within ten (10) days with the following exceptions:

A. Recipient has stated in writing that he/she no longer wishes to receive the services.

B. Recipient gives information that requires the termination of Medicaid benefits and he/she knows that this action is a result of giving the information.

C. Recipient has been admitted to an institution where he/she is ineligible for Virginia State Plan for Medical Assistance Services.

D. Recipient moves to another state and has been determined eligible for Medicaid in the new jurisdiction.

E. Recipient’s whereabouts are unknown. The agency will determine the whereabouts are unknown if mail sent to recipient is returned as undeliverable.


40






41

THE COURT SERVICE UNIT PROGRAM Program Purpose The Court Service Unit Program provides mental health and substance use assessments, individual, family and group counseling, and case coordination to juveniles referred by the 6th and 12th District Court Service Units. The goal of the Court Service Unit Program is to expedite access to behavioral health services and to reduce recidivism of juvenile offenders. Consumers Served The Court Service Unit Program provides mental health and substance use assessments, counseling and case coordination to juveniles age 10-21 referred by the 6th and 12th District Court Service Units. Services are provided in the 6th and 12th District Court Service Unit offices, the local courts and in the local detention centers. Staffing Staffing of all Specialized Children’s Services programs is done in accordance with 12VAC35-105-590 and§ 37.2-203 of the Code of Virginia.

Specialized Children’s Services Manager: The Manager is responsible for the overall administrative and clinical functioning of Specialized Children’s Services Program and staff. The Manager provides direct clinical supervision to all Specialized Children’s Services staff. Clinical supervision occurs at a minimum of once per month. The Manager must be a Licensed Mental Health Professional (LMHP). Court Service Unit Clinicians: The Court Service Unit Clinicians provide mental health and substance use assessments, counseling and case coordination to juveniles referred by the 6th and 12th District Court Service Units. Court Service Unit Clinicians are Qualified Mental Health Professionals-Child (QMHP-C) with a minimum of a master’s degree in a human service field and at least one year of clinical experience with children and adolescents. The staff-to-consumer ratio for Court Service Unit Clinicians is 1:20.


42


Student Interns: Specialized Children’s Services staff are encouraged to be field instructors for student interns. All student interns will be supervised according to agency policy.

Treatment Process The continuum of primary services begins following intake and assessment. The consumer’s case is opened to the District 19 system and assigned a primary clinician for therapy and case management services. The clinician will make recommendations regarding specific program placement consistent with the consumer’s condition. Case consultation across District 19 programs and services is utilized as needed. Each consumer enrolled in Specialized Children’s Services has his or her case clinically staffed in individual supervision. Cases may also be staffed at monthly case staffings. Each consumer’s signed individualized service plan is reviewed for progress no less than every ninety days and modified as needed. Updates and addendums to the treatment plan reflect goals accomplished as well as new problems that have emerged. The consumer and the clinical team are mutually involved in the ongoing process of defining treatment goals. During regular business hours, clinicians are available to respond in person, electronically, or by telephone to preadmission screening evaluators of individuals with open cases at the CSB, to provide relevant clinical information to help facilitate appropriate dispositions related to the civil involuntary admissions process. In situations where the preadmission screening evaluator would like additional clinical information, they will attempt to contact the primary clinician first, but if unsuccessful, then they will contact the Manager and/or Supervisor of the program. During regular business hours, Managers/Supervisors are available by email, if they are not available in person or by phone.

