1. Region 1 South Crisis Care System System of Care Overview Policy and Procedures
Illinois Department of Human Services
Division of Mental Health
Jackie Manker, LCSW
Associate Director
Community Services
June 6, 2012
6/6/2012

2. Materials for today
Region 1 South Crisis Care System Policies and Procedure Chapter of Provider Manual
Calendar
Presentation Slides
6/6/2012

3. Objectives of OVERVIEW
Understand the flow of new Crisis Care System
Understand key policies
Understand procedures
Understand any interim policies and procedures
The first three principles guide all of our work at DHS.
First is the recovery principles….that persons with MI can recover and live full lives in their communities…..hope is central to this belief as well as self advocacy. We want to take any opportunity at systems reform to infuse and teach this principle to our partners.
Services are trauma informed informed…….persons with mental illness, especially those in crisis have experienced some sort of trauma in their lives……when care is trauma informed, every part of the organization is service delivery system must include a basic understanding of how trauma affects peoples lives…..how traditional service delivery systems may re-traumatize and exacerbate…..and so programs must be designed to be more supportive and avoid retraumatization….( personss are respected, informed, connected….work collaboratively consumers and famiies in an empowering way.
We must be about to demonstrate outcomes with services we purchase. And that is this case with this reform effort…..we will be relying on evidence based clinical practices…. And we must assume responsibility for monitoring our systems change efforts to assure we are getting the outcomes we desire with the reforms.
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4. 6/6/2012

5. DHS/DMH Intent
To replace services previously provided by Tinley Park Mental Health Center with a re-balanced system and services that are:
Community-based
Recovery oriented
Trauma informed
Outcome validated
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6. Services Eligibility and Disposition Assessments (EDA)
Community Hospital Inpatient Psychiatric Services (CHIPS)
Mental Health Crisis Residential
DASA Residential Crisis Stabilization
Acute Community Services (ACS)
Transportation
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7. Eligibility
Individual presents in Region 1 South E.D.
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8. City of Chicago South of 67th Street South Suburban Cook County
Region 1 South Area
City of Chicago South of 67th Street
South Suburban Cook County
Kankakee County
Will County
Grundy County
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9. Community Hospitals to be Served
Region 1 South Area
Community Hospitals to be Served
City of Chicago South of 67th Street
Roseland Community Hospital
St. Bernard Hospital
South Suburban Cook County
Franciscan St. James Health
Metro South Medical Center
Advocate South Suburban Hospital
Palos Community Hospital
Little Company of Mary Hospital
Advocate Christ Medical Center
Ingalls Memorial Hospital
Kankakee County
Riverside Medical Center
Provena St. Mary’s Hospital
Will County
Provena St. Joseph Medical Center
Silver Cross Hospital
Adventist Bolingbrook Hospital
Grundy County
Morris Hospital
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10. General Eligibility determined by E.D.
Uninsured with no other resources
Preliminary diagnosis of mental illness or mental illness and substance use disorder
No acute medical illness or excluded medical condition
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11. When all criteria are met, E. D
When all criteria are met, E.D. calls for an Eligibility and Disposition Assessment conducted by a DMH funded evaluator assigned to that E.D.
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12. Community Hospitals to be Served
Region 1 South Area
Community Hospitals to be Served
Assigned Eligibility & Disposition Assessment Agency
City of Chicago South of 67th Street
Roseland Community Hospital
Human Resource Development Institute
St. Bernard Hospital
To Be Determined (TBD)
South Suburban Cook County
Franciscan St. James Health
Metro South Medical Center
Advocate South Suburban Hospital
Grand Prairie Services
Palos Community Hospital
Little Company of Mary Hospital
TBD
Advocate Christ Medical Center
Ingalls Memorial Hospital
Kankakee County
Riverside Medical Center
Provena St. Mary’s Hospital
Helen Wheeler Mental Health Center
Will County
Provena St. Joseph Medical Center
Silver Cross Hospital
Adventist Bolingbrook Hospital
Will County Behavioral Health
Grundy County
Morris Hospital
Grundy County Health Department
6/6/2012

