Transcript NC Mental Health: Perspectives from an Intensive In

NC Community Mental Health
and Occupational Therapy
Therapeutic Solutions of NC, LLC
Tomeico Faison, OTR/L, Manager
November 12, 2013
Objectives
 Participants
will become familiar with
current NC community-based mental
health services for persons and families
with mental illness/es
 Participants will recognize and understand
the current and potential roles of
occupational therapists in NC community
mental health
About Therapeutic Solutions
 Opened
by Tomeico Faison in 2003
 Provides assessment, treatment and
consultative services to clients in the
Triangle and surrounding areas
 Services focus on functional participation
in meaningful activities of daily living
 Mental illness, developmental disabilities,
low vision
 Group homes, psychiatric facilities, clinics,
home environments, community-based
agencies
Community Mental Health Service
Credentials
 QP-Qualified
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Professional
4 year degree and 2 years of human service
experience; masters degree preferred
Qualifications vary nationally
Relevance to OT: AOTA MH Document
AP-Associate Professional-2 year degree or
less-no longer utilized
 Other
Terms: QMHP and QDDP same as
QP and Q
Other Team Members
 Therapists-MSW,
LPC, LMFT
 Teachers
 Department
of Social Services (DSS)
 Department of Juvenile Justice (DJJ)
 Natural Support Persons (family members,
friends, religious associates)
 CLIENT!!
Community Mental Health Services
in NC
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ACTT Team
Multi-systemic Therapy
Peer Support
Community Support-obsolete
Community Support Team-adults
Residential Services
Mobile Crisis
Intensive In-home services-Family
PSR
MCO
Other Services:
http://www.ncdhhs.gov/mhddsas/providers.htm
ACTT TEAM
“The Assertive Community Treatment Team, or
ACTT, is a community mental health service that
offers treatment and support to adults who are
homeless or at risk for homelessness, and have
a history of incarceration or hospitalization. The
program offers individuals professional support
while they continue to live and work or volunteer
in their community.”
 http://nc.eastersealsucp.com/services/mentalhealth-crisis-services/
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Multi-systemic Therapy and
Intensive In-Home
 MST
and Intensive In-Home, provides
high-intensity family-based counseling for
adolescents with court involvement or at
risk for out-of-home placement due to
delinquent behaviors. Services include inhome counseling, case management and
crisis support.
 http://nc.eastersealsucp.com/services/men
tal-health-crisis-services/
Peer Support Services
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“Peer Support Services (PSS) is a community-based
service for adults age eighteen (18) and older who have
a mental illness or a substance abuse disorder. PSS is
provided by a Certified Peer Support Specialist who has
self-identified as a person in recovery from mental illness
or substance abuse issues and is committed to his or her
own recovery. PSS provides structured, scheduled
activities that promote recovery, self-determination, selfadvocacy, and enhancement of community living skills.”
http://www.ncdhhs.gov/mhddsas/comm_support/handout
sworkdoc/psss-draft-8-28-09.doc
Community Support
 No
longer utilized
 Issues and concerns regarding service
provision, documentation, credentials and
billing
Community Support Team-Adults
“The community support team is a community
mental health service that assists adults in
developing coping skills, improving selfmonitoring of symptoms and behaviors, and
enhancing independence in daily activities. The
team works in both one-on-one situations and
family-based interventions.”
 http://nc.eastersealsucp.com/services/mentalhealth-crisis-services/
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Residential Services
“Residential Supports provide services for
individuals to live in group homes, shared
apartments or independently in the
community. Typical supports include personal
assistance for daily living activities, skills
training, and specialized services to assist
individuals in accomplishing their personal
goals.”
 http://nc.eastersealsucp.com/services/mentalhealth-crisis-services/
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Mobile Crisis
 “Team
of individuals that respond to crisis
on the community level, providing
community based training, person
centered supports, that may enable an
individual to be able to stay in the natural
setting( home).”
 http://nc.eastersealsucp.com/services/men
tal-health-crisis-services/
Psycho-Social Rehabilitation
PSR
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For some, recovery from mental illness is a long and
especially challenging road. For people with Severe and
Persistent Mental Illness (SPMI). PSR utilizes evidencebased practices to empower individuals with the skills
they need to serve as active members of their
community. PSR staff members work with people in a
group setting where positive peer support is part of the
healing initiative. Group sessions are designed to
increase self-confidence, maintain mental stability,
develop employment opportunities, and seek out
increased community interaction
Switch from LME to MCO

