Minutes

Provider Advisory Workgroup

September 21, 2005

Attendance:

Susan Walkama, Wheeler Clinic; Linda Russo, Wheeler Clinic; Heather Gates, CHR; Jill Benson, CHR; Rosemarie Burton, Klingberg; Jim Rush, CHA; Mark Schaefer, DSS; Karen Andersson, DCF.

Review of Recommendations on Guidelines from BH Oversight Committee meeting on September 16^th

The BH Oversight Committee delegated responsibility for final review on all recommendations to the PA Workgroup. The recommendations for review as follows:

Outpatient Level of Care

1. Last two lines of the definition delete”as the child/youth and family are able to function more effectively” and replace with “when the symptoms and problems that brought the child/youth and family to treatment have been substantially ameliorated or resolved.”

Discussion: Maintaining a focus on improved functioning has been critical in the view of the workgroup. The consensus is improved functioning should remain the measure of treatment progress and completion.

2. First sentence: Add school based health clinics to list of eligible providers.

Discussion: School based health clinics should be included in the list of eligible providers.

Intermediate Level of Care

Children treated at this level of care will be attending school. General recommendation: “The ASO should encourage integrated care planning and provider involvement with schools for all children especially those placed at higher levels of care.”

Discussion: A high degree of coordination between schools and school based health clinics with community providers is essential. This recommendation should be included in the general recommendations.

PRTF

General recommendation: “DCF/DSS establish procedures for admissions to PRTFs that originate directly from the community.”

Discussion: It is assumed that referrals to this level of care from the community would come through the ASO, local systems of care, DCF managed service systems, emergency rooms, emergency mobile psychiatric services and other community based providers.

Early Intervention

Children that are exposed to trauma require early intervention to prevent the development of maladaptive behaviors or mental health problems. Recommendation: “A level of care is developed to allow for early intervention for children and youth at risk”

Discussion: Children/youth that are exposed to trauma and require early intervention to prevent development of mental health issues can be referred to the Child Guidance Clinics.

Making Level of Care Decisions

Application of Criteria:

Add a statement addressing the motivation of the child and adult caretakers. “The ASO will recognize that clients referred on an involuntary basis for mental health or substance abuse treatment will require interventions to address their motivation for treatment and their treatment engagement and compliance.”

Under environmental factors:

Add: educational functioning

Discussion: Motivation is stated in “Making Level of Care Decisions” as a mitigating factor to be taken under consideration. Workgroup recommends that “educational functioning” be added to the list of mitigating environmental factors.

General Statement to be added to each LOC admission section:

Proposed by Dr. Kant:

“In any case in which a request for services does not satisfy the above criteria, the ASO reviewer must then apply the document Guidelines for Making Level of Care Decisions and in these cases the child/adolescent shall be granted the level of care requested when

1.) those mitigating factors are identified and

2.) if not doing so would otherwise limit the child/adolescent’ ability to be successfully maintained in the community or is needed in order to succeed in meeting child/adolescent’s treatment goals.”

Discussion: This statement should be added to each level of care following the admission criteria section.

Susan indicated that the additional recommendations would be added and forwarded to the DCF/DSS Clinical Management Committee for consideration.

Psychological and Neuropsychological Testing Guidelines

(Current LOC under review)

§ In some settings it may not be necessary for a psychologist to conduct an initial assessment of the client to determine necessary tests. (Where psychologist is primary clinician or working as part of a treatment team actively engaged with the client)

§ Computerized scoring of testing may not be possible in all clinics. Allowing for some variation in the method of scoring may be useful. The test manufactures directions on scoring may be the standard of care that is preferable although some exceptions may be required.

§ Testing that is solely for educational purposes is the legal responsibility of the schools.

§ Take exclusionary criteria and re-work to include within the admission criteria.

Recommended changes to language will be summarized and distributed to the group next week.

It will be necessary to complete reviews on the remaining levels of care by October 30, 2005. The following meetings of the Provider Advisory Workgroup have been scheduled:

October 5, 19, 26 from 3:00-5:00 LOB Room 2600 and October 28 from 9-11 location to be announced.