43

Crisis, individual, and family counseling are available based on the clinician’s comprehensive assessment and the needs of the consumer. Consumers are encouraged to participate in treatment and psychoeducational groups. Program Description The Court Service Unit Program provides community-based mental health and substance use assessments, counseling, and case coordination to juveniles age 10-21 referred by the 6th and 12th District Court Service Units. Services are provided in the 6th and 12th District Court Service Unit offices, the local courts and in the local detention centers. Referrals for services are received from Juvenile and Domestic Relations Court Judges, juvenile probation officers and juvenile parole officers. Services are provided by a Qualified Mental Health Professional-Child (QMHP-C) with a minimum of a master’s degree in a human service field and at least one year of clinical experience with children and adolescents. Court Services Clinicians will assess juveniles and make service recommendations. They will also identify and arrange for the needed services, either by providing the services themselves or referring the adolescent to the CSB or another community-based provider. The goal of the service is to expedite access to behavioral health services and to reduce recidivism of juvenile offenders. The program provides a multitude of mental health and substance use services including any of the following: Mental Health and Substance Use Assessment Individual, Group and Family Counseling Case Coordination Relapse Prevention Counseling Educational Groups Crisis Intervention Coordination

44

Case Consultation Liaison Services Referral Process Referrals for services are received from Juvenile and Domestic Relations Court Judges, juvenile probation officers and juvenile parole officers. Eligibility Criteria All adolescents referred for services, under supervision, on probation or on parole with the 6th and 12th District Court Service Units are eligible for the Court Service Unit Program. All adolescents referred by Juvenile and Domestic Relations Court Judges in the 6th and 12 Districts are also eligible. Exclusion Criteria Individuals may be excluded from a program if, based on a comprehensive assessment, he or she has psychiatric issues, behavioral issues, or otherwise requires a level of care which is unable to be met by the program based on the supervision and other supports offered by and available to the program. This will be determined on an individual basis and if it is believed that a consumer’s needs are not able to be met by a particular program, that Program Manager must approve the decision not to serve the individual. More appropriate placement(s) must be sought, whenever possible. Adolescents not referred by the 6th or 12th District Court Service Unit or the Juvenile and Domestic Relations Judges of those areas are not eligible for the Court Service Unit Program. Assessment and Intake Protocol Once a referral is received for the Court Service Unit Program, the Court Service Unit Clinician meets with the adolescent and their parent/guardian to complete a comprehensive needs assessment. All treatment records will include the health history of the consumer and the general condition of the consumer. Also included will be gender assigned at birth on the birth certificate, gender identity and preferred pronouns. The emergency information for the consumer will include significant communication

45

information, as well as notice of advance directives. Treatment records will be reviewed for accuracy and information added as appropriate. All treatment records will be completed in accordance with current District 19 Policies and Procedures. Recommendations for services will be made based on the outcome of the comprehensive needs assessment. The adolescent will either follow the orders of the judge, be seen by the Court Service Unit Clinician for treatment services or be referred to the CSB or another community-based provider, if applicable. Discharge Protocol Discharge planning for the consumer begins with the comprehensive needs assessment and is addressed throughout the treatment process. Planned discharge is discussed with the consumer and his family in greater detail as he or she nears program completion. Additional referrals are clarified and facilitated, as needed, and a written discharge plan is developed. Discharge status is usually characterized as successful or unsuccessful, based on the clinical assessment of the individual at the time of termination of services. With a signed consent form, the referral source will be notified of the discharge status and recommendations. Successful completion of treatment indicates that the goals for the individualized treatment plan have been substantially met. The consumer’s prognosis may be clinically evaluated as “good”, “fair”, “guarded” or “poor.” Unsuccessful discharge results from not completing treatment due to non- attendance or non-participation, leaving the program against staff advice or lack of compliance with the treatment plan. Prior to unsuccessful discharge, several attempts are made to contact the consumer to assure that the individual has a reasonable period of time in which to demonstrate compliance with his or her treatment plan. To be eligible for closing, cases must meet at least one of the following criteria:

A. The consumer has moved from District 19’s catchment area.

46

B. The consumer has decided to receive behavioral health services from another agency. In such cases the CSU clinician is responsible for verifying the consumer’s new service provider.

C. The consumer is sentenced to be incarcerated for one month or longer.

D. The consumer has requested in writing that his/her record be closed to District 19. In such cases the CSU clinician shall respond via letter to the consumer or legal guardian that the request for termination has been received. The letter should also include a statement of treatment and service recommendations to prevent relapse and/or hospitalization; acknowledgement of the individual’s right to resume District 19 services in the future; and information about the availability of District 19’s Crisis Hotline/District 19 Emergency Services.




