Transcript Community Psychiatric Rehabilitation

Rehabilitatio
n
Presented by Susan Blume, M.Ed.
Certification Coordinator
Department of Mental Health
Division of Comprehensive Psychiatric
Services
The goal of today’s
presentation is to
answer questions
such as:
 What
is the community psychiatric
rehabilitation (CPR) program?
 What is the philosophy of this program?
 Who is eligible for services?
 What services are available through
CPR?
 What is the funding stream for services?
Community
Psychiatric
Rehabilitation
 was
established in Missouri in 1989
 is funded by both the Missouri
Department of Mental Health (DMH) and
by Medicaid
 is part of the rehabilitation option to the
Missouri State Medicaid Plan
Community
Psychiatric
Rehabilitation
 is
administered jointly by the DMH
Division of Comprehensive Psychiatric
Services (CPS) and the Division of
Medical Services, which is part of the
Department of Social Services
 the development and implementation of
the Community Psychiatric
Rehabilitation program is an important
component of the DMH communitybased system of care
Community
Psychiatric
Rehabilitation
 CPR
programs provide a range of
mental health services to adults with
serious and persistent mental illness
and children and youth with serious
emotional disturbances
Services are designed
to:
 maximize
independent functioning
 promote the recovery and selfdetermination process
 increase interagency coordination and
collaboration in all aspects of the
treatment planning process and
 reduce inpatient hospitalizations and outof-home placements
The core services that must
be provided in order for an
agency to be certified by
DMH as a CPR program are:
 Evaluation
 Community
Support
 Crisis Intervention
 Medication Administration
 Medication Services
 Consultation and
 Psychosocial Rehabilitation
Evaluation
 Assessment
and evaluation are crucial
to the delivery of quality services since
the findings of the assessment provide a
foundation for determining service
delivery needs and developing
strategies for intervention and level of
care
 Evaluation occurs at intake and annually
after that
The intake evaluation
focuses on:
 presenting
problems
 history of treatment
 history in areas such as family, vocation,
education and community
 current functional strengths and
weaknesses
 physical and medical complaints and
 recommendations for treatment
Annual evaluations
focus on:
 changes
over the past year in all areas
of assessment
 update of diagnostic formulation and
 recommendations for treatment
Treatment Planning
 Treatment
plans and treatment plan
reviews are part of the evaluation
package
 Treatment plans are developed from the
assessment and in partnership with the
consumer in order to have goals that are
individualized and realistic
 Treatment plan reviews summarize
progress toward goals for a three month
period
Community Support
Services
 Many
individuals with mental illness
experience difficulty being included in
the community and accessing
community resources
 This is due in part to the segregation
and isolation that they may have
experienced, and in part to the
disabilities associated with their mental
illness
Community Support
Services
 Is
defined as those activities designed to
ease an individual’s immediate and
continued community adjustment
Community support
activities
include:
 teaching community living skills
 advocating
for individuals and families
 coordinating delivery of mental health
services with services provided by other
agencies
 providing individualized guidance and
support and
 monitoring progress in organized
treatment programs
Community Support
Services
 Community
support workers (CSW) are
responsible to assure that appropriate
resources are available to individuals
and to support them in attaining their
highest level of functioning in their
families and in the community
Community Support
Services
 In
order to be included in the community,
individuals are assisted in filling
legitimate, valued social roles such as
worker, student, neighbor, voting citizen,
church member, volunteer, spouse and
parent
A typical day for a
team of CSWs might
include:
 helping
a person with a medical or
psychiatric appointment
 monitoring a person’s mental health
 developing or reviewing a treatment
plan
 providing support to someone in the
hospital and participating in hospital
discharge planning
A typical day
(continued)
 training/coaching
in daily living skills such
as housekeeping, cooking, grooming,
budgeting
 training/coaching in community living skills
such as paying bills, taking the city bus,
shopping for groceries within a budget or
within special dietary constraints
 helping someone with an appointment at
DFS, the housing authority or vocational
rehabilitation
A typical day
(continued)
 For
example, with vocational
rehabilitation, CSW’s can help their
client remember and keep
appointments, complete paper work,
and understand what is required when
receiving services
Crisis Intervention
 Crisis
intervention services include
telephone access and face-to-face
emergency response. Interventions are
available to the consumer 24 hours a
day, 7 days a week
 Services are provided by Access Crisis
Intervention (ACI) providers regionally
(see handout) with back-up by program
staff locally
Crisis Intervention
 Crisis
personnel have access to a
physician for consultation purposes 24
hours a day
 Crisis personnel assist clients in utilizing
natural supports or perhaps, if needed, in
admission to an inpatient psychiatric
facility
Crisis Intervention
The goals of crisis service are to:
 Provide immediate response,
intervention and referral for persons
experiencing mental health crisis,
whether in a rural, urban or metropolitan
area
 Respond to crisis by providing
community-based intervention in the
least restrictive environment, e.g. home,
school
Crisis Intervention
 Avert
the need for hospitalization to the
greatest extent possible
 Stabilize persons in crisis and refer
them to appropriate services to regain
an optimal level of functioning and
 To mobilize and link individuals with
services, resources and supports
needed for ongoing care following a
crisis, including natural support
networks
Medication Services
 Psychiatrists
or Advanced Practice
Nurses assess individuals in the need
for medication as well as e ongoing
management of the medication regimen.
