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HomeMy WebLinkAboutMH-201 Mental Health Priority Populations1 FRANKLIN/FULTON COUNTY MENTAL HEALTH/INTELLECTUAL & DEVELOPMENTAL DISABILITIES/EARLY INTERVENTION 425 Franklin Farm Lane Chambersburg, PA 17202 (717) 264-5387 MH/IDD/EI PROCEDURE STATEMENT PROCEDURE SUBJECT: Mental Health Priority Populations PROCEDURE NUMBER: MH-201 Effective Date: October 29, 2014 Date Revised: December 26, 2019 Reference: OMHSAS-19-03 Serious Mental Illness: Adult Priority Group INTRODUCTION: MH/IDD/EI prioritizes the provision of mental health services to those persons who have a serious mental illness (SMI). The presence of Behavioral Health Managed Care currently implemented in our area clearly defines our priority populations based on the HealthChoices and Consolidated Community Reporting System/Performance Outcome Measurements (POMS) definitions. Serious Mental Illness: Adult Priority Group  In order to be in the Adult Priority Group, a person must meet the federal definition of serious mental illness, must be age 18+, (or age 22+ if in Special Education); must have a diagnosis of Bipolar Disorder, Major Depressive Disorder, Schizophrenia, Schizoaffective Disorder, Other Specified Schizophrenia Spectrum and Other Psychotic Disorder, or Borderline Personality Disorder (Reference DSM-V, ICD-10 codes, as designated by the American Psychiatric Association for the diagnostic codes), and must meet at least one of the following criteria: A. Treatment History 1. Current resident in or discharge from a state mental hospital within the past two (2) years; or 2. Two (2) admissions to community or correctional inpatient psychiatric units or crisis residential services totaling twenty (20) or more days within the past two (2) years; or 3. Five (5) or more face-to-face contacts with walk-in or mobile crisis or emergency services within the past two (2) years; or 4. One (1) or more years of continuous attendance in a community mental health or prison psychiatric outpatient service [at least one (1) unit of service per quarter] within the past two (2) years; or 2 5. History of sporadic adherence to treatment as evidenced by at least three (3) missed appointments within the past six (6) months, inability or unwillingness to maintain medication regimen, one (1) or more court orders for an involuntary outpatient commitment or assisted outpatient treatment within the past two (2) years. B. Functioning Level 1. World Health Organization Disability Assessment Schedule (WHODAS) 2.0 with an overall score in the severe difficulty range; or 2. The use of an equivalent assessment of functioning instrument to determine severity. C. Co-Occurring Disorder or Condition 1. Concurrent Substance Use Disorder; or 2. Intellectual or Developmental Disability; or 3. HIV/AIDS; or 4. Physical disability; or 5. Homelessness i. An individual who lacks a fixed, regular, and adequate nighttime residence, such as those living in emergency shelters, transitional housing, or place not meant for habitation. (SAMHSA Definitions of Homelessness used by SOAR and SSA) 6. Release from Criminal Detention i. Applicable categories of release from criminal detention are jail diversion, final date of maximum expiration (FDME), probation/parole.  In addition to the above, any adult who met the standards for involuntary treatment (as defined in Chapter 5100 Regulations Mental Health Procedures) within twelve (12) months preceding the assessment is automatically assigned to the high priority group. Child and Adolescent Target Groups 1, 2 & 3 (54, 55, 56)  The Child and Adolescent Priority Group One (1) includes persons who meet all four (4) criteria below: A. Age: birth to less than 18 years (or age 18 to less than 22, if enrolled in special education services) B. Currently, or at any time in the past year, have had a DSM-V (or its successor documents as designated by the American Psychiatric Association) diagnosis (excluding those whose sole diagnosis is Intellectual & Developmental Disabilities or psychoactive substance use disorder or a “V” code) that resulted in functional impairment, which substantially interferes with or limits the child’s role or functioning in family, school, or community activities. C. Receive services from mental health and one or more of the following: 1. Intellectual & Developmental Disabilities 2. Children and Youth 3. Special Education 4. Drug and Alcohol 5. Juvenile Justice 6. Health (the child has a chronic health condition requiring treatment) 3 D. Identified as needing mental health services by a local interagency team, e.g., Child and Adolescent Service System Program (CASSP). In addition to the above, any adolescent who met the standards for involuntary treatment within the twelve (12) months preceding the assessment (as defined in Chapter 5100 -Mental Health Procedures) is automatically assigned to this priority group.  Priority Group Two (2) is associated with children at-risk of developing a serious emotional disturbance by virtue of: A. A parent’s serious mental illness B. Physical or sexual abuse C. Drug dependency D. Homelessness E. Referral to the Student Assistance Programs (SAP)  Priority Group Three (3): Children and Adolescents who currently or at any time during the past year have had a DSM-V diagnosis (or its successor documents as designated by the American Psychiatric Association) (excluding those individuals whose sole diagnosis is Intellectual & Developmental Disabilities, or psychoactive substance use disorder or, a “V” code) that resulted in functional impairment, which substantially interferes or limits the child’s role or functioning with family, school or community activities, and who do not meet criteria for child and adolescent target groups 1 & 2. PROCEDURE: When a request for services is received at the Base Service Unit (BSU) Case Management (Service Access and Management in Franklin County and True North Wellness Services in Fulton County), the case manager will, to the best of their ability, given the information received, make a determination as to the status of the presenting problem and whether or not the individual meets the eligibility criteria for serious mental illness. If the person has documentation which supports this criteria, as well as financial criteria for Mental Health (MH) as payer of last resort, they will be assigned a case manager. If the person appears to meet the criteria, but has no documentation to support that a psychiatric evaluation has been completed, one will be scheduled to verify the individual’s diagnosis prior to them being opened with MH for ongoing services. When the individual does not meet the above criteria, they will be referred to an agency/program as the case manager determines appropriate. If at any time the diagnosis indicates that they meet the criteria of serious mental illness, a referral may be made again to MH for services. If a request for services is received that does not meet these guidelines, but the individual has extenuating circumstances, eligibility may be considered on an individual basis, but must be approved by the MH/IDD/EI Administrator. The case management unit would forward a written request for a waiver of the requirement to the MH/IDD/EI Administrator for review.