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Metrowest Medical Center

Metrowest Medical Center. Mental Health Assessment, Treatment and Discharge Process Mary Mullany, APRN-BC. Introduction. Psychiatric screening process Who, when and where Options for treatment Outpatient, partial hospital program or inpatient unit Course of treatment

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Metrowest Medical Center

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  1. Metrowest Medical Center Mental Health Assessment, Treatment and Discharge Process Mary Mullany, APRN-BC

  2. Introduction • Psychiatric screening process • Who, when and where • Options for treatment • Outpatient, partial hospital program or inpatient unit • Course of treatment • Discharge planning process

  3. First Contact • Evaluation and Referral Team is located at MWMC in Natick • (508) 650-7380 • Coordinator, Tina Marian R.N. • Licensed mental health clinicians, licensed social workers, dual diagnosis specialist and graduate student interns • Psychiatrist

  4. Referral Process • Call (508) 650-7380 to speak with mental health clinician • Referrals come from a wide geographical region • Give clinical information about current crisis • Provide insurance information • Different options with different insurers: MBHP, Tufts, Blue Cross, UBH.

  5. Next Steps • Initial telephone screening with referring people, schools, parents, self • Directed to come to Emergency Department • Framingham ER covered by Advocates in a contractual arrangement with MWMC • Natick ER is covered by MWMC staff clinicians

  6. Emergency Room Process • ER medical staff will provide medical clearance, physical exam and labs as needed • Immediate safety assessment • If there is concern about safety to self or others, patient will be maintained on constant observation with trained staff

  7. Decision Process • Mental health clinician and psychiatrist will evaluate and determine disposition • If hospitalization is required clinician must seek authorization from insurance company • Medicaid insurance requires PES Team (Advocates) to evaluate and determine disposition

  8. Inpatient Child Development Unit (CDU) • 12 bed licensed DMH unit located at Leonard Morse Hospital in Natick • Multidisciplinary team • Psychiatrist, nurses, social workers, psychologist, on-site teacher, counselors, recreational therapist, nurse practitioners and pediatrician

  9. Diagnosis • Ages: 3- 18 • Length of Stay: 7-10 days • Diagnosis : Depression, mood disorders oppositional defiant disorder, school phobia, psychosis, ADHD

  10. Behaviors • Multiple forms of risk behaviors: • Substance use • Violence • Sexual activity • Suicide thoughts and behaviors • Bullying • Cutting

  11. Treatment • Milieu treatment, groups, recreational activity, setting daily goals, mood monitoring journals • Classroom • Pet therapy program • Adolescent groups • Psychopharmacological evaluation • Diagnostic assessment • Collateral Contact with out patient providers , therapist, psychiatrist, pediatrician

  12. Partial Hospital Program • Day program located at LMH, MWMC Natick • Hours: 8:30 a.m. - 3:00 p.m. • Ages 15 years old and up • Must have transportation available • Good treatment program for depression, substance abuse or dual diagnosis • Step-down from inpatient hospital • Alternative to hospitalization

  13. Treatment Modalities: PHP • Groups • Psychopharmacological assessment • Psychosocial and family assessment • Staff: • Coordinator: Kathy Natale, OTR • Psychiatrist : Annette Hanson, MD • Social workers • LMHC • Psychiatric APRN

  14. Discharge Planning • Essential contact from day ONE: • Parental/guardian involvement • Contact with school staff • Engagement with social service agencies, e.g. DCF • Outpatient treatment team, psychiatrist, therapist • DMH referral • Residential

  15. Clinical Illustrations • 17 year old female • Acute suicidal thoughts and history of binge drinking • Disclosed extent of her depression and suicidal thoughts to guidance counselor when talking about college application process • Parents in denial and minimizing risk

  16. Clinical Illustrations • 17 year old male • Difficulty with impulse control • Mood disorder • Precipitating behaviors: physical altercation with school personnel; verbally abusive to substitute teacher

  17. Clinical Illustrations • 15 year old female • ADHD and PTSD • History of cutting/gauging arms • Precipitating behavior: engaged in physical altercation (punching) with mother in school setting

  18. Rewards and Challenges • Staff are dedicated and committed to making a difference in the lives of the children who we serve • We welcome ongoing involvement from the staff in the schools • HIPAA may limit what we can share but we still recognize that we are all in this together • It takes a village…

  19. QUESTIONS ? • QUESTIONS ?

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