Iowa Mental Health and Disability Services System Redesign Interim ...

More documents

Recommendations

Info

Workgroup Recommendations: A. Provide a provision in Chapter 229 that allows for a pre-commitment screening process prior to the initial filing. B. Pre-commitment screening service for involuntary commitments needs to be a core service. C. The pre-commitment screening services would be the role of the CMHC or a designated facility contracted by the region. 3. Court authorization to order an involuntary hold of a patient under Chapter 229.10 for not more than 23 hours who was not initially taken into custody, but declined to be examined pursuant to a previous order. Discussion Points • Clarification of prescreen/assessment/observations. Pre-commitment screening for appropriate services is what is needed. • Maybe a 23-hour hold for a screening could take place in a hospital emergency room. Maybe at a hospital without a psychiatric bed. • A pre-commitment screening is for a person who does not need to be in immediate custody. • Story County has Crisis Beds available in a location separate from the hospital staffed 24 hours with access to psychiatric staff. It is less expensive than a hospital bed. It is funded by Magellan and the county. • The Acute Care Task Force recommended in 2009 that crisis stabilization services be available 24 hours. • Currently an emergency commitment cannot be ordered between 8:00am and 4:30pm. It needs to be available anytime. Workgroup Recommendation: A. Make a change in Chapter 229.22 to allow for the 48-hour hold to be available 24 hours a day. This would necessitate a change in section 602.6405, subsection 1, concerning limitations on nonlawyer magistrates. 4. Revising requirements for Mental Health Professionals involved in the court committal process. Discussion Points • There are two definitions of mental health professionals in Iowa Code, chapter 228.1 (Mental Health Professional) and Chapter 229.1 (Qualified Mental Health Professional). • A two-tiered system makes sense but this occurs in 228, not 229. 112
• Inclusion of Physician Assistants makes sense, not just Advanced Registered Nurse Practitioners (ARNP). However, Physician Assistants must work under the supervision of a physician and an ARNP does not. • Regarding the issue of who makes the report to the court, the physician must evaluate the patient and he/she generally testifies by telephone. The physician incorporates the observations of those working with the patient, which may include professionals other than those designated in 229.1. Therefore, there is no need to include a definition of a qualified mental health professional in chapter 229. The physician will utilize the information from those working most closely with the patient, and those that have observed the patient. Therefore a qualified mental health professional does not need to be defined. Workgroup Recommendations: A. Remove from Chapter 229 the title and definition of Qualified Mental Health Professional and any reference to it. B. Support the provisions in Chapter 229 that only a physician is to examine the patient and provide a report to the court during the committal process. C. Support the provisions in Chapter 229 that a Psychiatric Advanced Registered Nurse Practitioner may provide the annual report to the court for an outpatient committal. 5. The role, supervision and funding of mental health and substance-related disorder advocates. Discussion Points • Mental Health Advocates are appointed by the Chief Judge and paid for by the county. • There is no consistency in the compensation and benefits of mental health advocates, nor what is funded. • Presentation by Rose McVay, Mental Health Advocate for 7 th Judicial District. Additional information provided by Beth Baldwin, Court Administrator and Kelly Yeggy, Mental Health Advocate. • A mental health advocate job description has been developed and approved by the Judicial Council, but it has not been consistently utilized. • Section 229.19 of the Code implies that the state supervises the mental health advocate position; however, there is not a state entity designated for this responsibility and the position is handled differently depending on the county. The position needs consistent training, policy, procedure, audits, and oversight across the state. • What about mental health advocates for children, those with substance abuse and those committed with other disabilities Currently most advocates are assigned to adults with mental health issues. • Children that are committed have either their parents, and if they are not available, then DHS is generally involved. In substance abuse commitments, they are short term, and after detox they are generally better able to advocate for themselves. For those with co-occurring substance abuse and mental health, a mental health advocate would be beneficial. 113
