Applicant File Review Process October 2015 Conducting the Interview of Applicants with Mental Health Histories

Presenter Lead Mental Health Specialist, Humanitas, Inc. Valerie Cherry, PhD 2

3. OBJECTIVES Specifically, participants will be able to: 1. Define the purpose of the applicant interview as part of the applicant file review process. 2. List the critical clinical areas to be included in the applicant interview. 3. Identify questions that may be considered revisiting eligibility or discriminatory. 4. Conduct and document a thorough interview of applicants with mental health histories.

4 Applicant File Review Process The HWM completes a review of the “Job Corps Health questionnaire (ETA 653)” and the medically related documentation to determine: The health care needs of the applicant and whether JC can meet those needs, and If the applicant presents a direct threat to self or others. The HWM determines who else may need to review the protected information based upon the determination of “need to know.” This is your File Review Team (FRT)! Appendix 107 Center File Review Process

5 Goal of File Review Team (FRT) Review information with applicant Identify and assess functional limitations (symptoms and behaviors) of disclosed condition(s) Determine barriers to Job Corps enrollment Purpose of the “Applicant Interview” Evaluate the information in the folder Conduct an interview

Applicant Interview and Enrollment Decisions  There are three potential outcomes of this assessment:  To determine if the applicant poses a direct threat to self or others that cannot be alleviated with reasonable accommodation. If indicated, you will complete the Direct Threat Assessment Form (PRH 6: Appendix 609).PRH 6: Appendix 609  To determine whether the applicant's health care needs are manageable at Job Corps or whether, even with reasonable accommodations, the needs are beyond Job Corps' basic health care responsibilities. If indicated, complete the Health Care Needs Assessment Form (PRH 6: Appendix 610).PRH 6: Appendix 610  To recommend enrollment into the program and review reasonable accommodations for applicants with mental health disabilities. For guidance regarding whether an applicant is a person with a disability, refer to PRH 6: Appendix 605.PRH 6: Appendix 605

Applicant Interview is KEY!  Interactive in-person or telephone  Do not revisit eligibility as determined by the AC, unless there is new information disclosed by applicant that AC was not aware of.  PRH Exhibit 1-1 –Essential Admission Requirements (EARs)  Only ask specific questions regarding any behaviors or information of concern that has been disclosed or documented in the applicant file. 7

Revisiting Eligibility? Yes or No  Are you currently on probation?  YES, PRH Exhibit 1-1, Criterion M: Court Involvement and/or Agency Supervision  Have you had thoughts of hurting yourself or someone else?  NO!  Are you involved in gang activity?  YES, PRH Exhibit 1-1, Criterion L: Community Relations

Possible Discriminatory Questions? Yes or No  You only reported on the 6-53 you take Lexapro. What do you take Lexapro for? How long have you been taking it?  NO!  You mentioned you have ADHD, has anyone ever told you that you were bipolar too?  YES!

The Applicant Interview Telephone or In-Person 10

What should you review in preparation for the interview?  ETA 6-52 (Outreach and Admissions Applicant Information Sheet)  ETA 6-53 (Health Questionnaire)  CCMP Provider Forms  Inpatient psychiatric or medical hospitalizations or Emergency Department visits (if relevant), treatment summaries  IEP, 504, and other educational information provided  Psychological Assessment  Background Check  Individual Statement from Applicant 11

What else should you consider in preparation for the interview?  Accommodations needed for interview  Interpreters  Specific questions from information in the file  “Consent for Pre-Enrollment Interview” 12

13 JOB CORPS PROGRAM INSTRUCTION NOTICE NO June 10, 2015

Critical Clinical Areas  Harm to Self or Others  Functional Limitations (Behaviors and Symptoms)

Harm to Self or Others  Threat of violence – assaultive behavior  Threat of sexually inappropriate behavior  Suicidal behavior  Homicidal behavior  Self-injury  Paranoid thinking 15

Functional Limitations (Symptoms and Behaviors)  Difficulty with social behavior, including impairment in social cues and judgment  Avoidance of group situations and settings  Difficulty managing stress  Difficulty regulating emotions  Uncontrolled symptoms/behaviors that interfere with functioning  Interpersonal difficulties with authority figures and/or peers  Sensory impairments  Impaired decision making/problem solving  Difficulty with self-care  Difficulty with concentration  Difficulty handling change 16

Barriers  Frequency and length of treatment  Unstable psychiatric symptoms that currently interfere with functioning and require treatment  Therapeutic milieu required  Complex behavior management system beyond Job Corps current system  Daily assistance with activities of daily living 17

Setting the Stage – Rapport  Introduce yourself and make an assessment of any potential communication problems or need for accommodations.  Talk about what the interview session will involve.  Review informed consent.  Always start with less intrusive questions.

