Transcript Community Mental Health and Substance Abuse Services

Community Mental Health &
Substance Abuse Services of
St. Joseph County
Service Overview
Lynelle Thrasher
June 3, 2015
Don't let the
situation
confuse
you...
Community Mental Health Service
Structure
Michigan Department
Of Health
and Human Services
Medicaid Prepaid
Inpatient
Health Plans
Community Mental Health
Service Boards
• CMHSP’s 46 in Michigan
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serving all 83 counties
Medicaid Prepaid
Inpatient Health Plans
(PIHP’s) – 10 in Michigan
responsible for managing
the services and supports
for persons enrolled in
Medicaid, MiChild Healthy
Michigan, Autism services
and Substance Use
Disorders
How to Access Services
• Access Department
• Requests for services – person must be either seen for an intake
within 15 days of request or determined not eligible for specialty
mental health services due to presenting issue and referred to other
providers
• Emergent situations – person must be served within 3 hours
CMH Structure
Access/Emergency
Services
Adults with
Mental Illness
Children with
Severe
Emotional
Disturbance
Individuals with
Intellectual/
Developmental
Disabilities
Individuals with
Substance Use
Disorders
Medicaid
• It is an entitlement
• Bifurcated system – split between CMH and
HMO’s
HMO
CMH
Mild to moderate
impairment
20 outpatient therapy
services
Serious to severe
impairment
Specialty Services
Insurance
• Medicaid HMO – either adult with severe and persistent mental
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illness, child with severe emotional disorder, or adult or child with
developmental disability
MI Child and Healthy Michigan – Clinic Services are an entitlement,
access to enhanced services are conditional on medical necessity
and as used as an alternative to more restrictive care or placement
Open Medicaid – Entitlement, however no fee for service providers
available so CMH serves a broader range of diagnosis with this type
of Medicaid.
Indigent –No entitlements, services are provided according to
availability of funding. Priority given to individuals with the most
severe forms of MI, SED and DD, and those in urgent or emergent
situations
Private Insurance - Same as indigent and must have exhausted all
available resources in the private sector
MI Health Link – Individuals with Medicare/Medicaid enrolled in
newest managed care program.
Severe & Persistent Mental Illness
(Master Contract)
• Pertains to eligibility for Medicaid Recipients
• Must meet diagnostic criteria and one of the
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following: degree of disability, duration of illness
or prior service utilization
Diagnosis – Psychotic and Major Affective
Disorders
Criteria for duration and degree of disability can
be found in assessment forms
Serious Mental Illness
(Mental Health Code)
• Pertains to eligibility for General Fund
(non Medicaid Recipients)
• Diagnosable mental, behavioral or
emotional disorder that has resulted in
functional impairment that substantially
interferes with or limits one or more major
life activities.
Developmental Disability
• If older than 5, a severe chronic condition that is
attributable to a mental or physical impairment
or a combination of both that:
– Is manifested before the age of 22
– Is likely to continue indefinitely
– Results in substantial functional limitations in 3 or
more of the following areas of major life activity
• Self care
• Receptive & expressive language
• Learning
• Mobility
• Self-direction
• Capacity for independent living
• Economic self-sufficiency
Developmental Disability
• If under age 5, a substantial
developmental delay or a specific
congenital or acquired condition with a
high probability of resulting in
developmental disability as defined for
individuals over age 5.
Severe Emotional Disturbance
• Diagnostic mental, behavioral, or emotional
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disorder. (Not SA, DD, or V code)
Degree of Disability determined by CAFAS
– 50 or greater
– Two 20’s
– One 30
• Duration – existed during past year for a period
of time sufficient to meet diagnostic criteria
Substance Use Disorder
• Substance use disorder, also known as
drug use disorder, is a condition in
which the use of one or more substances
leads to a clinically significant impairment
or distress.
Medical Necessity
• Determination that a specific service is
medically (clinically) appropriate,
necessary to meet needs, consistent with
the person’s diagnosis, symptomatology
and functional impairments, is the most
cost-effective option in the least restrictive
environment, and is consistent with clinical
standards of care.
Psychiatric Hospitalization
• Immediate danger to self or others based on
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mental health diagnosis
Inability to care for basic needs based on a
mental health diagnosis
Need close and continuous medical observation
and supervision to make significant changes in
psychotropic medication
Close and continuous medical observation and
supervision is necessary to manage side effects
of psychotropic medication
Adult Services
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Outpatient Therapy
Psychiatric Evaluation & Med Management
Assertive Community Treatment
Case Management
Co-Occurring Treatment
Emergency Services and Evaluation
Peer Support Services
Adult Clubhouse
Specialized Residential
Older Adult Services/Services
Intellectual/ Developmental
Disabilities Services
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Supports Coordination & Case Management
Psychiatric Evaluation & Med Management
Guardianship
Respite
Community Living Supports
Skill Building
Specialized Residential
Supported Employment
Children’s Services
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Outpatient Therapy
Psychiatric Evaluation and Medication Management
Case Management
Home Based Therapy (Includes Early Childhood
Services)
Kids Clubhouse
Respite
Community Living Services
School Based Prevention Services
Autism Parent Support Group
Kinship Care Support Group
Substance Abuse Services
• Individual and Group Therapy
• Women’s Specialty Services – Case
Management
• Recovery Coach
• Coming in July – Intensive Outpatient
Services
• Prevention Services
Evidenced Based Practices
• Seeking Safety - A present focused therapy
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model to help individuals attain safety from
PTSD and substance abuse, focusing on
interpersonal issues, cognitive sessions, and
behavioral sessions.
Parent Child Interaction Therapy- Model is for
children 2- 7 years of age. Treatment emphasis
is placed on the parent-child relationship and
changing parent-child interaction patterns.
Evidenced Based Practices
• Dialectical Behavior Therapy Group- Group that teaches
skills on core mindfulness, emotion regulation skills,
interpersonal effectiveness skills and distress tolerance
skills. For teens and their caregiver.
• Trauma Focused Cognitive Behavior Therapy- Treatment
method proven to decrease symptoms of Post Traumatic
Stress Disorder, anxiety, depression and other child
behavior problems, decrease shame, improve parenting
skills and strengthen child-caregiver relationship.
Components of treatment: psychoeducation and
parenting skills, relaxation, affect regulation cognitive
coping, trauma narrative development, enhancing safety
and social skills. Model for children 3 – 18 years.
Evidenced Based Practices
• IDDT Services – Integrated Dual
Diagnosed Treatment – Clinical services
for individuals who have a co-occurring
mental health and substance use disorder
diagnoses.
Remember to Access Services
• Call the Access Department
• 269-467-1000
• 1-800-622-3967