Where the Rubber Meets the Road! Understanding- How to get Needed Services

1. Where the Rubber Meets the Road! Understanding- How to get Needed Services AOC Training- August 31, 2012 Cindy Ehlers. LPC -

2. Children and Youth in Your System Have the Children or Youth that show up in Your system had a traumatic experience that may have threatened their own or someone’s life, safety, or well being? Cindy Ehlers. LPC -

3. Risk When we don’t get this right! • Child traumatic stress can lead to Post Traumatic Stress Disorder (PTSD) • Trauma impacts a child’s development and health through out his or her life. • Complex trauma is associated with risk of delinquency. • Traumatic exposure, delinquency, and school failure are related. • Trauma assessments can reduce misdiagnosis, promote positive outcomes, and maximize resources. • There are mental health treatments that are effective in helping children and youth who are experiencing child traumatic stress. • There is a compelling need for effective family involvement. Cindy Ehlers. LPC -

4. Children and Youth are Resilient! Cindy Ehlers. LPC -

5. Trauma Informed Systems CHANGE lives Cindy Ehlers. LPC -

6. Role of MCO/LME • Access to Care-24/7/365 • Crisis Services • Care Coordination • Customer Services • Authorization of Services Cindy Ehlers. LPC -

7. Access • Toll free access 24-7 (required by the state) • Education to help people Access assessment and evaluations to determine services they may need for Medicaid and Uninsured target populations only. • Assess Urgency of Need and link to Crisis services • Referral for Assessment for appropriate level of care and type of service • Schedule First Appointment • Follow Up to make sure needs were met and appointments were kept Cindy Ehlers. LPC -

8. Crisis Services • Family and Natural Support systems • First Responder (if currently in treatment) • Mobile Crisis (if not currently in treatment) • Emergency Room • Facility Based Crisis / Non Medical Detox • Inpatient Cindy Ehlers. LPC -

9. Customer Services • Helps consumers and families understand how to Navigate the system • Provides Consumer Education • Takes complaints and grievances from community related to service delivery or gaps in services. Cindy Ehlers. LPC -

10. Process • Call to make appointment for Assessment (or court order) • Assessment determines what type of treatment is needed. Always starts with the least restrictive so most often it is outpatient therapy and medication evaluation and management must be tried first. • Receives treatment and ongoing assessment. • If the demonstrated needs exceed the scope of traditional therapy the youth may be referred to a higher level of care. • Most youth will not start at the PRTF level of care Cindy Ehlers. LPC -

11. ???? Confusion???? When a child is removed from the custody of the parent(s) and they have a MH/DD/SA issue that does not automatically mean they meet the medical necessity or entrance criteria for higher levels of care such as a group home. In fact in most cases those higher levels of care can cause trauma for a child. Most children need foster care ONLY with basic therapy that is trauma informed to meet their behavioral health needs. Assessment determines the need for treatment and the level of treatment needed, not placement barriers. LME/MCOs purchase treatment services not placements. LME/MCO can ONLY use public money for medically necessary services. Public safety and poor parenting do not meet medical necessity criteria. LME/MCO can require independent assessment if the initial assessment does not seem appropriate. Youth who do not meet criteria for PRTF or Level III treatment will step down to lower levels of care just like they do when private insurance is the payor. Cindy Ehlers. LPC -

12. Parents in Treatment • Process is the same Access is just a phone call and an appointment will be scheduled for Medicaid and Uninsured target populations. • All Women with addiction are a target population • All Children and Youth are a target population • Few Men will meet the target population for Medicaid or Uninsured funding unless they meet the criteria for Age, Blind, Disabled Medicaid or Medicare which starts with the Social Security administration and disability determination. Cindy Ehlers. LPC -

13. Court Orders Court order are a tool the system can use to require a person to participate in assessment and medically necessary treatment. The court order should say that the individual will schedule and complete a comprehensive clinical assessment for mental health and/or substance abuse treatment concerns and follow treatment recommendations. Court Orders CANNOT override medical necessity criteria Cindy Ehlers. LPC -

14. Payment ECBH and other LMEs cover two different types of public benefits. State funded services- for individuals who meet state defined target populations Medicaid – individuals who are eligible for Medicaid services Cindy Ehlers. LPC -

15. Questions and Answers Cindy Ehlers. LPC -