Understanding the community mental health system

YOUTH, and
August 25, 2010
Julie de Losada, Angela Fraser, & Pat Morris
Adapted from Children’s Mental Health Services, by Judy Gosney, 2003.
Centers for Medicare
& Medicaid Services
Federal Government
Mix of State Mental
Health and Federal $$
North Sound
Mental Health
•Region 3
DDD JRA other other
•Pearl Street
• Tamarack
•Catholic Community Services NW
•Whatcom, Skagit, Snohomish
•Compass Health
•Skagit, Snohomish, San Juan
•SeaMar Behavioral Health
•Skagit, Snohomish, Whatcom
•Whatcom Counseling & Psychiatric
From Washington to Washington…
39 Counties Grouped into 13 RSNs
Role of VOA
 24/7/Phone Crisis Intervention (800-584-3578)
 24/7/ Triage Clinician Line (800-747-8654)
 Linkage to Regional (Five-County) Integrated
Crisis Response System
 Regional Lifeline call center (1-800-273-8255)
 ACCESS to Outpatient counseling (888-693-7200)
 Inpatient Certification & Authorization (800-707
Offers ASIST and safeTALK community trainings
Access to Care
4 Ways to Enter the Community Mental Health System
Crisis Services
Outpatient Services
Inpatient Services*
Volunteers of
America (VOA)
*Neither NSMHA nor our Providers deliver inpatient or CLIP services. NSMHA may authorize for these levels of
Accessing Crisis Services
 24/7 Phone Crisis Intervention Services @ 800-584-3578
100,000 Annual Total Calls
Serving Five North Sound Counties
Self-Defined Crisis
Mental Health Professional Staff
 Consultation with Crisis Intervention
 Access to Consumer Info Database
 Crisis Appointments
 Crisis Planning
 Crisis Respite
 Dispatch for voluntary Outreach
 Dispatch for Involuntary Evaluations
Accessing Outpatient Services
 MUST meet Medicaid Financial Eligibility
o Established by Community Service Office (CSO)
 MUST have a covered “Access to Care” diagnosis
 MUST meet “medical necessity”
 MUST call ACCESS to Mental Health Services @ 888-693
Access to Care “B” Diagnosis
RSN/ CMHA Service
Outpatient services offered by NSMHA contracted
Community Mental Health Agencies
 Catholic
Community Services NW
 Compass Health
 SeaMar
 Whatcom Counseling and Psychiatric Services
ALL Providers Offer…
Assessment/ Evaluation
Individual Therapy
Group Therapy
Family Therapy
Medication Management
Case Management
Coordination with formal systems
Coordination with natural supports
SOME Providers Offer…
CHAP – Children’s Hospitalization
Alternative Program
by Children’s Administration for 16 yrs.
 Individualized/ intensive care
 In-home & out-of-home
Compass Health:
 Respite
Snohomish/ Island
 24/7 Crisis Response
 Co-Funded
Catholic Community
Services: Whatcom
SOME Providers Offer…
 Family-driven/ Youth-Guided
 Team
 Natural Supports
 Community Based
 Culturally Competent
 Strengths Based
 Collaboration
 Persistent
 Outcomes Based
Compass Health:
Snohomish/ Island
Catholic Community
Services: Whatcom/ Skagit
Individual and Tailored Care
Each person has a unique combination of strengths and needs.
 Services should be designed to:
utilize strengths
 meet needs
 n the least restrictive manner.
Plans Should…
 Include age appropriate normal activities.
 Be provided in a natural environment.
 nclude a mix of formal services and informal supports.
Family Voice and Participation
Assessments based on family strengths and needs.
Families should be included in the entire planning and
treatment process.
Considerations for Adolescents
Youth who are thirteen and older can request mental
health services without the consent of their parents.
RCW 71.34.500
Youth who are thirteen or older and who are a danger
to themselves or others, and refuse treatment may be
involuntarily detained and hospitalized. RCW
Accessing Inpatient Services
Two ways to access inpatient services
RCW 71.34.600 : Parent may request determination
whether minor has mental disorder requiring inpatient
treatment — Minor consent not required
(1) A parent may bring, or authorize the bringing of, his or her
minor child to an evaluation and treatment facility or an inpatient
facility licensed under chapter 70.41, 71.12, or 72.23 RCW and
request that the professional person examine the minor to
determine whether the minor has a mental disorder and is in need
of inpatient treatment.
When is Inpatient Appropriate?
Needs crisis stabilization in order to avoid a higher
level of care.
Potential danger to self, others, or property.
Caregiver or youth are unable to ensure safety.
Needs constant supervision and adult intervention to
assure safe environment
Inability to think clearly or distinguish reality.