H. The consumer is deceased. I. The consumer has completed treatment goals/objectives. J. The consumer has not received active behavioral health services

for a period of ninety (90) days. Once it is determined that a case is eligible for closing, the following steps should be taken to disenroll a consumer:



47




48

MENTAL HEALTH INITIATIVE FUNDS SCS will utilize Mental Health Initiative (MHI) funding in accordance with the following DBHDS guidelines for CSA non-mandated services:

1. MHI funds must be used exclusively to serve currently unserved children and adolescents or provide additional services to underserved children and adolescents with serious emotional disturbances and related disorders that are not mandated to receive services under the Children’s Services Act (CSA). Underserved refers to populations which are disadvantaged because of their ability to pay, ability to access care, or other disparities for reasons of race, religion, language group or social status.

2. Children and adolescents must be under 18 years of age at the time services are initiated. MHI funds can be used to bridge the gap between the child and adolescent and adult service systems, if the service was initiated before the adolescent’s 18th birthday. MHI funds cannot be used to initiate new services once an adolescent turns 18 years of age.

3. MHI funds must be used to purchase services which will be used to keep the child or adolescent in the least restrictive environment and living in the community.

4. MHI funds should not be used when another payer source is available. 5. Services must be based on the individual needs of the child or

adolescent and must be included in an individualized services plan. Services must be child-centered, family focused, and community-based. The participation of families is integral in the planning of these services.

6. CSBs must develop policies and procedures for accessing MHI funds for appropriate children and adolescents The CSBs shall work collaboratively with its local Community Policy Management Teams (CPMTs) to establish a MHI Fund Protocol for how the CSB will expend the MHI funds for the target population, as defined below.

7. Services shall be provided in the least restrictive and most appropriate settings, including homes, schools, and community centers.

Target Population for Mental Health Initiative Funds The target population to be exclusively served with MHI funds is children

49

and adolescents with serious emotional disturbance and related disorders who are not mandated for services under the CSA. Serious emotional disturbance in children is defined as a diagnosable mental, behavioral, or emotional disorder in the past year, which resulted in functional impairment that substantially interferes with or limits the child’s role or functioning in family, school, or community activities

Related disorders are not defined in the appropriations act. However, the assumption for the purposes of these guidelines is that the language “related disorders” allows the necessary flexibility to serve children with mental health or co-occurring mental health and substance use problems who may not fit the definition above but who, in the opinion of CSB clinical staff, are in need of services that can only be provided with the use of MHI funding. This shall be documented in the child’s file and on the service plan. Appropriate Services to be Supported by Mental Health Initiative Funds Types of services that these funds may be used for include: emergency, outpatient, intensive in-home, intensive care coordination, case management, Family Support Partners, Parent Child Interaction Therapy (PCIT), Trauma Focused Cognitive Behavioral Therapy (TF-CBT, Multi-systemic Family Therapy (MST), Family Functional Therapy (FFT), therapeutic day treatment, alternative day support (including specialized after school and summer camp, behavior aide, or other wrap-around services), and highly intensive, intensive, supervised family support services.

Given the population to be served, children and adolescents with serious emotional disturbances, services need to be appropriately intensive and comprehensive. Prevention and Early Intervention-Part C services are not appropriate uses of these funds. MHI funds may not be used for residential care services or for CSA-mandated populations. All expenditures shall be linked to an individualized service plan for an individual child. Expenditures may be for something that is needed by more than one child, providing it can be linked to the individualized service plan of each child.

