MENTAL HEALTH SERVICES

MENTAL HEALTH SERVICES I. DEFINITION OF SERVICE Mental Health includes psychological and psychiatric treatment and counseling services offered to individuals with a diagnosed mental illness, conducted in a group or individual setting, based on a detailed treatment plan, and provided by a mental health professional licensed or authorized within the State to provide such services, typically including psychiatrists, psychologists, and licensed clinical social workers. Documentation of: v Appropriate and valid licensure and certification of mental health professionals as required by the State Documentation of the existence of a detailed treatment plan for each eligible client that includes: Ø The diagnosed mental illness or condition Ø The treatment modality (group or individual) Start date for mental health services Ø Recommended number of sessions Ø Date for reassessment Ø Projected treatment end date Ø Any recommendations for follow up Ø The signature of the mental health professional rendering services v Documentation of service provided to ensure that:: Ø Services provided allowable under Ryan White guidelines and contract requirements Ø Services provided consistent with treatment plan II. DESCRIPTION OF SERVICE SERVICE PERFORMANCE MEASURE/METHOD MONITORING STANDARD LIMITATIONS Funding of Mental Health Services that include psychological and psychiatric treatment and counseling services offered to individuals with a diagnosed mental illness, conducted in a group or individual setting, based on a detailed treatment plan, and provided by a mental health professional licensed or authorized within the State to provide such services, typically including psychiatrists, psychologists, and licensed clinical social workers. 1. Documentation of appropriate and valid licensure and certification of mental health professionals as required by the State 2. Documentation of the existence of a detailed treatment plan for each eligible client that includes: The diagnosed mental illness or condition The treatment modality (group or individual) Start date for mental health services Recommended number of sessions Date for reassessment Projected treatment end date Any recommendations for follow up The signature of the mental health professional rendering service 3. Documentation of service provided to ensure that: Services provided are allowable under Ryan White guidelines and contract requirements Services provided are consistent with the treatment plan Obtain and have on file and available for grantee review appropriate and valid licensure and certification of mental health professionals Maintain client charts that include: A detailed treatment plan for each eligible client that includes required components and signature Documentation of services provided, dates, and consistency with Ryan White requirements and with individual client treatment plans Maintain program records documenting services provided Prepared by Germane Solutions QI Revised April 2015 1 P age

III. NATIONAL FISCAL MONITORING STANDARDS (HRSA issued April 2013): SERVICE PERFORMANCE MEASURE/METHOD MONITORING STANDARDS LIMITATIONS SECTION D: Imposition & Assessment of Client Charges 1. Ensure grantee and subgrantee policies and procedures require a publicly posted schedule of charges (e.g. sliding fee scale) to clients for services, which may include a documented decision to impose only a nominal charge 2. No charges imposed on clients with incomes below 100% of the Federal Poverty Level (FPL) 3. Charges to clients with incomes greater than 100% of poverty are determined by the schedule of charges. Annual limitations on amounts of charge (i.e. cap on charges) for RW services are based on the percent of client s annual income, as follows: 5% for clients with incomes between 100% and 200% of FPL 7% for clients with incomes between 200% and 300% of FPL 10% for clients with incomes greater than 300% of FPL Review of subgrantee policies and procedures, to determine: Existence of a provider policy for a schedule of charges. A publicly posted schedule of charges based on current Federal Poverty Level (FPL) including cap on charges Client eligibility for imposition of charges based on the schedule Track client charges mad and payments received How accounting systems are used for tracking charges, payments, and adjustments Review of provider policy for schedule of charges to ensure clients with incomes below 100% of the FPL are not charged for services Review of policy for schedule of charges and cap on charges Review of accounting system for tracking patient charges and payments Review of charges and payments to ensure that charges are discontinued once the client has reached his/her annual cap. Establish, document and have available for review: Policy for a schedule of charges Current schedule of charges Client eligibility determination in client records Fees charged by the provider and the payments made to that provider by clients Process for obtaining, and documenting client charges and payments through an accounting system, manual or electronic Document that: Policy for schedule of charges does not allow clients below 100% of FPL to be charged for services Personnel are aware of and consistently following the policy for schedule of charges. Policy for schedule of charges must be publicly posted. Establish and maintain a schedule of charges and policy that includes a cap on charges and the following: Responsibility for client eligibility determination to establish individual fees and caps Tracking of Part A charges or medical expenses inclusive of enrollment fees, deductibles, co-payments, etc. A process for alerting the billing system that the client has reached the cap and should not be further charged for the remainder of the year Personnel are aware and consistently following the policy for schedule of charges and cap on charges. Prepared by Germane Solutions QI Revised April 2015 2 P age

