tfc, ihbs, icc and epsdt · to tfc caregivers? past/current illnesses and medical conditions...

TFC, IHBS, ICC and

EPSDT©

Program Application and Documentation Standards

Developed by:

Lisa Scott-Lee, CEUS

ceus@msn.comFor County of Santa Clara Behavioral Health Services

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Special Thanks to…

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Nancy Nation, LCSW, Mental Health Program Specialist, Behavioral Health Services

Chiaki Nomoto, LMFT, Learning Partnership Training Manager

Presentation Overview/Outline

EPSDT Defined: Requirements & Criteria

Defining Therapeutic Foster Care (TFC), Intensive Behavioral Health Services (IHBS), and Intensive Care Coordination (ICC) Services

Documentation Samples: Do’s and Don’ts tied to TFC, IHBS and ICC services

Since TFC Parents require a minimum of 40 initial hours of training with 24 hours of Continuing education annually,this seminar counts towards those hours! And counts as CE’s for licensed/registered/trainee staff as well!

What is EPSDT?

Early and Periodic Screening, Diagnosis and Treatment

Defined under California Code of Regulations (CCR), Title 9, §1810.215 as a “Supplemental Mental Health Service”

Mental Health Service under WIC 5601 is any service directed toward early intervention in, or alleviation or prevention of, mental disorder, including, but not limited to, diagnosis, evaluation, treatment…. socialization, case management……..information, referral, consultation, and community services.

Claimable under Medi-Cal (Medicaid)

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How Does EPSDT impact Medical

Necessity?

EPSDT broadens the definition to allow intervention

to “correct or ameliorate” a mental health condition and does not restrict services to

“Severely Emotionally Disturbed” (SED) child/youth, therefore expanding the target population served (larger net, less restrictive) Medical Necessity threshold is lowered…

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How does one “define”

Medical Necessity?

Two Medical Necessity Features:

• An “Included or Covered” Primary Diagnostic Features based on the Diagnostic Statistical Manual (DSM) and International Classification of Disorders (ICD)

• Functional Impairment impacting quality life

that requires intervention or assistance

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For more Information see

Santa Clara QI 03-22-2018\Clinical Practice Guidelines.pdf

Why is “Medical Necessity” Important?

Without Medical Necessity:

✓ You may not be providing the right service for your clients

✓ You may limit your opportunity or deprive another client who meets Medical Necessity a needed service

✓ Cannot Claim/Bill for Medi-Cal

For more Information see Received From Santa Clara QI 2018\Clinical Practice Guidelines.pdf

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Why is Assessment Important?

Santa Clara County

Initial Mental Health Assessment

(Completed by Clinician)⚫ Identifies Behaviors

⚫ Contributing Issues

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Stakeholders Defined

Clinician/Mental Health Rehab Specialist

Significant Support Persons (including Foster Care Parent)

Community/Resources

The Child/Youth

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YOU are the conduit for continuing servicesand updated Assessments!

How does one “define”

Comprehensive Assessment?

Assessment

is defined by CCR Title 9 §1810.204 as:

…a service activity designed to evaluate the current status of a beneficiary's mental, emotional, or behavioral health.

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What is Title 9 and DHCS Guidance Letters

and Memorandums….

and why should I care?

Regulations and Guidance governs and directs all services you provide

By following the language used in Title 9 and guidance will protect your documentation from outside auditors

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Number One Audit Exception (Mistake)

on Assessments?

Leaving _______....BLANKS

Potential Errors of Omission!

Need evidence of asking or query, even if no info available (Example):

“Jamie’s developmental history is unknown according to Foster parent. Will contact County Social Worker for additional information”

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What is assessed?

How can I help?

