integrated assessment and treatment planning

IM+CANS Training Office

INTEGRATED ASSESSMENT AND TREATMENT PLANNINGU S I N G T H E I M + C A N S

Judith Howard, LCSWMatthew Stinson, LCPCCandace Kovacs, LCPC


IM+CANS PARTNERSHIP

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All materials related to TCOM (CANS, ANSA, CAT etc.) are provided in collaboration with:

Sponsored by:

Administered by:


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ITO MISSION

• The IM+CANS Training Office (ITO) is designed to support the implementation of the new Medicaid service of Integrated Assessment and Treatment Planning (IATP).

• As Illinois seeks to raise clinical standards and improve access to services to better serve the state’s population, the ITO is here to provide dedicated and ongoing training and support to all Medicaid enrolled front line behavioral health practitioners and supervisors.

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LEARNING OBJECTIVES

1. Identify the unique components of the IM+CANS model, which integrates Mental Health Assessment and Treatment Planning into one service and process.

2. Understand how this new tool was implemented statewide with emphasis on past and current challenges and lessons learned.

3. Apply information from the IM+CANS assessment to inform the development of a treatment plan.

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IM+CANS MODEL & TOOL

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IATPIntegrated Assessment and Service Planning (IATP) is a new (effective January 1, 2019) service in the Medicaid mental health service array, that defines the formal process of information gathering and review, and prescribes a standardized assessment and service planning tool in order to:

1) Identify a client’s integrated healthcare needs and strengths across all domains;

2) Recommend services needed to ameliorate a client’s condition and improve well-being; and

3) Develop, review, and update an individualized treatment plan.

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IM+CANS OVERVIEW • The Illinois Medicaid Comprehensive Assessment of Needs and Strengths

(IM+CANS) is a unique model for integrating assessment and treatment planning into a single process, in support of the IATP service

• Built for Illinois in consultation with Dr. Lyons and his team, and with input from state agency partners

• The IM+CANS serves as the foundation of Illinois’ efforts to transform its publicly funded behavioral health service delivery system.

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IM+CANS STRUCTURE The IM+CANS is a lifespan tool that provides a standardized, modular framework for assessing the global needs and strengths of individuals who require mental health treatment in Illinois, including:

• A complete set of core and modular CANS items;

• Integrated mental health assessment and treatment plan;

• Integrated physical Health Risk Assessment (HRA);

• Caregiver resources and needs addendum;

• Population-specific addendum for youth involved with the child welfare system; and,

• Crisis subset of CANS items, referred to as the Illinois Medicaid Crisis Assessment Tool (IM-

CAT), used to screen and assess individuals experiencing a behavioral health crisis.

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TREATMENT PLANNING

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STEP 1: CLINICAL FORMULATION

Following the assessment, begin the process of establishing a Clinical Formulation:

Clinical Formulation: creates a communication framework for developing the most suitable approach to treatment. In essence, clinical formulation summarizes the:

• Diagnostic impressions, functional impairments and needs recorded in the assessment; and

• The approach for maximum reduction of mental disability and restoration to the best possible functional level.

Clinical Formulation establishes Medicaid Medical Necessity.

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IM+CANS Box 12MHA Summary


STEP 2: OUTSTANDING CLINICAL QUESTIONS

Identify any necessary assessment activities required in the completion of the IM+CANS:

IATP “Clinical Assessment Tool”: Performed by, or under the supervision of, an LPHA using a nationally standardized assessment instrument resulting in a written report or documented outcome that includes the identification of a clinical issue or tentative diagnosis to assist in the completion of the IATP.

Referral for other assessment activities:psychiatric, psychological, neuropsychological, other specialty assessments, etc.

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IM+CANS Box 13Additional Evals


STEP 3: SORTING OF IM+CANS ITEMSSort the IM+CANS items:

• Background Needs – Identify the needs that we cannot change but must be mindful of as they may continue to impact the individual.

• Treatment Target Needs – Identified actionable needs we can change

• Anticipated Outcome Needs – Identify needs we expect to change in the process.

• Resources/Strengths – Link needs with strengths that can be used or built to effect change.

This process begins to solidify the Clinical Formulation and starts discussion around theory of change.

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IM+CANS Box 14Sum of Needs/Strengths


STEP 4: DEVELOPING A SHARED VISION

Develop a Shared Vision with Client and Team:• Create space for the client and team to express “Why they are here” and “what they want

to change”

• Discuss the items we clinically identified as Target Treatment Needs; Be prepared forfeedback – we may not have gotten it right the first time.

• Work with the client and team to begin to establish a vision of where they would like to go together; use person centered language.

• Begin the process of managing expectations to help guide reasonable and attainable changes.