IV. MENTAL HEALTH SERVICE COMPONENTS Program outcome: Numerator: 80% of clients with mental health concerns will show maintenance in mental health functioning from baseline assessment at care entry. Denominator: Total # of clients in mental health Indicators: Number of clients who maintain or decrease mental health symptom distress from baseline to follow up via a validated symptom distress scale. Number of clients attending Mental Health services who are engaged in treatment.* Number of clients who have addressed at least 2 treatment goals. *Engaged= individual invested in treatment and attends a minimum of 50% of appointments. Service Unit(s): Face to Face Individual Level Mental Health Visit Face to Face Group Level Mental Health Visit Standard of Care Outcome Measure Numerator Denominator Data Source Goal/Benchmark I. Organizational A. Staff licensure and accreditation: As per Connecticut State Statutes and DMHAS regulations, professional staff will be licensed, certified or supervised by a licensed behavioral health professional A. Verification Mental Health staff is currently licensed, certified or licenseeligible Verification that all unlicensed/certified staff is supervised by a licensed behavioral health A. Number of Mental Health Staff licensed, certified or licenseeligible Number of unlicensed/ certified staff is supervised by a licensed behavioral A. Total number of Mental Health staff Number of unlicensed staff A. Administrative records of agency A. 100% of all agencies providing mental health services have licensed, certified or certified-eligible staff 100% of all agencies have unlicensed/certified staff supervised by licensed professional B. Continuous Quality Improvement (CQI) including Ongoing professional staff training in HIV-specific topics C. Crisis Intervention Policy professional. B. At least 10 hours of HIVspecific training per year for each professional staff member serving RW clients CQI plan updated annually ensures ongoing improvement of services C. Mental Health service providers will have a crisis intervention policy to assist a client in life-threatening situations. health professional B. Number of professional staff with evidence of attending 10 hours of training during year Number of agencies with CQI Plan updated annually C. Number of Mental Health Provider agencies with a Crisis Intervention Policy B. Total number of professional staff serving RW clients Total number of Mental Health agencies C. Number of Mental Health Provider agencies B. Employee files contain training certificates or proof of attendance Agency CQI Plan C. Agency Crisis Intervention Plan B. 100% of professional staff serving RW clients will attend at least 10 hours of HIV-specific training annually 100% of agencies will have a CQI Plan updated annually C. 100% of Mental Health agencies will have a Crisis Intervention Policy Prepared by Germane Solutions QI Revised April 2015 3 P age

Standard of Care Outcome Measure Numerator Denominator Data Source Goal/Benchmark II. Process D. Intake/Assessment: All charts will contain a completed intake and assessment (per DMHAS regulation schedule) and will screen for depression. D. Number of new client charts with assessment completed within 14 days of first face-toface visit D. Total number of new clients E. Treatment Plan compliant with DMHAS regulations * Engaged client = individual invested in treatment and attends 50% of appointments D. New client charts will have an individual intake and assessment completed and documented no later than 14 days after clients first faceto-face visit with a behavioral health professional. Assessments contain a screen for depression and a supervisor s signature. E. Treatment is delivered with an individualized treatment plan, addresses adherence, is co-constructed with client, and signed by client within 30 days of intake. (Treatment Plan documents suggested therapy/frequency/estimated end dates and/or rationale for continuation with note of frequency of interventional plan) If the Treatment Plan indicates any change in psychopharmacotherapy prescribing, charts will document contact with the client s medical provider within 72 hours of prescribing, or documentation of client refusal to authorize this communication. Engaged* clients address at least 3 treatment goals that are agreed upon with clinician. These are reviewed with clients every 6 months at a minimum. E. Number of clients with a treatment plan completed within 30 days of intake Number of clients with clients with coconstructed, cosigned treatment plans Number of clients with treatment plans addressing adherence every 6 months Number of client charts with change in pharmacotherapy document medical provider contacted within 72 hours of prescription Number of engaged* clients address 60% of treatment goals E. Total number of clients Number of clients with change in pharmacotherapy D. Chart audit D. 100% of new client charts have and individual intake and assessment completed and documented no later than 14 days after clients first face-toface visit with a behavioral health professional. Assessments contain a supervisor s signature E. Chart audit E. 100% of client charts have treatment plan completed and documented no later than 30 days of intake. 100 % of Treatment Plans are co-constructed with client, and signed by client 100% of Treatment Plans will address adherence to all client medications a minimum of every 6 months If Treatment Plan indicates change in psychopharmacotherapy, 100% of the charts document contact with the client s medical provider within 72 hours of prescribing, or documentation of client refusal to authorize this communication. Engaged* clients address at least 60% of treatment goals agreed upon with clinician.. Prepared by Germane Solutions QI Revised April 2015 4 P age