Assessment Guidance

(SCC BHSD Practice Standards Manual, Page 13-22)

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• TFC Parent should share any behavioral changes

• Any additional knowledge not documented, or you thinkis important and relevant

Sources of Information

• Child/Youth

• Family/TFC Parent/Guardian

• Social Services*

• Criminal justice*

• Spiritual Leader*

• School*

• Other*

*NOTE: These sources may also be classified as additional “Significant Support Persons”

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Significant Support Person Defined

CCR, Title 9, §1810.246.1

"Significant support person" means persons, in the opinion of the beneficiary or the person providing services,

who have or could have a significant role in the successful outcome of treatment,

including but not limited to the parents or legal guardian of a beneficiary who is a minor, the legal representative of a beneficiary who is not a minor*, a person living in the same household as the beneficiary, the beneficiary's spouse, and relatives of the beneficiary.

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Support Systems: Your potential

“Collateral” contacts

Significant community support

(extended family, school teacher, neighbor, place of worship, civic, social)

NOTE: Potential “Significant Support Person” in Treatment Plan

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Whose the client?

The child/youth, however…

Example of Caregiver needing help:

Caregiver’s inability to set limits on the child/youth resulting in role reversals and conflicts at home

Example of School Teacher needing help:

child/youth has difficulty focusing in classroom and is falling behind in classroom.

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Current Mental Health

Presentation

Critical!!

Include:

• Current symptoms

• Current and Persistent behaviors

• family response to current situation including stressors

• Most importantly, MATCHES & supports Diagnosis (for medical necessity)!

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Mental Health History

Knowing the past helps the TFC caregiver with insights on the present….however, CURRENT behaviors justify continued and future services

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Child/Youth/Family Strengths

e.g., motivation, insight, support of family/community, special talents, abilities, and interest, etc.

Capitalizing on these insights can reinforce goals and objectives and be part of your youth’s Treatment Plan!

YOUR Documented Observations are Important! 20

Cultural factors which may influence

presenting problems

The Youth’s ethnicity, race, language, immigration, level of acculturation or assimilation, religion/spiritual practices, sexual orientation, socioeconomic background and past living environment.

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Strength based does not mean…

Ignoring the elephant in the room; you need to describe the negative behaviors to be addressed, and

Then, incorporate youth’s strengths/resilience and social supports to address targeted behaviors

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Psychosocial History

Tells us about the youth’s:

• Prenatal (FAS, low birth weights)

• Developmental milestones

• Family History (financial, relationship issues, living arrangements, mental health/Substance Use)

• Education… Individualized Educational Plan

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Medical History & Substance

History in the Assessments

Tells us about the youth’s medical and substance use history, not the parents/caregivers!

Parent’s and Caregiver’s history is in “psycho social” section!

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Why is Medical History Important

to TFC Caregivers?

Past/current illnesses and medical conditions include previous hospitalization)

Alternative healing practices (e.g., acupuncture, hypnosis, etc.): Date, Provider/Type, Reasons for Treatment, Outcome (was it helpful and why)

Current medication/previous medication(include all prescribed and over-the counter medications and holistic/alternative remedies): Experienced Side Effects

Allergies!!!

Primary Physician: name and phone number.

Date of last physical /dental exam?

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Primary Care History Requirement

• EPSDT Requirement of the Primary Care assessment

• TFC Caregiver’s and/or ICC Coordinator must link with Primary Care Physician (PCP) for any medical issues, etc… chart it!

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Assessment Identify Targeted

Behaviors…

Youth’s Behaviors that Impact on functioning (their self-care, their ability to cope with home, school, and community).

Life events that lead to current situation (e.g., divorce, losses, moves, school changes, financial difficulties).

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Knowing the Youth’s

Substance/Alcohol Use

Tobacco use and caffeinated drinks, use of pain meds, marijuana other drug use, past and current gives TFC caregivers a heads up on potential concerns [e.g., missing work/school, encounters w/law enforcements].

Chart your observations AND interventions

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Purpose of Risk Assessments

Reduce the likelihood or chance of potential risk of current or imminent harm.