Page 1 and 2:
Iowa Mental Health and Disability S
Page 3 and 4:
E. Process and Timeframes for the F
Page 5 and 6:
The second source of principles is
Page 7 and 8:
order to standardize approaches, re
Page 9 and 10:
Children’s Disability Services Wo
Page 11 and 12:
The Workgroup strived to attain a r
Page 13 and 14:
Psychiatric Medical Institutions fo
Page 15 and 16:
performance measures developed by t
Page 17 and 18:
II. METHODOLOGY Senate File 525 cal
Page 19 and 20:
III. VISION AND PRINCIPLES FOR THE
Page 21 and 22:
Individual Outcomes • People make
Page 23 and 24:
IV. REPORT OF THE INTELLECTUAL AND
Page 25 and 26:
• Financial - Medicaid eligible
Page 27 and 28:
1. Service Coordination Service Coo
Page 29 and 30:
5. Health and Primary Care People w
Page 31 and 32:
- in these difficult budget times -
Page 33 and 34:
D. Outcome Assessment and Performan
Page 35 and 36:
By using the Quality Framework, sta
Page 37 and 38:
The table below illustrates how typ
Page 39 and 40:
• Increased requirements by the C
Page 41 and 42:
of performance data, it is importan
Page 43 and 44:
9. Given the current inclusion of a
Page 45 and 46:
allows supervisors to track a DSP
Page 47 and 48:
Furthermore, this redesign process
Page 49 and 50:
C. Eligibility - Adults The Workgro
Page 51 and 52:
service should be considered for co
Page 53 and 54:
Any current or future state or regi
Page 55 and 56:
1. Peer Run Self-help Centers: The
Page 57 and 58:
areas. ACT teams in rural areas can
Page 59 and 60:
F. Olmstead and System Rebalancing
Page 61 and 62: continuum, how it should be funded,
Page 63 and 64: The Workgroup also recommends that
Page 65 and 66: H. Provider Qualifications and Moni
Page 67 and 68: VI. REPORT OF THE CHILDREN’S SERV
Page 69 and 70: • PMIC bed/Residential Services -
Page 71 and 72: • Learning Supports for Students
Page 73 and 74: order to provide a strong system of
Page 75 and 76: D. Initial Recommendations Recommen
Page 77 and 78: Recommendation Two: Rollout of init
Page 79 and 80: under the Iowa Plan 50 . Services w
Page 81 and 82: • Planning for implementation can
Page 83 and 84: • The RFP will seek proposals fro
Page 85 and 86: o I am part of a community; I belon
Page 87 and 88: We get lots of kids from southern I
Page 89 and 90: Table One: Summary of the Potential
Page 91 and 92: families from among the different d
Page 93 and 94: to begin operations and transition
Page 95 and 96: Table Two: Timeframe for Regional F
Page 97 and 98: Function Yes No Comments Data colle
Page 99 and 100: Function Regional discretion within
Page 101 and 102: • Designation of access points o
Page 103 and 104: o o Process to be used and resource
Page 105 and 106: Performance Domain Examples from ot
Page 107 and 108: • Maintenance of the strength of
Page 109 and 110: Service Integration and Coordinatio
Page 111: B. Regions designate a transportati
Page 115 and 116: and were resolved by the team in th
Page 117 and 118: 9. Mental Health Courts and Identif
Page 119 and 120: See Appendix F for details of each
Page 121 and 122: New Core Services Prioritized new c
Page 123 and 124: IX. REPORT OF THE PSYCHIATRIC MEDIC
Page 125 and 126: X. INTEGRATION AND TRANSITION PLANN
Page 127 and 128: eligible for Medicaid after 2014, t
Page 129 and 130: XI. CONCLUSION This report presents
Page 131 and 132: Services Currently Provided to Adul
Page 133 and 134: CMS State Balancing Incentive Payme
Page 135 and 136: Appendix C Children’s Disability
Page 137 and 138: o Roles o Data o Communication o Co
Page 139 and 140: o Crisis teams o Immediate access t
Page 141 and 142: • State plan for college/universi
Page 143 and 144: Appendix D Recommended Definition o
Page 145 and 146: Appendix E Brain Injury Definitions
Page 147 and 148: Appendix F Brain Injury Workgroup R
Page 149 and 150: Corresponding # to narrative recomm
Page 161 and 162: Adult Intellectual and Developmenta
Page 163 and 164:
Brain Injury Workgroup Name Agency
Page 165 and 166:
Judicial-DHS Workgroup Name Agency
Page 167 and 168:
PMIC Transition Workgroup Name Agen
Page 169:
Regionalization Workgroup Name Agen
show all

Iowa Mental Health and Disability Services System Redesign Interim ...

Create successful ePaper yourself

Delete template?

Save as template?