50

Referral Procedures for Mental Health Initiative Funds The FAPT/Lead Agency representative presents a case for staffing. FAPT reviews criteria to determine whether case is eligible for MHI funds. If case meets eligibility criteria/child is considered a viable candidate for MHI funds, a referral to the D19 MHI Case Manager is made. The following documentation must be completed and forwarded to the D19 MHI Case Manager when a referral is made: 1) IFSP; 2) CANS (optional); 3) D19 authorization to disclose confidential information forms (2) for

CSA vendor and FAPT/CPMT. The D19 MHI Case Manager completes the required D19 Mental Health Initiative ISP Summary Form. The forms are forwarded for authorization/processing. An authorized CPMT representative must sign the Mental Health Initiative ISP Summary Form to indicate approval for use of Mental Health Initiative Funds. Accountability and Reporting Requirements for Mental Health Initiative Funds D19 will maintain an open/enrolled case and case record on all children receiving MHI-funded services. The D19 MHI Case Manager should ensure that all funds are obligated and spent by June 30th of each year. The D19 MHI Case Manager will monitor MHI services and expenditures by contacting the child, parent(s) and vendors at least twice a month. The MHI Case Manager will review all MHI invoices to ensure accuracy; and to make certain that all invoices must be accompanied by monthly summaries. CSA-certified vendors will enter into MHI contracts with D19 to provide services to cases approved for MHI funds prior to service delivery. * All available funding sources must be accessed to provide services for these children and adolescents prior to utilizing the MHI funding. These sources include, but are not limited to, CSA non-mandated funding, Medicaid, Children’s Medical Security Insurance Plan, Family Access to Medical Insurance Security, private insurance, and other federal, state, or local funds. Other federal or state funds include: Promoting Safe & Stable Families funds, mental health federal block grant funds, Virginia Juvenile

51

Community Crime Control Act funds, and other state mental health general funds used by CSBs for child and adolescent services. *SEE D19 MHI SERVICES PROTOCOL DEVELOPED FOR D19 CSA LOCALITIES*

52

SECTION III

POLICY AND PROCEDURES

Policy and Procedures Overview

Required Reporting, Confidentiality & Human Rights Consumer Records

Emergencies

Management of Infectious Diseases

Use of Agency Vehicles

53

Policy and Procedures Overview This manual is consistent with all written Board-wide policy and procedures but does not duplicate all such materials here. The Director of Child and Adolescent Services and the Manager of Specialized Children’s Service are responsible for assuring staff access to site copies of Board policy and for periodic in-service training regarding staff awareness of and correct application of policy, procedures and legal requirements. Materials not duplicated here include, but may not be limited to: District 19 CSB Human Resources Policies and Procedures Manual District 19 CSB Human Rights Plan District 19 CSB Infection Control Policy and Procedures District 19 CSB Administrative Policies and Procedures Manual Rules and Regulations for Licensing Providers by the Department of Behavioral Health and Developmental Services (Commonwealth of Virginia)

54

Required Reporting, Confidentiality and Human Rights Programs shall comply with all Federal Confidentiality Regulations and the Statutes of Virginia, regarding reporting, disclosure, and research involving consumers and regarding consumer rights. Staff shall comply with all written Board policies and internal program-specific policies. Staff shall document all required information on current Board-approved forms and current required reporting forms. Programs shall comply with Virginia Code in reporting suspected abuse, neglect or exploitation of children and adults to local Departments of Social Services and shall comply with Virginia Code regarding protection of consumers from harm, abuse and exploitation. Staff shall comply with Board procedures regarding the Human Rights Policy. Staff will contact the current human rights advocate if there is any violation to the human rights policy. Staff should immediately report any suspected or known incidents violating federal or state law or client rights according to agency policy.