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Assessment Updates

IHBS, ICC and TFC services requires evidence of reassessing the strengths and needs of children and youth, and their families, at least every 90-days, for the purpose of determining if ICC and/or IHBS should be added or modified

What does the child/youth need, RIGHT NOW?

Assessment can be updated at anytime; needs The TFC Parent’s input!

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Day to Day Risk Assessments by TFC

Caregiver is important!

LOOK for, intervene (take action) and Chart what you see and what you do!

Inflicting Harm or being harmed by others (bullying vs. being bullied?)

Gang/Criminal involvement?

Engaging in High Risk Behaviors? (threatening to runaway, hyper-sexualized behaviors, and/or

Assessing Grave Disability?

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Assessing Grave Disability (Secondary to a Mental Disorder)

Different for Children and Youth vs. adults:

Not based on inability to provide “food, shelter, or clothing secondary to a Mental Disorder”

Instead it is the inability to “utilize”

food, shelter or clothing you provide them…

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Self-destructive Behavior:

Suicidal tendencies / Danger to Self

Documenting:

• Suicidal thoughts, threats, plans

(fleeting thoughts, seriousness, current?)

• Consulting with Supervisor/Clinician

• Interim Safety Plans

• TFC Parent immediate Interventions

• Planned and documented

timely Follow-up with team

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Checking in and Charting on

Risks for Self-Harm

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o Social Media Sites or Postso Self-Isolation

Assessing Risk for Harm to Others

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Victimization: Bully or Victim?

Charting Aggressive behavior

• Document [school detentions and suspension, law enforcement, crisis

services, and hospitalization?]):

• Charting precipitating events any precursors?

• INTERVENTION/ACTIONS

• Plans to avoid reoccurrence?

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TFC Parent more at the moment intervention skill-buildingIHBS focus on individual proactive, Life skill-buildingICC Coordinator: Ensure addressed in all plans and settings

At Risk of Higher Level of Service?

Meeting Criteria for more

intensive services or

Therapeutic Behavioral Services (TBS)

Crisis Stabilization or Inpatient Care?

Referral to Santa Clara County Mental Health Call Center (800) 704-0900

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Diagnosis

Made ONLY by a Licensed Practitioner of the Healing Arts (LPHA)

A CHILD IS NOT A DIAGNOSIS!

Avoid labeling!

You are charting

Child/Youth’s Presenting BEHAVIORS,

Your Interventions /ACTIONS,

Child/Youth’s Reactions /Responses

Your realistic Plans or your next steps38

What is meant by

“Functional Impairment”?

A significant impairment in an important area of life functioning (use developmental, social impairments to justify)

A probability of significant deterioration in an important area of life functioning (identify)

A probability a child/youth will not progress developmentally as individually appropriate.(use developmental milestones as measure)

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Probability of significant deterioration in

an important area of life functioning.

Without intervention child/youth will deteriorate:

• At TFC Home

• At School

• In Community

(i.e., loss of functioning in multiple settings, with multiple agencies need ICC Coordination)

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Probability a child/youth will not progress

developmentally as individually appropriate.

Lack of Progression OR Regression examples

• 10-year-old still OR starts sucking thumb

• 8-year-old cannot feed or dress self (secondary

to a mental disorder, not due to an intellectual disability)

• 14-year-old (without a medical condition) wets their bed

Your interventions plan is to reduce impairment, restore functioning, or prevent deterioration in an important area of life functioning, as outlined in the client’s plan

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Medical Necessity Necessities

TFC Parent Progress Notes⚫ Documents day to day behaviors and symptoms and

immediate interventions and their effectiveness (equally okay to note absence of symptoms and new symptoms to update plan)

⚫ Charting Interventions with examples of functional impairment (existing or new?)

IHBS staff may work individually to increase resilience, functioning and independence.

