UNDERSTANDING THE COMMUNITY MENTAL HEALTH SYSTEM Julie de
Losada, Laura Davis Yen. July 27, 2011 CHILDREN, YOUTH, AND
FAMILIES
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Federal Government DSHS DBHR ESH WSH RSN CMHA CLIP ADSA DDD CA
JRA other Centers for Medicare & Medicaid Services Mix of State
Mental Health and Federal $$ Pearl Street McGraw CSTC Tamarack
Catholic Community Services NW Whatcom, Skagit, Snohomish Compass
Health Skagit, Snohomish, San Juan SeaMar Behavioral Health Skagit,
Snohomish, Whatcom Whatcom Counseling & Psychiatric Clinic
North Sound Mental Health Administration Region 2 North NSMHA From
Washington to Washington
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39 C ounties G rouped into 13 RSNs
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How NSMHA works with Volunteers of America It All Starts at
ACCESS
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Access to Care 4 Ways to Enter the Community Mental Health
System 1.Crisis Services 2.Outpatient Services 3.Inpatient
Services* 4.CLIP* *Neither NSMHA nor our Providers deliver
inpatient or CLIP services. NSMHA may authorize for these levels of
care. Volunteers of America (VOA)
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Role of VOA 24/7 Phone Crisis Intervention (800-584-3578) 24/7
Triage Clinician Line (800-747-8654)Regional Lifeline call center
(1-800-273-8255) ACCESS to Outpatient counseling (888-693-7200)
Inpatient Certification & Authorization (800-707-4656) Offers
ASIST and SafeTALK community trainings
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Accessing Crisis Services 24/7 Phone Crisis Intervention
Services 100,000 Annual Total Calls Serving Five North Sound
Counties Self-Defined Crisis Mental Health Professional Staff
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Accessing Outpatient Services MUST meet Medicaid Financial
Eligibility o Established by Community Service Office (CSO) MUST
have a covered Access to Care diagnosis MUST meet medical necessity
MUST call ACCESS to Mental Health Services
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Access to Care Standards Examples
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Access to Care Standards Continued
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RSN/ CMHA Service Outpatient services offered by NSMHA
contracted Community Mental Health Agencies Catholic Community
Services NW Compass Health SeaMar Whatcom Counseling and
Psychiatric Services
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ALL Providers Offer Assessment/ Evaluation Individual Therapy
Group Therapy Family Therapy Medication Management Case Management
Coordination with formal systems Coordination with natural
supports
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SOME Providers Offer CHAP Childrens Hospitalization Alternative
Program Co-Funded by Childrens Administration for 16 yrs.
Individualized/ intensive care In-home & out-of-home Respite
24/7 Crisis Response Wraparound Family-driven/ Youth-Guided Team
Based Natural Supports Community Based Culturally Competent
Strengths Based Collaboration Persistent Outcomes Based INTENSIVE
SESSION Systems of Care and Wraparound: An Overview D AN E MBREE
2:40 RM 565 B/C
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Assessments and Evaluations How Long Does it Take to Get an
Appointment??!?!?!
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Time Lines 14 Calendar Days from Request to Intake 28 Calendar
Days from Intake to First Ongoing 7 Calendar Days from Inpatient
Discharge to Intake or First Ongoing.
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Each person has a unique combination of strengths and needs.
Services should be designed to: Utilize Strengths Meet Needs In the
least restrictive / most normative manner Individual and Tailored
Care
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F amily V oice and P articipation A SSESSMENTS BASED ON FAMILY
STRENGTHS AND NEEDS Needs are not Services F AMILIES SHOULD BE
INCLUDED IN THE ENTIRE PLANNING AND TREATMENT PROCESS Its not about
us with out us.
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C onsiderations for A dolescents Y outh who are thirteen and
older can request mental health services without the consent of
their parents. RCW 71.34.500 Y outh who are thirteen or older and
who are a danger to themselves or others, and refuse treatment may
be involuntarily detained and hospitalized. RCW 71.34.710 Y outh
who are thirteen and older can request mental health services
without the consent of their parents. RCW 71.34.500 Y outh who are
thirteen or older and who are a danger to themselves or others, and
refuse treatment may be involuntarily detained and hospitalized.
RCW 71.34.710
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Planning Ahead Transitioning to the Adult Mental Health
System
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Preparing for the transition Discuss transitioning to an adult
mental health provider with the current mental health provider:
Timing of the transition Which agency and program can best meet the
young adults needs? Keep in mind, some programs take time to get
into Apply for Medicaid if appropriate: Medical Cash assistance
Food Benefit Research and plan for housing: Housing authorities
programs including voucher programs and public housing Some mental
health agencies have limited housing resources
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Preparing for the transition, Continued Community Resources:
research what other assistance is available in your community Food
Banks Transportation Options Discounted utilities Any special needs
Develop skills for independent living Plan for
employment/education/daily activity Teach/coach the youth how to
communicate about and navigate health care; they will be driving
their own care as an adult.
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The Adult Mental Health System at a Glance
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A Brief Overview Inpatient MH Treatment
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Accessing Inpatient Services 2- Ways Voluntary Involuntary RCW
71.34.600 (1) A parent may bring, or authorize the bringing of, his
or her minor child to an evaluation and treatment facility or an
inpatient facility licensed under chapter 70.41, 71.12, or 72.23
RCW and request that the professional person examine the minor to
determine whether the minor has a mental disorder and is in need of
inpatient treatment.
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When is Inpatient Appropriate? Needs crisis stabilization in
order to avoid a higher level of care. Potential danger to self,
others, or property. Caregiver or youth are unable to ensure
safety. Needs constant supervision and adult intervention to assure
safe environment Inability to think clearly or distinguish reality.
AND other less restrictive services have been tried which were not
successful or were unable to ensure the youth's safety
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When is Inpatient Inappropriate? When less restrictive
interventions have not been attempted. Solely for medication
adjustments or medication vacations. In lieu of placement. When
another system can better or more appropriately serve the
child/youth (detention, Childrens Administration, primary care
etc.) When the crisis and youths primary diagnosis are not directly
related to mental health diagnosis.
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What to expect Time limited crisis stabilization (5-10 days)
Limited psychiatric evaluation/assessment Possible medication
assessments/ adjustments Coordination with outpatient provider (if
there is one) Coordination with other systems (if indicated)
Discharge Planning
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More about Inpatient Services NO child/youth psychiatric
inpatient facilities in our region. ALL child/youth psychiatric
inpatient facilities in WA are private. Fairfax (6-17) Seattle
Childrens (6-17) Two-Rivers Landing (11-17) Kitsap Youth Inpatient
Unit (8-17)