1. Community Support Services Training Session 5
Rutgers, The State University of New Jersey
School of Health Professions
Department of Psychiatric Rehabilitation and Counseling Professions

2. Review from Session 4 Person-First Language
Rehabilitation Needs Assessment
Knowledge, Skills, Resources Form
-successes and challenges with completing the form
SMART Documentation

3. Learning Objectives
Review Knowledge, Skill, Resource (KSR) and its connection to the rehabilitation plan.
Practice developing an Individualized Rehabilitation Plan.
Describe the critical components of a progress note.
Evaluate agency documentation.
Understand the impact of burnout.

4. Rehabilitation Plan Process
CRNA: Identifies goals.
KSR Form: Helps identify the critical components needed to achieve the goal. Once prioritized to 3 to 5 identified areas, written in S-M-A-R-T format, becomes the objectives in the Rehabilitation Plan.
Rehabilitation Plan: Incorporates the CRNA with the KSR form. Adds S-M-A-R-T interventions to match objectives and drives the intentional billable services.

5. Rehabilitation Plan
Preliminary Individualized Rehabilitation Plan (PIRP)
Individualized Rehabilitation Plan (IRP)
Completed upon admission based on medical necessity. Serves as authorization for first 60 days.
Completed within the first 60 days of admission
Review/Revise within 3 months of development
A new IRP should be completed and submitted to the IME every 6 months

6. Why Individualized Rehabilitation Planning?
Links the steps to achieve the goal with the interventions
Interventions aim to eliminate the deficits
Identifies who is responsible for doing what, by when, for how long, and where
Increases sense of accountability
Operationally defines the rehabilitation team approach
(Anthony, Cohen, Farkas, Gagne, 2002)

7. Individualized Rehabilitation Plan (IRP)
Valued life roles / Rehabilitation and recovery goals
Objectives
Strategy/intervention to be employed
Anticipated outcomes
Expected frequency and duration of each activity
Type (credential) of practitioner to provide the service
Location of service
( 47 N.J.R. 1827(a); Larosiliere, 2011)

8. Interventions… What is the intended service that you are providing?
Medicaid is paying for the intervention that you are providing

9. Individualized Rehabilitation Plan Example

10. IRP Checklist and Red Flags
Review IRP checklist and IRP red flags form
- As a larger group, practice using the IRP checklist on the example provided
Break up into groups, practice using the IRP checklist on the sample IRP’s that were brought in

11. Individualized Rehabilitation Plan – Activity Part 1
Step 1: Find a partner
Step 2: Choose a goal from one of your sample IRP’s
Step 3: Work with your partner to brainstorm a list of possible steps to achieve the goal.
Step 4: Take that list and break the items into knowledge, skills, or resource on the KSR form

12. Individualized Rehabilitation Plan – Activity Part 2
Step 1: Identify strengths and areas for improvement by checking off the appropriate boxes on the KSR form.
Step 2: Talk with your partner; prioritize 3 to 5 areas of need that you want to work on first.
Step 3: Break down the 3 to 5 prioritized items into S-M-A-R-T format.

13. Individualized Rehabilitation Plan – Activity Part 3
Transfer the information from the KSR Form to your Individualized Rehabilitation Plan
Keep in mind:
Strengths, Valued Life Role, Wellness Dimension
S-M-A-R-T objectives
Develop S-M-A-R-T interventions to match each objectives
Calculate the units
Select another sample IRP at the buzzer

14. Rehabilitation Plan Process
CRNA: Identifies goals.
KSR Form: Helps identify the critical components needed to achieve the goal. Once prioritized to 3 to 5 identified areas, written in S-M-A-R-T format, becomes the objectives in the Rehabilitation Plan.
Rehabilitation Plan: Incorporates the CRNA with the KSR form. Adds S-M-A-R-T interventions to match objectives and drives the intentional billable services.

15. Rehabilitation Plan Revisions
Goal (s) have been accomplished
Consumer no longer wants to work on chosen goal (s)
Unforeseen events
Disengagement
Incarcerations/Hospitalizations

16. Documentation Progress note for each encounter
Must relate to a service on the rehabilitation plan
There is adequate content for time billed
Should reflect the intervention(s) being addressed during the visit
Medicaid Regulations
(10:79B-2.5)
Date of the service
Type of service provided
Duration of the service
Name, credential, and title of the employee providing the service
Specific location service was provided

17. Data Data Linkage to the rehabilitation goal
Review of consumers follow-up activities
Specific interventions
Consumer report

18. Assessment Consumer response to the intervention
Assessment of progress towards IRP goals, objectives, and interventions
Assessment of change in consumer behavior

19. Plan Staff/Consumer next steps Date and time of next service delivery

20. Golden Thread of Documentation
CRNA
Rehabilitation Plan
Progress Note

21. D-A-P Checklist

22. D-A-P Format
Data
Assessment
Plan

23. Progress Note Exercise
Review your sample progress note
Use the DAP checklist to evaluate if the key components of a progress note are present

24. Burnout
A psychological syndrome that involves a prolonged response to chronic interpersonal stressors on the job.
Burnout consists of three components:
Emotional exhaustion
Cynicism
Personal efficacy
(Ray et al., 2013; Thompson, Amatea, & Thompson, 2014)

25. Burnout
Six areas of work life where mismatches between the person’s expectations and the job are considered to be predictive of burnout:
Workload
Control
Rewards
Community
Fairness
Values
(Ray et al., 2013; Thompson et al., 2014)

26. Factors that Trigger Burnout
Caring for patients
System problems
High census
Heave patient assignments
High acuity
Overtime
Extra work days
Personal issues
(Ray et al., 2013; Thompson et al., 2014)

27. Activity: Self-Care
How do you practice self-care?

28. Learning Application
Use the IRP checklist on two IRP’s at your agency.

29. Q&A and Evaluations

30. Zakia Clay, MSW, LCSW, CPRP Anthony Zazzarino MA, LPC, ACS, CPRP
Contact Information
Zakia Clay, MSW, LCSW, CPRP
Ann Reilly MA, LSW, CPRP
Anthony Zazzarino MA, LPC, ACS, CPRP

31. References
Alexander, M. J., & Haugland, G. (2000). Integrating services for co-occurring disorders. Final report prepared for the New York State Conference of Local Mental Hygiene Directors. Orangeburg, NY: Center for the Study of Issues in Public Mental Health, Nathan S.Kline Institute for Psychiatric Research. Retrieved from \ Services%20for%20CoOccurring%20Disorders_ pdf. Anthony, W., Cohen, M., Farkas, M., & Gagne, C. (2002).Psychiatric rehabilitation. (2nd ed., pp ). Boston: Center for Psychiatric Rehabilitation. Larosiliere, V (2011). Community Support Services [memo]. Retrieved from o_provi ders.pdf.

32. References (continued)
New Vitae. (2014). Documentation, the D.A.P. Format, and Writing Incident
Reports [Module #5]. Quakertown, PA: Human Resources.
Pratt, C. W., Gill, K. J., N.M, & Roberts, M. M. (2014). Psychiatric Rehabilitation. (3rd ed.) San Diego, CA: Elsevier Inc.
Ray, S. L., Wong, C., White, D., & Heaslip, K. (2013). Compassion satisfaction, compassion fatigue, worklife conditions, and burnout among frontline mental health care professionals. Traumatology, 19(4),
Thompson, I.A., Amatea, E.S., & Thompson, E.S. (2014). Personal and contextual predictors of mental health counselors’ compassion fatigue and burnout. Journal of Mental Health Counseling, 36(1),