Progress Notes support continued Medical Necessity documenting the “need” to intervene

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Pain-Point: Santa Clara QI states insufficient documentation that interventions support Medical Necessity

Client/Care Plan Requirements (Santa Clara’s MHP Contract with the State DHCS)

Client Plan must include, but are not limited to,

⚫ reference to child/youth’s participation and agreement in the body of the plan,

⚫ A signature (by the child/youth) signature &Caregiver (TFC Parent) on the plan, or

⚫ description of the youth and Caregiver’s participation and agreement in progress notes.

⚫ must be updated when there was a significant change in youth’s condition

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Santa Clara County Guidance also requires Client/Care Plans be SMART,• Specific, Measurable, Attainable, Realistic &

Signed and Time-Framed

Transformational

Care Planning

(TCP) in

Treatment PlansGoals

Objectives

Desired Results

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TCP Planning Means:

• Person-centered• Family driven• Principles of :✓ inclusion ✓ hope ✓ wellness ✓ resiliency and recovery.

A collaborative process between an individual/family and his/her service provider(s). (See example)

CCR Title 9, Focus of Intervention must address the

condition/functional impairment (i.e., DSM Diagnosis)

The expectation is that the proposed intervention will:

1. Significantly diminish/reduce the functional impairment

2. Prevent significant deterioration in an important area of life functioning

3. Allow the child/youth to progress developmentally as individually appropriate

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What are the Requirements of

Plans of Care?

Client Treatment Plan shall:

⚫ Have specific observable and/or specific quantifiable goals

⚫ Identify the proposed type(s) of intervention

⚫ Have a proposed duration of intervention(s)

⚫ Parenting Interventions has to support Treatment Care Plan!

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Client Plan Requirements cont.

Timeliness/Frequency of Client Plan

State requires most services to be updated at least annually.

For IHBS, ICC and TFC require evidence that it has a procedure for reassessing the strengths and needs of children and youth, and their families, at least every 90-days, for the purpose of determining if ICC and/or IHBS should be added or modified.

The MHP shall establish standards

for timeliness and frequency for the

individual elements of the client plan.

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Santa Clara County MHP Care Plan Timelines

▪ Initial – 60 days (except for cases open/closed less than 60 days)

▪ Transfers – 60 days, i.e., a transfer from one program to another, even within the same agency

▪ Change/Addition of services – requires new Treatment Plan or Interim Update Form to be completed prior to start of new services

What is the

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?

Assess Symptoms &

Behavior

Support DSM Diagnosis & Functional

Impairment

Transformational Care Plan (TCP)

address symptoms & Behaviors

Progress notes interventions

address Symptoms &

Behaviors in TCP

Support Medical Necessity

No Billing of Planned Services

Assessment and Care Plan must be completed PRIOR to the billing of most Services (including TFC, IHBS and ICC services).

Exceptions: Psychiatric Emergency (Crisis Intervention), urgent Med Support, Assessment and Plan Development

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No Billing !

=No Assessment No Care Plan

Putting our Knowledge to Use

Vignettes:

• A “Vignette” is a brief incident or scenario that allows us to practice with what we just learned and apply our knowledge in a practical, hands-on exercise.

• By design, vignettes requires you to add logical or additional details that support your practice notes…

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Vignette

Miyuen is a 7 y.o. Asian-American girl who presents as fidgeting, squirming, reported to constantly leave her seat during class; she often runs about or climbs on everything; Miyuen often has difficulty playing or engaging in leisure activities quietly and is often “ on the go” or often acts as if “driven by a motor”; Miyuen talks constantly, has difficulty waiting her turn and often interrupts others and intrudes on their personal space.

Miyuen is failing in most of her classes, she is rejected and teased by her peers.

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Vignette Analysis: Use the following guide with each

Vignette

➢ What Behaviors can you target?

➢ What is the functional impairment?

➢ How can you intervene/take action (to diminish, prevent, or allow developmental progress, one, two, all?)