13. EDA EVALUATORS
Minimum credential of Qualified Mental Health Professional (QMHP)
Available 24/7
Respond within (1) hour of call
Confirms general eligibility
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14. EDA EVALUATOR
Conducts clinical evaluation and documents on DMH Uniform Screening and Referral Form (USARF)
For individuals with suspected substance use, also assesses using ASAM Patient Placement Criteria
Completes level of care assessment using the Level of Care Utilization System (LOCUS)
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15. EDA EVALUATOR
Determines if individual meets 2 clinical criteria for Region 1S CCS
Diagnosis of:
Schizophrenia (295.xx) Schizophreniform Disorder (295.4)
Schizo-affective Disorder (295.7) Delusional Disorder (297.1)
Shared Psychotic Disorder (297.3) Brief Psychotic Disorder (298.8)
Psychotic Disorder NOS (298.9) Cyclothymic Disorder (301.13)
Major Depression (296.2x, 296.3x) Obsessive-Compulsive Disorder (300.30)
Anorexia Nervosa (307.1) Bulimia Nervosa(307.51)
Post Traumatic Stress Disorder (309.81)
Bipolar Disorders (296.0x, 296.4x, 296.5x, 296.6x, 296.7, , , )
LOCUS Score of 4 or greater
Recovery maintenance & health maintenance
Low intensity community based service
High intensity community based service
Medically monitored non-residential services
Medically monitored residential services
Medically managed residential services
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16. EDA EVALUATOR Individual does NOT meet clinical criteria
Inform ED physician/staff
Provide any alternative treatment
or service recommendation
e.g. DMH Non-Medicaid benefit package
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17. EDA EVALUATOR Individual does meet clinical criteria
Evaluator determines individual is a resident of Region 1 South geographic area
No – refer to Madden Intake
Yes – recommend level of care and service needs
CHIPS
Mental Health Crisis Residential
DASA Residential Crisis Stabilization
ACS
Transportation
6/6/2012

18. EDA EVALUATOR Is the individual willing?
Individual is NOT willing to engage?
Does he/she meet criteria for involuntary hospitalization?
Yes – proceed with process
No – explain outcome of assessment, recommend level of care to individual, ED physician/staff and others of individual’s choice
6/6/2012

19. EDA EVALUATOR Individual is willing to Engage
Inform ED physician/staff of recommended level of care
ED physician/staff concur
Evaluator calls the ACCESS line for
Authorization
Available services
Authorization number
1. What if ED/physician does NOT concur?
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20. Service Authorization
Illinois Mental Health Collaborative for Access and Choice
DMH’s Administrative Service Organization (ASO)
Toll free ACCESS Line (866)
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21. Service Authorization
Clinical Care Managers (CCM) available 24/7
Evaluator provides information
Demographics
Clinical presentation
Recommended disposition
CCM reviews for medical necessity
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22. Service Authorization
When medical necessity is present for recommended level of care, the CCM:
Provides authorization number
Provides location and contact information for
service provider
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23. EDA EVALUATOR Evaluator Contacts service provider to make referral.
Makes needed transportation arrangements using authorization number.
Ensures required documentation is complete and copy to ED and accepting service provider (USARF, LOCUS, ASAM, disposition and recommendations).
Confirms linkage occurred within 24 hours.
Registers individual in DHS/DMH consumer registration system.
6/6/2012

24. Hospital-Based EDA Evaluator (Advocate Christ and Ingalls Memorial)
All previous elements required PLUS
Physician conducts evaluations
May provide active treatment if applicable (e.g. extended observation, Medication administration/monitoring, crisis intervention)
DMH will provide training on registration
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25. Service Authorization Alternative Level of Care
If the CCM would propose a different level of care based on medical necessity or capacity
Evaluator discusses alternatives with ED physician/staff
If in agreement, authorization and referral process is initiated
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26. Service Authorization
If Not in agreement:
Collaborative CCM provides clinical presentation,
treatment recommended and capacity to Madden Intake.
Madden Intake physician reviews information and discusses with ED physician.
Madden Intake physician considers option and determines most appropriate level of care and informs both CCM and ED physician.
CCM contacts Evaluator with determination and authorizes services as appropriate.
6/6/2012

27. Community Hospital Inpatient Psychiatric Services (CHIPS)
Disposition Options
Community Hospital Inpatient Psychiatric Services (CHIPS)
DMH funded, short-term (less than 6 days), inpatient at community hospital.
Serve those experiencing psychiatric crises and exhibit acute behaviors or symptoms requiring inpatient setting.
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28. CHIPS Individual has symptoms consistent with a
diagnosis of one of the following mental
illnesses:
Schizophrenia (295.xx) Schizophreniform Disorder (295.4)
Schizo-affective Disorder (295.7) Delusional Disorder (297.1)
Shared Psychotic Disorder (297.3) Brief Psychotic Disorder (298.8)
Psychotic Disorder NOS (298.9) Cyclothymic Disorder (301.13)
Major Depression (296.2x, 296.3x) Obsessive-Compulsive Disorder (300.30)
Anorexia Nervosa (307.1) Bulimia Nervosa(307.51)
Post Traumatic Stress Disorder (309.81)
Bipolar Disorders (296.0x, 296.4x, 296.5x, 296.6x, 296.7, , , )
6/6/2012