AND other less restrictive services have been tried
which were not successful or were unable to ensure the
youth's safety
What to expect…
Time limited crisis stabilization (5-10 days)
Limited psychiatric evaluation/assessment
Possible medication assessments/ adjustments
Coordination with outpatient provider (if there is
Coordination with other systems (if indicated)
Discharge Planning
More about Inpatient Services
No child/youth psychiatric inpatient facilities in our
ALL child/youth psychiatric inpatient facilities in
WA are private.
 Fairfax
 Seattle Children’s (6-17)
 Two-Rivers Landing (11-17)
 Kitsap Youth Inpatient Unit (8-17)
When is Inpatient Inappropriate?
When less restrictive interventions have not been
Solely for “medication adjustments” or “medication
In lieu of “placement”.
When another system can better or more
appropriately serve the child/youth (detention,
Children’s Administration, primary care, etc.
When the crisis and youth’s primary diagnosis are
not directly related to mental health diagnosis.
What is CLIP?
CLIP stands for Children’s Long-Term Inpatient Program.
The highest, most restrictive, most intensive level of mental health
treatment in Washington State.
Provides inpatient treatment for youth who have severe psychiatric
Services are available to both Medicaid and non-Medicaid
There are 3 ways to access CLIP: Voluntary application,
Involuntary commitment and RCW 10.77 competency /
A CLIP admission is not available as a crisis service, nor
are children admitted to a CLIP Program solely because
they need a safe place to live.
CLIP Facilities
There are 91 beds total divided among 4 CLIP facilities that
serve the entire state:
McGraw Center in Seattle has 19 beds
Pearl Street Center in Tacoma has 12 beds
Child Study & Treatment Center (CSTC) in Lakewood has 47 beds
divided in 3 cottages:
Camano Cottage youth 7 to 11
Ketron Cottage youth 12 to 14
Orcas Cottage youth 15 to 17
Tamarack Center in Spokane has 13 beds
All facilities admit both male and female youth.
Region 3 youth are not typically admitted to Tamarack Center.
Core CLIP Services
Core CLIP Services that are generally offered by each of
the 4 facilities. These may vary depending on the facility:
Individualized evaluations, assessments and care plans
24 hour psychiatric & nursing care
Medication, as needed
Safe, structured environment
Crisis stabilization
Behavior management
Family, group and individual therapy
Full educational program on site
Core CLIP Services
Social work/case management
Recreational, expressive, and leisure therapy
Social skills development
Dietary assessments & monitoring
Occupational Therapy
Parent support & advocacy
Chemical dependency assessments & treatment
Minimum Admission Criteria
Must be under 18 yrs. prior to admission to CLIP.
Must be legal residents of WA state or in the custody of a
guardian who is a legal resident.
Applicants must have a severe psychiatric impairment.
Less restrictive treatment setting should be attempted
prior to application.
Applicants will not be excluded from consideration due
to intellectual functioning, physical or medical
Applicants 13 yrs and younger vs. applicants 13 yrs. and
older. (ITA).
Voluntary Application
Two Tiered Process:
 A comprehensive application must be submitted to RSN
CLIP Coordinator.
 Next, a screening date is set for youth’s legal guardian and
other team members to present to the RSN CLIP
 The RSN CLIP committee refers youth to the CLIP
Administration .
 The CLIP Administration Process & Decision.
 Again, youth 13 yrs and older must agree to the voluntary
Involuntary Application
Involuntary Commitment (ITA) 180-day Restrictive
Orders for Inpatient Treatment:
 Under
RCW 71.34, adolescents aged 13-17 may be
committed for up to 180 days of involuntary inpatient
psychiatric treatment.
 Under this 180-day restrictive court order, the adolescent
becomes eligible for admission to a CLIP Program.
 The adolescent's name is placed on the statewide waiting
list as of the date of the 180-day Restrictive ITA order.
 RSN CLIP committee consults with CLIP Administration
RCW 10.77 Competency / Restoration
 Competency
/ Restoration is the least common
way to CLIP:
10.77 allows for children to be court-ordered,
through the criminal justice system for psychiatric
evaluation at CSTC and/or to regain competency to
stand trial.
 RCW 71.34 also permits the transfer of an adjudicated
youth from a Juvenile Rehabilitation Administration
(JRA) facility to CSTC for up to 14 days of psychiatric
evaluation and treatment.
Other notes on CLIP
Length of stay can be from 6-12 months. Most youth
average about 9 months. RSN CLIP Coordinator will
follow the youth’s treatment throughout their stay.
Youth are returned to their home community as soon as
possible. Community partners, including family, DSHS
caseworkers, therapists, schools, RSN, etc., are expected to
collaborate with the CLIP Program to assure appropriate
discharge resources are in place prior to discharge.
Youth can be admitted to CLIP more than once as long as
admission criteria has been met and there is expected
If an application is not recommended by RSN, treatment
recommendations will be made by the local committee.
Julie de Losada, M.S. [email protected]
Angela Fraser, M.A. [email protected]
Pat Morris, M.Ed [email protected]

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