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Red Flag Reminders

No Late Treatment Plans

Focus of Intervention consistent with behaviors identified & match Diagnosis

Specific observable/quantifiable goals

Must be signed or co-signed by LPHA

Evidence of youth or caregiver (TFC Parent) participation and agreement (signature)

Parenting Interventions support TCP Treatment Plan that focus on child’s symptom reduction or child’s mental health

Billing

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IHBS, TFC, ICC

and EPSDT Crosswalk

A Reference Guide

Primary focus is plan development, rehabilitation, collateral and case management notes

Red Flags: Non-claimable activities Crosswalk

Therapeutic Foster Care (TFC) is….

Short-term, intensive, & highly coordinated,

Trauma- informed, and individualized intervention,

Provided by a TFC parent

To a child or youth who has complex emotional and behavioral needs.

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Therapeutic Foster Care (TFC)

Need based on each child’s or youth’s strengths and needs.

Appropriate for children and youth with more intensive needs, or who are in or at risk of placement in residential or hospital settings, butcould be effectively served in the home and community.

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Therapeutic Foster Care (TFC)

Eligible for

❑ Plan Development

❑ Collateral

❑ Rehabilitation

“bundled” at a daily rate

Provided by TFC Parent primarily in the home and in the community.

May be provided in conjunction with other services as medically necessary

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INTENSIVE HOME BASED SERVICES (IHBS)

Individualized, strength-based interventions to address the mental health needs of the youth predominantly provided in the home, school, or community, NOT THE OFFICE

Service includes:

❑ Skill based interventions

❑ Developing functional skills

❑ Developing replacement behaviors

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INTENSIVE HOME BASED SERVICES (IHBS)

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Claimable IHBS activities include:

Improvement of symptom/self-management

Education of mental illness (includes SSP)

Develop social supports and address behaviors that interfere with

a stable and permanent family life seeking & maintaining a job youth’s educational achievement independent living

INTENSIVE CARE COORDINATION (ICC)

Intensive targeted case management

intended for youth with more intensive needs requiring cross agency collaboration.

Service activities include:

❑ Assessment

❑ Care planning (plan development)

❑ Coordination of services (case mgmt.)

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PROGRESS NOTES

If it “ain’t” documented….

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Progress Notes

Document all contacts & interventions

Due within 5 business days of service

Late entry, include date of service. Sign and put date you wrote the late entry in progress note.

Not all actions will be claimable, but all observations are helpful insights and explanations.

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PROGRESS NOTES REQUIREMENTS

One progress note per service

Date of service (month, day, year)

Duration of service in minutes

Place of Service (home, office, community)

Type of service, e.g., Rehab, CM, Plan Dev.

Signature, County title/credential, include license/registration #, date of signature

Legibility

All progress notes document services provided in the client’s preferred language.

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Progress note and billing must match or risk disallowance.

Santa Clara BH Standard Progress Note

Considerations…PIR + Goal or Plan

P = Presenting problem (why is client there)

I = Interventions (what did you provide; therapeutic techniques).

Does this service: • Reduce Impairment?

• Restore Functioning? or • Prevent significant deterioration in an important area of life functioning as outlined in the client plan?

R = Response (of client)

G+P = Goal or Plan as appropriate (next steps or

follow-up)

*Assessment, Plan Development and Case Management do not have to follow PIR format.

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Review: Assessment Notes

9 CCR §1810.204

a service activity designed to evaluate the current status of a beneficiary's mental, emotional, or behavioral health. Assessment includes but is not limited to one or more of the following: mental status determination, analysis of the beneficiary's clinical history; analysis of relevant cultural issues and history; diagnosis; and the use of testing procedures.