 Services also include reviewing for side
effects and providing education about
medications
Medication
Administration
Medication administration services
provide for:
 coordination with pharmacies and
indigent drug programs
 setting up medication boxes
 monitoring of medication compliance
 consumer and family education
 therapeutic injection of medication
Consultation Services
CPR personnel often consult with human
service and other government agencies as
well as natural and professional supports
The goals of consultation services are to:
 provide direction to treatment
 promote effective working relationships
 heighten awareness of the characteristics
and needs of the population
 advocate for an individual or group
Psychosocial
Rehabilitation
Services
 Psychosocial
rehabilitation services
(PSR) are defined as a combination of
goal-oriented rehabilitative services
provided in a group setting as outlined in
the person’s treatment plan
Psychosocial
Rehabilitation
Services
Services focus on development of
behaviors and abilities that allow the
person to:
 fully participate in community living
 maximize independence
 enhance interpersonal relationships
 develop support systems
 Participate in meaningful recreation and
socialization activities that are
appropriate to the age and interest of
Psychosocial
Rehabilitation
Services
Some agencies may include prevocational services as part of PSR.
These services are designed to assist a
person in preparing for employment,
including:
 interview and job application skills
 therapeutic work opportunities
 temporary employment opportunities
 referral to a community-based agency
that specializes in the provision of
vocational services
CPR Program
Philosophy
The CPR program is based on the following
1.
ten specific principles and values:
Persons with mental illness should be
active participants in program planning
as well as individualized treatment
planning, consistent with individual
abilities. In the case of children, the child
and parent(s) are an integral part of the
treatment team and have ownership of
the plan.
CPR Program
Philosophy
2. To the extent possible, community
integration, inclusion, recovery and selfdetermination shall be goals for service
delivery.
3. Outreach, engagement and ease of
service access are essential
characteristics of successful programs
serving adults with serious mental illness
and children with serious emotional
disturbance.
CPR Program
Philosophy
4. Continuity and coordination of care are
essential to the delivery of quality mental
health services.
5. Services shall be available in varying
levels of intensity based on the
individual’s need.
6. An interdisciplinary and interagency team
approach to service delivery is a model
which best assures the quality and
continuity of care.
CPR Program
Philosophy
7. Services and programs shall be
responsive to the needs of those it
serves and sensitive to the individual’s
community, ethnic and cultural context.
8. Natural supports existing within the
community shall be utilized whenever
possible.
CPR Program
Philosophy
9. The focus of the CPR program is on
the strengths of the individual.