Sample Interview Questions Kellie Miller, LCSW – CMHC Loring JCC  What prompted you to apply to ______________ Job Corps Center?  Has anything changed since completing the paperwork with the Admission’s Counselor (AC)?  How would you describe your experiences with school?  What do you think you will like about living in a dormitory setting?  What are your concerns about living in a dormitory setting?

Sample Interview Questions  From the following documentation provided in your applicant file (i.e., 6-53, CCMP, IEP, etc.) or per your self-disclosure, it indicates you have a diagnosis of: ___________________________________  How do you manage your condition(s)?  What are your stress triggers or what makes your condition worst?  How do you calm yourself or make yourself feel better when you are stressed? 20

Sample Interview Questions  Do you currently participate in outpatient therapy or treatment for the disclosed condition(s)?  If yes, do you have any scheduled follow-up appointments?  Who is your provider?  What kinds of things is your provider helping you with?  What medications are you currently prescribed for the disclosed condition(s)?  Do you know the dosage and how often you take it?  Do you take your medication the way you were told to by your provider? 21

Sample Interview Questions  When was the last time you experienced thoughts of wanting to die or kill yourself in the past?  Did you ever have a plan of how you would kill yourself?  Have you ever attempted suicide?  If yes, how and when?  Have you ever wanted to harm others?  Have you ever physically assaulted another person?  When was the last time you experienced the urge to harm others? 22

Sample Interview Questions  Have you been hospitalized for the disclosed condition(s)?  When was your last hospitalization?  What were the treatment recommendations?  Did you follow through with treatment recommendations?  Mental Status Questions  Do you have any questions for me? 23

Mental Status  I. Appearance  II. Behavior  III. Attitude  IV. Level of Consciousness  V. Orientation  VI. Speech and Language  VII. Mood  VIII. Affect  IX. Thought Process/Form  X. Thought Content  XI. Suicidality and Homicidality  XII. Insight and Judgment  XIII. Attention Span  XIV. Memory  XV. Intellectual Functioning 24

Applicant was interviewed by telephone. He has a documented diagnosis of bipolar. Applicant was pleasant and cooperative, but at times it was difficult to understand his answers as his speech would become rapid and pressured. The applicant acknowledged ongoing difficulty with emotional dysregulation and outbursts, but felt that he would be much happier “away from home.” He felt like the stress at home is the reason he currently feels depressed and has no motivation. He reports that his emotions get in the way of his relationships. He tends to “pop off” and was not able to discuss any positive ways to manage stress and his emotions. He denies any current suicidal behavior, but was hospitalized 6 months go for taking several Tylenol pills and alcohol to “just get away from it all.” This was also after he stopped taking meds and got into a fight with his girlfriend. According to applicant he was doing better when he was on meds, but discontinued because he doesn’t like taking medicines He is currently non-compliant with medications. He seemed anxious during the phone call and became easily irritated with outbursts when asked questions about specific mental health symptoms (particularly related to the cycling behavior) and recent termination from previous group home due to not following rules and engaging in arguments and fights with members in the group home. 25

Appendices 609 and 610 Where to place the applicant interview summary?  Appendix 609-Direct Threat Assessment  #3. What is the likelihood that the potential harm will occur (i.e., high, moderate, or low)?  Appendix 610-Health Care Needs Assessment  #2. What is the applicant’s history and present functioning to support statement of health care needs? (Include information from ETA 653, file review, Chronic Care Management Plan (CCMP) Provider Form, and interview with applicant.)  Applicant Interview Summary 26

Quick Check!  The goal of the applicant clinical interview is to review information, identify functional limitations and reasonable accommodations? True or False  False, consideration of reasonable accommodations is done by the reasonable accommodation committee (RAC) and lead by the Disability Coordinator with CMHC participation. “Barriers to enrollment”  What are the 2 critical clinical areas to include in your applicant interview write up?  Harm Behaviors and Functional Limitations Is it acceptable to ask questions about an issue not in the file that applicant discloses during the interview?  YES! 27

28 Resources

Job Corps Health & Wellness Website 29

Regional Mental Health Specialists  Region 1 - David Kraft, MD, MPH   Region 1 (Puerto Rico)- Maria Acevedo, PhD   Region 2 - Valerie Cherry, PhD   Region 3 - Suzanne Martin, PsyD, MPH   Region 4 - Lydia Santiago, PhD   Region 5 - Helena MacKenzie, PhD   Region 6 - Vicki Boyd, PhD  **When sending documents that contain PII use jobcorps.org Ex: 30