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ICC Assessment Note Example 1

03-02-20 85 mins. In our initial office session with TFC Parent Maria, I summarized and assessed the presenting problem (Jamie striking others when frustrated or angry), evaluating and reviewing the behavioral triggers, and impact of consequences of the behavior. Reviewed with Maria her perception of problem behaviors, completed intake assessment. Plan is to review different types of Intensive Care programs in the community with TFC Parent Maria and community partner providers in CFT. Next steps is to develop a comprehensive, cross agency TCP Care Plan.---Joe Staff, LCSW, 1234

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ICC Assessment Note Example 2

03-08-20 91 mins TFC Home. Completed initial session with TFC Parent Maria without Jamie present at TFC Home. Obtained written consent for services and reviewing the limits of confidentiality; I interviewed Maria about Jamie’s presenting problems and behaviors, conducted a functional analysis of the problem behaviors, Jamie’s “likes and dislikes” and asked Maria to complete standardized assessment measures of Jamie’s behavior and parenting practices. Plan is to review assessment findings with Maria and care plan community partners to complete the TCP Plan of Care next week. ----Joe Staff, LCSW 1234

Importance of including the family

dynamic in the Assessment

Leads to a family goal that addresses behavior and significant impairment of the client in the Transformational Care Plan

Will assist the parent in addressing a “family goal” and help with supportive documentation as well!

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ICC and Child and Family Team

CFT meeting may claim for the time he or she contributed to the CFT meeting, up to the length of the meeting, plus documentation and travel time

Participation in the CFT meeting is claimed as ICC

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Review: Plan Development

9 CCR §1810.232

a service activity that consists of developmentof client plans, approval of client plans, and/or monitoring of a beneficiary's progress.

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TFC Plan Development Example(Clinician)

05-21-20 44 mins. OFFICEP: Jamie striking others when frustrated or angry.I: Spoke with Jamie’s social worker about behavior goals. Working with TFC Parent about home plan for Jamie to use his words when angry. Goal is to set initial lower threshold and reinforcement for Jamie to use words when angered with reward of computer time (see TCP Plan dated 05-21-20). P: Follow-up plan is for ICC Coordinator to connect with community partners next week to implement TCP plan in school and community---Joe Staff, LCSW 1234

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Plan Development by TFC Parent

Example

05-21-20 19mins TFC Home. P: Jamie hits others when angry and does not get his way. Jamie I: I told Jamie I will work with him and his social worker on a home plan to use his words when angry. I will look for rewards to use when Jamie uses his words and not his fists. R: Jamie liked this plan and said, “that will work!”P: Plan is to call social worker tomorrow to work on TCP-----Joe Parent, TFC Parent

Review: Case Management/Brokerage

9 CCR §1810.249

services that assist a beneficiary to access needed medical, educational, social, prevocational, vocational, rehabilitative, or other community services. The service activities may include, but are not limited to, communication, coordination, and referral; monitoring service delivery to ensure beneficiary access to service and the service delivery system; monitoring of the beneficiary's progress; placement services; and plan development.

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Linkage/Brokerage/Consultation T1017

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Case Management/Brokerage Activity

and Linkage and ICC Example

06-01-20 28 mins. Office.Contacted Jamie’s TFC Parent, Jack about his follow-

through with referral to community organizations to help Jamie redirect his time to increase his socialization skills and use as a positive reinforcer. Response: Jack states he will use referral list provided by the Boys and Girls Club. Plan: Plan is to follow-up on this linkage

next session.- Jill Staff, ICC Coordinator

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Case Management/Brokerage

Consultation Example

05-12-20 74 mins. School.Met with Ms. Jones, (schoolteacher) about Miyeun’s school performance and classroom behavior that create barriers to her education. Plan is to coordinate a plan with classroom school aide, at school on possible ways to redirect Miyeun to increase her attention and decrease distraction in the classroom. Next follow-up to monitor progress on 06-21-20---Katy Staff, MFT, 1234

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Case Management/Brokerage /

Non-Licensed Staff Example

06-06-2020 31 mins OFFICESpoke with TFC Parent Jack regarding Jamie’s need for a dental appointment due to cavities. Jack said Jamie has an appointment next week, but Jamie does not want to go because of his fear of dentists. Plan is to work with Jack on possible behavioral interventions and redirects to decrease Jamie’s anxiety about going to the dentist-----------Joe Staff, MHRS, BA

Using and Charting ICC Coordination in the TFC Home

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Intensive Care Coordination (ICC)

targeted case management service that facilitates assessment of, care planning for and coordination of services, including urgent services for Youth with intensive needs

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Intensive Care Coordination (ICC)

Provided to clients living and receiving services anywhere in the community (including in a TFC home, hospitals, STRTPs or any institutional placement.