29. Hospitals with CHIPS Contracts
Advocate Christ Medical Center, Oak Lawn Ingalls Memorial Hospital, Harvey MacNeal Hospital, Berwyn Mt. Sinai Hospital, Chicago Riverside Hospital, Kankakee St. Anthony’s Hospital, Chicago St. Bernard Hospital & Health Care Center, Chicago Provena St. Mary’s, Kankakee University of Illinois Hospital, Chicago
6/6/2012

30. Mental Health Crisis Residential
DMH funded, short-term 24/7 continous supervision and treatment in a provider controlled facility.
Grand Prairie Services is the current provider.
6/6/2012

31. Mental Health Crisis Residential
Individual’s symptoms require psychiatric stabilization services.
Individual has symptoms consistent with a diagnosis of one of the following diagnosis.
Schizophrenia (295.xx) Schizophreniform Disorder (295.4)
Schizo-affective Disorder (295.7) Delusional Disorder (297.1)
Shared Psychotic Disorder (297.3) Brief Psychotic Disorder (298.8)
Psychotic Disorder NOS (298.9) Cyclothymic Disorder (301.13)
Major Depression (296.2x, 296.3x) Obsessive-Compulsive Disorder (300.30)
Anorexia Nervosa (307.1) Bulimia Nervosa (307.51)
Post Traumatic Stress Disorder (309.81)
Bipolar Disorders (296.0x, 296.4x, 296.5x, 296.6x, 296.7, , , )
6/6/2012

32. DASA Residential Crisis Stabilization
Short term (5-10 days) residential treatment that targets:
Stabilization of problems related to biomedical, emotional, behavior, or cognitive conditions as described in ASAM Dimensions 1-3.
Diagnosis of mental illness and substance use disorder.
Planned regimen of care of at least 3 hours of treatment services per day.
Must link with Acute Community Service provider upon discharge.
6/6/2012

33. DASA Residential Crisis Stabilization Providers
The Haymarket Center, Chicago Healthcare Alternative Systems, Chicago The South Suburban Council on Alcoholism & Substance Abuse, East Hazel Crest The Women’s Treatment Center, Chicago
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34. Acute Community Service (ACS)
Any services and supports needed by the individual to continue stabilization from crisis.
Grant funding allows the provider ultimate flexibility in determining type, amount, frequency, etc., including medication
Services must be initiated within 24 hours of discharge from ED
Services must be initiated within 48 hours of discharge CHIPS, crisis residential, or SOH, and those discharged from DASA residential with co-occurring disorder.
6/6/2012

35. Acute Community Service (ACS)
Individual eligible for services up to 12 months of initial assessment
Provider agrees to serve all referred individuals
Provider required to assist individual with application for medical assistance
Provider required to register each individual through DHS/DMH information system
Individuals will be referred to provider in their geographic proximity but will have choice if requested
6/6/2012

36. Acute Community Care Service Providers
Region 1 South Area
Acute CCS Provider
City of Chicago South of 67th Street
Human Resource Development Institute
Metropolitan Family Services
South Suburban Cook County Township
Bremen, Thornton, Rich, Bloom
Grand Prairie Services
Lemont, Calumet, Palos, Worth, Orland
Kankakee County
Helen Wheeler Mental Health Center
Will County
Will County Behavioral Health
Cornerstone Services
Grundy County
Grundy County Health Department
6/6/2012

37. Madden Mental Health Center Services
Will serve as safety net when other services are not appropriate or available.
6/6/2012

38. Madden Mental Health Center Services
When an individual presents with the following, Madden may be consulted for consideration of DMH admission.
History indicating need for extended inpatient treatment
Presents challenges in discharge placement from inpatient
setting, such as being homeless
Co-occurring substance use disorder requiring medical
observation that exceeds the capability of available community
inpatient psychiatric services
6/6/2012

39. Madden Mental Health Center Intake
Responsible for managing the referrals to DMH hospitals to ensure available capacity
For individuals from Region 1 Central who presents at one of the four DMH contracted CHIPS hospitals, Madden Intake may choose to utilize CHIPS, Mental Health Crisis Residential or SA Residential Crisis Stabilization beds when appropriate and needed to manage DMH hospital capacity
6/6/2012

40. Transportation
DMH will purchase transportation services between Emergency Departments, CHIPS hospitals, MH Crisis Residential and DASA Residential Crisis Stabilization
Individual must meet all eligibility criteria
The Authorization number received from the Collaborative will serve as authorization for transportation
Transportation provider must respond within 60 minutes of request
6/6/2012

41. Region 1 South Crisis Care System System of Care Overview Policies and Procedures
Thank you!!
Questions??
6/6/2012