10. Services are community-based.
Service Linkages
 Consistent
with the principles of
coordination and continuity of care, the
CPR program must establish linkages
with service/government agencies and
natural supports that interact with
individuals served by the program
Service Linkages
Key service functions in brokering a
range of services to individuals include
 developing working relationships with
other service providers
 possessing knowledge of access to and
operation of other service providers
 identifying interventions to support or
enhance the quality of services received
through other service providers
Service Linkages
 These
types of activities must take place
to assure that individuals are referred to
other service providers as necessary to
meet their needs and to maximize the
benefit of those services
Standards for mental health
programs further state that
the CPR provider shall
provide services and liaison activities to
state and local public assistance/housing
agencies and employment/training
agencies in order to provide assistance to
persons with serious mental illness in
seeking public benefits
 work closely with the staff of state and
local public assistance/housing and
employment/ training agencies, within the
limits of confidentiality, to expedite the
application process and continuation of
the client’s eligibility

Service Linkages
 Additionally,
standards (also known as
the code of state regulation) indicate
that a key service function of the
community support service is to assist
the client in accessing and utilizing a
variety of community agencies and
resources to provide ongoing social,
educational, vocational and recreational
supports and activities
Service Linkages
 As
a result, consultation with these
agencies can significantly influence the
quality and quantity of services provided
to individuals
 Consultation and education by CPR
program staff with criminal justice,
juvenile courts, public assistance,
housing and employment agencies,
schools and DFS is critical
Department Oversight
 Community
Mental Health programs that
provide CPR services must be certified
by the Department of Mental Health
 Each agency is reviewed on an annual
basis to determine compliance with the
code of state regulation as defined by
the CPS division
Department Oversight
 Certification
activities may consist of a
team going to an agency for four or five
days to review governing authority,
environmental safety, policy and
procedure guidelines, quality assurance
systems, fiscal management, personnel
qualifications/background/training, as
well as, clinical review of client records
for service provision and documentation
DMH Visions and
Values
 In
addition to being in compliance with
the code of state regulation, agencies
are expected to fall in line with the
Department of Mental Health’s vision
and values
 These values should be recognized and
reflected in the operation of the CPR
program
Eligibility
 To
be eligible for CPR program services,
individuals must be determined to be
seriously and persistently mentally ill, or,
for children, have a serious emotional
disturbance, as measured against
diagnostic, disability and duration
criteria.
Disability
 There
is clear evidence of serious
and/or substantial impairment in the
ability to function at an age or
developmentally appropriate level in
each of the following two areas of
behavioral functioning:
Disability
1. Social role functioning/family life – the ability to
sustain functionally the role of worker, student,
homemaker, family member or a combination
of these.
For children, consider their play and leisure
activities, ability to establish or maintain
satisfactory relationships with peers and
adults, capacity to live in a family or the
equivalent of a family, learning ability, self
expression or ability to communicate
effectively with others, and their ability to
function in school.
Disability
2. Daily living skills/self-care skills – the
ability to engage in personal care
(grooming, personal hygiene, etc.) and
community living (handling individual
finances, using community resources,
performing household chores,
interacting with peers, etc.), learning
ability/self-direction and activities
appropriate to the individual’s age and
social role development.
Diagnosis
A physician, advanced practice nurse, or
licensed psychologist shall certify a
primary diagnosis of any of the
following, which may coexist with other
psychiatric or medical diagnoses:
Diagnosis










Schizophrenia (7 types)
Delusional disorder
Bipolar I disorders (4 types)
Bipolar II disorders
Psychotic disorders NOS
Major Depressive disorder – recurrent
Obsessive-Compulsive Disorder
Post Traumatic Stress Disorder
Borderline personality disorder
Anxiety disorders (5 types)
Diagnosis
(for children and
youth only)
 Major
depressive disorder, single
episode
 Bipolar disorder, not otherwise specified
 Reactive attachment disorder of infancy
or early childhood
Duration
is evidenced by one or more of the following
occurrences:
 Psychiatric treatment more intensive
than outpatient and received more than
once in a lifetime (crisis services,
alternative home care, partial hospital,
inpatient)
Duration
 Continuous
residential care other than
hospitalization, for a period long enough
to disrupt the normal living situation
 Psychiatric disability has been present
for one year or more and/or
 Treatment of a psychiatric disorder has
been or will be required for longer than
six months
Funding Stream
 CPR
program services have multiple
funding sources, including Medicaid for
Medicaid eligible individuals, Division of
Comprehensive Psychiatric Services
general revenue Purchase of Service
(POS) funds for those providers who
have a POS contract, and individual fee
for services
Funding Stream
 Because
CPR is a Medicaid supported
program, the federal government pays
approximately 60 percent of the costs
for clients with Medicaid eligibility
 The departments of Mental Health and
Social Services assume responsibility
and accountability for administration and
reimbursement of service delivery
consistent with requirements
Funding Stream
 The
Department of Mental Health
monitors each CPR provider through an
annual billing audit, that coincides with
the certification survey, to review for
adequate service provision and
compliance with Medicaid requirements
Any questions?