AOC Training- August 31, 2012

Cindy Ehlers. LPC -

Children and Youth in Your System

Have the Children or Youth that show up in Your system had a traumatic experience that may have threatened their own or someone’s life, safety, or well being?

Cindy Ehlers. LPC -

Risk When we don’t get this right!Child traumatic stress can lead to Post Traumatic

Stress Disorder (PTSD)Trauma impacts a child’s development and health

through out his or her life.Complex trauma is associated with risk of

delinquency.Traumatic exposure, delinquency, and school failure

are related.Trauma assessments can reduce misdiagnosis,

promote positive outcomes, and maximize resources.There are mental health treatments that are effective

in helping children and youth who are experiencing child traumatic stress.

There is a compelling need for effective family involvement.

Cindy Ehlers. LPC -

Children and Youth are Resilient!

Cindy Ehlers. LPC -

Trauma Informed Systems

CHANGE lives

Cindy Ehlers. LPC -

Role of MCO/LMEAccess to Care-24/7/365 Crisis ServicesCare CoordinationCustomer ServicesAuthorization of Services

Cindy Ehlers. LPC -

AccessToll free access 24-7 (required by the state)Education to help people Access assessment

and evaluations to determine services they may need for Medicaid and Uninsured target populations only.

Assess Urgency of Need and link to Crisis services

Referral for Assessment for appropriate level of care and type of service

Schedule First AppointmentFollow Up to make sure needs were met and appointments were kept

Cindy Ehlers. LPC -

Crisis ServicesFamily and Natural Support systemsFirst Responder (if currently in treatment)Mobile Crisis (if not currently in treatment)Emergency RoomFacility Based Crisis / Non Medical DetoxInpatient

Cindy Ehlers. LPC -

Customer ServicesHelps consumers and families understand

how to Navigate the systemProvides Consumer EducationTakes complaints and grievances from

community related to service delivery or gaps in services.

Cindy Ehlers. LPC -

Process Call to make appointment for Assessment (or

court order)Assessment determines what type of treatment is

needed. Always starts with the least restrictive so most often it is outpatient therapy and medication evaluation and management must be tried first.

Receives treatment and ongoing assessment.If the demonstrated needs exceed the scope of

traditional therapy the youth may be referred to a higher level of care.

Most youth will not start at the PRTF level of care

Cindy Ehlers. LPC -

???? Confusion???? When a child is removed from the custody of the parent(s) and they have

a MH/DD/SA issue that does not automatically mean they meet the medical necessity or entrance criteria for higher levels of care such as a group home. In fact in most cases those higher levels of care can cause trauma for a child. Most children need foster care ONLY with basic therapy that is trauma informed to meet their behavioral health needs. Assessment determines the need for treatment and the level of treatment needed, not placement barriers.

LME/MCOs purchase treatment services not placements. LME/MCO can ONLY use public money for medically necessary services.

Public safety and poor parenting do not meet medical necessity criteria.

LME/MCO can require independent assessment if the initial assessment does not seem appropriate.

Youth who do not meet criteria for PRTF or Level III treatment will step down to lower levels of care just like they do when private insurance is the payor.

Cindy Ehlers. LPC -

Parents in TreatmentProcess is the same Access is just a phone call

and an appointment will be scheduled for Medicaid and Uninsured target populations.All Women with addiction are a target populationAll Children and Youth are a target populationFew Men will meet the target population for

Medicaid or Uninsured funding unless they meet the criteria for Age, Blind, Disabled Medicaid or Medicare which starts with the Social Security administration and disability determination.

Cindy Ehlers. LPC -

Court OrdersCourt order are a tool the system can use to require a

person to participate in assessment and medically necessary treatment.

The court order should say that the individual will schedule and complete a comprehensive clinical assessment for mental health and/or substance abuse treatment concerns and follow treatment recommendations.

Court Orders CANNOT override medical necessity criteria

Cindy Ehlers. LPC -

PaymentECBH and other LMEs cover two different

types of public benefits.

State funded services- for individuals who meet state defined target populations

Medicaid – individuals who are eligible for Medicaid services

Cindy Ehlers. LPC -

Questions and Answers

Cindy Ehlers. LPC -