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ICC Service Components

Comprehensive Assessment and Periodic Reassessment

Development and Periodic Revision of the TCP (within CPM Model)

Referral, Monitoring & Follow-upActivities

Transition planning for long term stability using natural supports & Community Resources

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ICC Progress Notes

Should Include

CFT Participation

Core Practice Model (CPM) elements

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The ICC Coordinator is under the direction of a Licensed Mental Health Professional (LMHP) or a Waivered or Registered Mental Health Professional (WRMP)

INTENSIVE HOME BASED SERVICES

(IHBS) KATIE A

Individualized, strength-based interventions to address the mental health needs of the youth predominantly provided in the home, school, or community.

Service includes:

Skill based interventions

Developing functional skills

Developing replacement behaviors

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Collateral (Individual) Example by

a family specialist/coach

06-10-20 112 mins. TFC HomeService provided in Spanish. Provided training and consultation to Matteo’s caregiver (Ms. Romero) on how to speak with Matteo more effectively. Used Effective Parenting Handouts to practice saying exactly what she means, to look directly at Matteo, use a firm, but pleasant voice on “do” directions avoiding “don’t” directions. Worked on a tracking plan to target Matteo’s positive behaviors using Matteo’s goal to attend football game. Ms. Romero plans on using intermittent reinforcement to prolong positive change.---Jane Staff, MHRS

Review: Rehabilitation (Rehab)

9 CCR §1810.243

a service activity which includes, but is not limited to assistance in improving, maintaining, or restoring a beneficiary's or group of beneficiaries' functional skills, daily living skills, social and leisure skills, grooming and personal hygiene skills, meal preparation skills, and support resources; and/or medication education.

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H2015 All staff can claim for Rehab

INTENSIVE HOME BASED SERVICES (IHBS)

Individualized, strength-based interventions to address the mental health needs of the youth predominantly provided in the home, school, or community.

Service includes:

Skill based interventions

Developing functional skills

Developing replacement behaviors

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INTENSIVE HOME BASED SERVICES (IHBS)

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Claimable IHBS activities include:Improvement of symptom/self-

management Education of mental illness Develop social supports and address

behaviors that interfere with

➢a stable and permanent family life ➢ seeking & maintaining a job ➢youth’s educational achievement ➢ independent living

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IHBS (Individualized) Example by

Family Specialist/Coach

06-06-20 122 mins. TFC HOMEP: Argues with caregiver and peers when bored or frustrated.I: Worked with individually with Jamie on how to occupy his free time with activities. Worked with Jamie on the Stop, Think, Say “No” and Go Look for something else to do by selecting board games as structured activity. R: Jamie was in engaged and liked the board games provided. P: Plan is to continue developing replacement behaviors to decrease frequency of negative outbursts. Next session 06-13-20--------------------------------------------Jane Staff, MHRS, IHBS

Review: Crisis Intervention

9 CCR §1810.209

a service, lasting less than 24 hours, to or on behalf of a beneficiary for a condition that requires more timely response than a regularly scheduled visit. Service activities include but are not limited to one or more of the following: assessment, collateral and therapy….