As a result of legislation passed in the summer
of 2011, the state’s mental health agencies were
compelled to make a transition from service
coordination agencies to managed care
organizations (MCOs), which essentially act as
small insurance companies. These MCOs
receive a set monthly payment for each client
and have to provide services for everyone under
their care using that pot of money.
Local Management Entity- (LME) Managed Care Organization (MCO )
Happened (January 1, 2013)
Sample Referral Process
 Make
referral based on qualifications for
service
 Intake form completed (Diagnostic
Assessment)
 Intake form given to director or assistant
director
 Intake given to a team lead and assigned
to the corresponding team
 Family contacted and meeting set-up
Referral Process Continued
 Person
Centered Plan (PCP) completed
while meeting with the family
 Complete inpatient treatment report (ITR)
completed and sent to insurance agencies
for approval (example-Health Choice,
Value Options-medicaid, IPRS-state
funding-alternative for people without
insurance)
 Services approved or denied typically
within one week
Authorization Process for Services
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Typically in order to receive an authorization for
these services you would have to complete the
following and submit it to the MCO for approval;
( PCP, Mental Health Assessment, and
discharge plan)
Monitoring of Service Provision
 NC
TOPPS: State regulation of service
provision
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https://nctopps.ncdmh.net/ci1011/index.asp
Collaborative Relationships
 OT
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and Community Mental Health
Referral Example from Psych Hospital to the
Community
Referral from Community-based agencies to
OTs
Endorsed Provider Database:
• http://www.ncdmh.net/endorsedprovider/pub
• liclogin.htm
Areas of Interest for OT’s
 PSR
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Programs and Recovery Programs
(WRAP at Freedom House)
 CST
(Adults with challenges with
independent living).
 Quadrant IV Clients-transitioning into
adulthood
 Tenancy Support-support services to help
persons remain in their community-based
setting
Occupational Therapy’s Role
 Increase
the person’s ability to live as
independently as possible in the
community while participating in
meaningful activities
Occupational Therapy’s Role
 Home/Health
Management
 Community Mobility/Skills
 Computer Technology Skills
 Time/Routine Management
Service Reimbursement
 Medicaid
and Medicare
 Medicaid up to age 21 and prior approval
required
 Medicare B-limited number of visitsdoctor’s order required, must have a
change in previous level of function and
demonstrate good rehab potential
 Private pay
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Sliding fee scale
Carolina Center for Medical
Excellence

CCME provides education, leadership and services in
review and quality care improvement and program
management for healthcare providers in the Carolinas.
CCME also conducts research to measure, monitor, and
improve health care and provide education services for
health professional and physicians to earn required
credit hours. (This the prior approval company for OTs
that want to bill Medicaid)
Marketing, Marketing,
Marketing!
 Brochures
and business cards
 Presentations-private companies and
associations
 Social networking
 Free services: Volunteering and students
 Collaborative projects to meet social
needs
Questions/Comments
 Contact:
[email protected]
 1201 Aversboro Rd Suite H201 Garner,
NC 27529
 919-239-4805 (office)
References
 Correria,
C.J., Benson, T. A., Carey, K.B.
(2005). Decreased substance use
following increases in alternative
behaviors: A preliminary investigation.
Addictive Behaviors, 30, 19-27.
Websites
 http://www.ncdhhs.gov/mhddsas/comm_s
upport/handoutsworkdoc/psss-draft-8-2809.doc
 http://nc.eastersealsucp.com/services/men
tal-health-crisis-services/