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IM+CANS Box 15aClient Vision Statement


STEP 4: DEVELOPING A SHARED VISION

Develop a Shared Vision with Client and Team:

• Solidify the vision and enhance buy-in by seeking out client preferences:

- Would services be delivered best in the home? At the school? After hours?- Are there certain things they have tried that didn’t work before?- Are there preferred providers or supports that are needed in the process?

• Service preferences become logistical elements to be managed by the Treatment Plan throughout the service process.

Clinical Formulation strengthens with buy-in and becomes the Theory of Change

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IM+CANS Box 15bService Preferences


STEP 5: ESTABLISH THEORY OF CHANGE

Theory of Change: Clinical understanding of the client’s challenges, based upon the assessed needs, and the collaborative belief about what could be done to transform their lives using the available resources to achieve the anticipated outcomes.

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GOALS AS A TOOL

DefinitionGoals: structured constructs that become personal achievements upon the completion of one or more Objectives, or actions taken.

Goals should be based upon the Shared Vision and must be:

• Issue-specific, Measurable, • Attainable, Relevant, and Time Bound

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IM+CANS Box 16Treatment Goals / Objectives

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BUILDING OBJECTIVES

Objectives are action steps.• Each objective should be specific, concrete actions to be achieved by the client

or the team directly related to the client’s Goal.

Objectives, Goals and Shared Vision are intrinsically linked:• Achieving Objectives will eventually increase Common Ground and improve

Engagement and Buy-In.

• If built correctly, achieving Objectives will systemically decrease needs and increase strengths, creating improved clinical outcomes.

IM+CANS Box 16Treatment Goals / Objectives


STEP 6: ALIGN SERVICES AND SUPPORTS WITH OBJECTIVES

Design a plan to meet the Client’s Goals.

Do not get caught by the general traps:

• Needs ≠ Services;

• Everything on the plan does not have to be a Medicaid service;

• The plan should be what the client needs, not what the provider sells or provides.

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IM+CANS Box 16Services / Interventions

NeglectDisruptions in Caregiving/Attach Losses

XX

AnxietyOppositionalAdjustment to TraumaAnger Control/ Frustration Tolerance

Talents and InterestsEducational SettingResiliency

Family StrengthsInterpersonalNatural Supports

Caregiver Social Resources Caregiver SupervisionCaregiver Involvement in Care Caregiver Knowledge

Family FunctioningLiving SituationSocial FunctioningSchool BehaviorSchool Achievement

Caregiver Medical/Physical

X

XX

XXX

X

XXX

X

XX

XX

X

X

X

X

X

19MIKE


IM+CANS FORMAT: PUTTING IT TOGETHER

CANS Item(s): Anger Control; Adjustment to Trauma; Social Functioning, School Behavior, School Achievement, Family Strengths/Support- STR; Natural Supports- STR; Interpersonal/Social Connectedness- STR; Education Setting- STR; Resilience- STR

CLIENT GOAL 1: Mike will address the anger that is triggered by his peer interactions. In doing so, he will identify ways of expressing his feelings (Anger Control, Adjustment to Trauma) that do not involve fighting with peers or result in school suspension (Social Funct; School Bx). This will also increase Mike’s participation and success at school (Education Setting, School Achievement). Mike will learn ways to use his supports to avoid fighting and arguing with others (Interpersonal/Social Connectedness; Family; Natural Supports; Resiliency)

MIKE20


PHILOSOPHY IN PRACTICE

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IMPLEMENTATION

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ACHIEVEMENTS

• First IM+CANS class July 12, 2018

Trained 8204 providers, at over 250 agencies

5092 (62%) were certified within 30 days

1284 (16%) certified beyond 30 days

1828 (22%) never certified

• Launched Treatment Planning Sept. 5, 2019-Approx 200 trained

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CHALLENGES

• Merging of 2 services into one

• Existing Processes

• Electronic Health Records

• Length of the tool

• Clinical discussion

• Portal delay

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NEXT STEPS

• Continue training existing courses

• Develop new courses

• Field Support/Coaching

• Support for HFS Behavioral Health Initiatives

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QUESTIONS?

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Email: [email protected]

Phone: 217-300-7812

Judith Howard [email protected] Stinson [email protected] Kovacs [email protected]

mailto:[email protected]





WEB RESOURCES

• For more about IATP, see the Illinois Department of Healthcare and Family Services at: https://www.illinois.gov/hfs/MedicalProviders/behavioral/Pages/default.aspx

• For more about IM+CANS or the Training Office, visit the School of Social Work at the University of Illinois at Urbana-Champaign: http://socialwork.illinois.edu/about-ssw/engagement-initiatives/im-cans/

• IM+CANS tools are available on both sites.

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https://www.illinois.gov/hfs/MedicalProviders/behavioral/Pages/default.aspx

http://socialwork.illinois.edu/about-ssw/engagement-initiatives/im-cans/

integrated assessment and treatment planning

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