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CPT staff claim 90839 first 60 mins. Add-on code: 90840 each additional 30 mins

HCPC User: H2011

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Crisis Intervention Example

09-02-20 59 mins. OFFICE Received urgent phone call from TFC caregiver outside of prescheduled appointment due to Shona "blowing" out. Shona is at immediate risk of losing foster care placement due to threats of property destruction, self-harm and harm to others. Worked with caregiver on how to redirect Shona and model calm behavior. Briefly practiced interventions. Intervention proved effective; caregiver was able to deescalate Shona. Plan is to follow-up tomorrow at the caregiver’s home with a risk assessment and additional support. Provided caregiver with interim safety plan--- Joe Staff, LCSW, 1234

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Crisis Intervention (TFC) Example

09-02-20 78 mins. TFC HOMEP Shona refuses to clean her room. Tells me she is going to kill someone and kicks lamp over.I I called the social worker for help. Joe stayed on phone and told me what to say to Shona to calm her down. I spoke with Shona calmly and gave her some choices and we agreed to work out a plan. R Shona said she was sorry and came out of her room.P Joe told me to call him back if Shona starts up again or 911 if I need to. Joe said he will be coming here tomorrow to work with us on a new plan.--- Sondra Parent, TFC Parent

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Pain Points: in Crisis Intervention

• Cannot claim for hours of Crisis Intervention in Emergency Rooms.

• Can only claim for time spent on • well documented intervention!

• However, can claim for Case Management during intervention by not for Crisis Stabilization.

Review: Collateral

a service activity to a significant support person in a beneficiary's life for the purpose of meeting the needs of the beneficiary in terms of achieving the goals of the beneficiary's client plan. Collateral may include but is not limited to consultation and training of the significant support person(s) to assist in better utilization of specialty mental health services by the beneficiary, consultation and training of the significant support person(s) to assist in better understanding of mental illness, and family counseling with the significant support person(s). The beneficiary may or may not be present for this service activity.

9 CCR §1810.206

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Rehab users should always bill H2015

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Collateral (Individual) Example by

Family Specialist/Coach

06-06-2020 102 mins. TFC HomeP: Matteo ignores caregiver directionsI: Trained TFC caregiver (Ms. Romero) how to talk with her son, Matteo. Used Effective Parenting Handouts to practice saying exactly what she means, to look directly at Matteo, use a firm, but pleasant voice on “do” directions avoiding “don’t” directions. R: Ms. Romero states she will use this technique tonight and report back at next session.P: Will work with Ms. Romero on using intermittent reinforcement to prolong positive change next session on 06-12-20.--Jane Staff, MHRS

Do’s and Don’t EVER!

Progress Note Guidance

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Progress Note Do’s

Include time, date, type of contact

Include all contacts

Brief, succinct

Include behavior being addressed or mitigated

Include intervention or action

Include follow-up plan or next step

Sign it!!! (electronically okay)

Consult with supervisor when in doubt 98

Don’t EVER…

Disallowed Claiming for:

⚫ Transport

⚫ Providing Mental Health Services to a person other than the client

⚫ Clerical Activities (filing, copying, faxing)

⚫ Making/Cancelling an Appointment

⚫ No Shows without action.

⚫ Translating or Interpreting

⚫ Researching a topic or intervention

⚫ Recreation or Vocational Intervention/training

99

PRACTICE TIME

You will be randomly assigned to an on-line chat room.

You will be provided a Vignette

Answer the following questions as a group:

100

Vignette Analysis: Use the following guide with each

Vignette

➢ What are the functional impairment? (ALL)

➢ Does it meet Medical Necessity and why? (ALL)

➢ Recommendations for an intervention to (diminish, prevent, or allow developmental progress, one, two, all three?)

➢ Compose a TFC Parent Progress Note together. Required elements for TCP Parent notes? Any Cultural Considerations? (ALL)

101

Contacting SCC Quality

Improvement

The Quality Improvement Program oversees program compliance to all local, State, and Federal Guidelines for quality of care, certification, and utilization management.

Phone 1 (408) 793-5894

102

Questions?

103

104

Please Note

No part of this presentation or its handouts may be reproduced, translated, stored in a retrieval system or transmitted, in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission of the Presenter