55

Consumer Records All consumers shall be fully informed as to the content and applications of all consent forms and documents that they sign. Refusal to sign certain forms will not restrict the person’s access to services except in those cases where signed consent is required by law or by Board policy in order to deliver the service. The probable results of a refusal to sign must be explained to the consumer in a manner that he/she can understand the importance and benefit of written consent. Any consumer may view his/her record upon request to the Specialized Children’s Services Manager, following Board policy, except when it is determined by the consulting psychiatrist not to be in the best interest or welfare of the consumer. The proper court order restricting access must be obtained. If access is denied, the District 19 HIPAA policy will be followed. District 19 CSB utilizes both electronic and paper consumer health records. Electronic health records must be maintained in accordance with policies regarding confidentiality, computer usage, and HIPAA. Electronic consumer information is subject to the same privacy and confidentiality restrictions as non-electronic (paper) consumer information. Accordingly, each CSB employee is responsible for the security of electronic consumer information. Consumer electronic and paper health records will be secured and stored in compliance with state and federal confidentiality regulations. Only authorized District 19 personnel will be allowed access to consumer health records. Consumer paper health records currently being utilized on-site for administrative and/or clinical purposes shall be stored in a locked room. Any material reflecting client data that is not part of the official consumer health record shall be kept in the same confidential manner until it can be shredded. See District 19 Administrative Policies and Procedures RM003 General Medical Records Documentation Guidelines and RM011 Electronic Health Records: Addendum to “General Medical Records Documentation Guidelines RM008”. The District 19 HIPAA policy will be followed regarding consent to treatment services.

56

Emergencies District 19 Community Services Board has an Emergency Services Unit, which is available throughout the Board’s catchment area. The Emergency Services team responds to citizen requests on a 24-hour, 7 day a week basis. The requests for help may be based on mental health, intellectual disability or substance use issues. Emergency Services can be contacted at (804) 862-8000 or toll free at (866) 365-2130. In the event of any deviant, dangerous or criminal behavior occurring at any D19 facility, the police should be called immediately, and if it is safe to do so, staff shall take appropriate steps to protect all persons and property as possible. All staff present should team together for self and agency protection until police arrives. Staff will follow the outlined policies and procedures as written in Policy HSM 016: Workplace Violence. Medical or psychiatric emergencies occurring onsite generally necessitate a call for external assistance, such as a D19 Emergency Services worker, rescue squad or police. Each agency vehicle has a well stocked first aid kit that is maintained and readily accessible for minor injuries and medical emergencies. Crater Youth Care Commission has a well stocked nurse’s office with nursing services available to handle emergencies. All Crater Youth Care Commission staff are trained in basic first aid. Juvenile Corrections Clinicians will follow Crater Youth Care Commission policies regarding medical and psychiatric emergencies that occur at the Crater Youth Care Commission. Each Court Service Unit has a first aid kit available in the office. Court Service Unit clinicians will follow the respective Courts Service Units policies regarding medical and psychiatric emergencies that occur on DJJ property. Each site has fire extinguishers, exit lights and fire plans available with the governing regulations. Fire drills are held in accordance with regulations that pertain to each respective site.

57

Management of Infectious Diseases No consumer shall be refused admission or face discharge solely on the basis of suspected or diagnosis of infectious disease. Program staff will be made aware of clients with diagnosed infectious diseases and will be trained regarding the management of serum transmission and infectious diseases. Program staff will annually take Bloodborne Pathogens training and will use Universal Precaution in any situation with the potential for contact with body secretions. Test results for infectious diseases will be disclosed to appropriate sources only in strict accordance with federal and state laws. Consumer records will reflect a diagnosis of an infectious disease only if the client has been diagnosed through laboratory testing confirmed by a physician. Staff will comply with current District 19 policies and procedures re: the management of infectious diseases.

58

Use of Agency Vehicles Only staff with a current Virginia Driver’s License with an agency approved driving record shall be permitted to drive agency vehicles. Specialized Children’s Services utilizes the agency pool of cars for program purposes. Finance staff hold the keys for the pool vehicles as well as the sign-out logs. Staff can schedule the use of pool vehicles by emailing [email protected] .The vehicles may not be used for staff personal business. Each driver should complete the appropriate Vehicle Mileage Log on each occasion, indicating the date, time in/out, odometer readings/total mileage and purpose of trip. There is no smoking in agency vehicles. Vehicle usage and maintenance are done in compliance with current District 19 CSB policies and procedures.

mailto:[email protected]

Specialized Children’s Services

Documents

Transcript of Specialized Children’s Services