Standard of Care Outcome Measure Numerator Denominator Data Source Goal/Benchmark F. Access to and Maintenance in Medical Care: RW clients ongoing participation in primary HIV medical care G Referral to Support Services H. Discharge of Client for Services III. Outcome I. Efficacy of Services: clients are satisfied with their treatment Treatment Plans are reassessed every 6 months and signed by the client F. Each client is assessed and verified for engagement in HIV medical care and assisted with establishing linkages to care if not currently receiving it. Assessed initially, then reassessed and documented every 3 months. G. Mental Health providers routinely coordinate all necessary services along the Continuum of Care. H. Upon termination of active substance abuse services, a client case is closed and contains a closure summary documenting the case disposition. I. Standardized Ryan White Part A Client satisfaction surveys are conducted annually. #of clients with reassessment of Treatment Plan every 6 months F. Number of clients assessed/verified for medical care initially and every 3 months G. Number of clients with referrals to support services H. Number of client charts with closure summary I. Number of clients offered a survey F. Total number of clients G. Total number clients with documented need for referral H. Total number of closed charts I. Total number of clients 100% of client charts document reassessment of the Treatment Plan every 6 months and signed by client. F. Chart audit F. 100% of clients are assessed and verified for engagement in medical care. This is assessed initially, then reassessed and documented every 3 months. G. Chart audit G. 100% of treatment plans that have documentation of appropriate referrals to support services as appropriate. H. Chart audit H. 100 % of closed cases include documentation stating the reason for closure and a closure summary with a supervisor s signature indicating approval. I. Chart audit or site data system I. 100% of clients are offered a standardized Ryan White client satisfaction survey annually V. DATA REPORTING Part A service providers are responsible for documenting and keeping accurate records of Ryan White Program Data/Client information, units of service, and client health outcomes. Reporting units of service are a component of each agency s approved work plan. Please refer to the most current work plan, including any amendments, for guidance regarding units of service. Summaries of service statistics by priority will be made available to the Planning Council by the Grantee for priority setting, resource allocation and evaluation purposes. The Chart Audit Tool for Mental Health Services is attached on the next page. Prepared by Germane Solutions QI Revised April 2015 5 P age

PROGRAM SITE: REVIEWER(S): New Haven/Fairfield Counties Ryan White Part A Program Mental Health Service Standards New Haven Ryan White Part A HIV Chart Review: Mental Health-Quality CHART #s: REVIEW DATE: STRUCTURE ( Who ) STAFF 1 2 3 4 5 6 7 8 9 10 Verification Licensure 1 Mental Health staff is currently licensed, certified or license-eligible Verification Supervision: of all unlicensed/certified staff is 2 supervised by a licensed behavioral health professional Documentation of Training: At least 10 hours of HIV-specific training per year, 10 hours of Mental Health training and 5 hours of 3 co-occurring disease for each professional staff member serving RW clients INFRASTRUCTURE 1 2 3 4 5 6 7 8 9 10 System of Care in place Documentation/discussion of Mental Health System of Care and 4 integration/connection to other care systems (i.e. HIV Medical Care, Substance Abuse, other core or support services, Community Mental Health and/or Substance Abuse Continuum) Model/Tools/Program Design outlined Documentation that Program Design, Model used provides 5 supporting tools or instruments to assess progress, outcomes and have some scientific basis for use. CQI plan updated annually ensures ongoing improvement of 6 services. Plan exists, has EMA-wide components and is updated on a yearly basis. A crisis intervention policy in place to assist a client in lifethreatening situations including not limited to suicidal, homicidal, 7 child abuse or neglect issues PROCESS ( How ) INITIAL ASSESSMENT 1 2 3 4 5 6 7 8 9 10 Documentation of Presenting Issue 8 Chart shows that some system for Presenting Issue is recorded AXIS, DSM, etc. Suggested Therapy/ Treatment Chart states suggested therapy given Presenting Issue defined by 9 Individual, Group; Level of Care (OP MH Counseling, Psych referral, IOP, PHP, IP Hospital) Suggested Treatment Frequency/Duration 1 Estimated # of sessions by type (individual, group); estimated end 0 date (documented) or rationale for continuation with note of frequency of intervention/plan TREATMENT PLAN DEVELOPMENT 1 2 3 4 5 6 7 8 9 10 11 a b Treatment Plan Treatment plan addresses adherence, intervention (individual, group and specific modality), suggested number of sessions, anticipated start and end date. Signed by client within 30 days of intake (where appropriate) Prepared by Germane Solutions QI Revised April 2015 6 P age

Psycho-pharmacotherapy 12 Any change in psycho-pharmacotherapy prescribing document contact with medical provider within 72 hours of prescribing, or of client refusal to authorize this communication Goals Set Documentation, signature and date, where appropriate 13 with treatment goals set with client and therapist/clinician. Date documented for review/reassessment OUTCOME ( What Impact ) CARE STATUS 1 2 3 4 5 6 7 8 9 10 14 Goals Met Documentation that goals are met, dated. Further treatment plan outlined. Active Care Status: documentation that client is in active HIV 15 medical care or that efforts are being made to attach or re-attach client to care. HIV regimen: documentation of core components of HIV 16 medical regimen including if on ART, annual documentation of CD4 and/or viral load, and every 6 month visit to HIV medical doctor (or reason that client is not compliant and efforts to attach) REFERRAL FOR CARE / CLIENT SATISFACTION 1 2 3 4 5 6 7 8 9 10 Referral of Follow-up (if indicated) 17 Coordination of all necessary services along the Continuum of Care Satisfaction Survey 18 Standardized Ryan White Part A satisfaction surveys are offer to client annually FISCAL MONITORING REQUIREMENT Sliding Fee Scale 19 Provider maintains current sliding fee scale in accordance with HRSA mandates Y = Yes N = No NC=Non-Compliant (cannot be determined from information in chart; or due to client transfer or non-compliance) Engaged* clients address treatment goals agreed upon with clinician. NA=Not Applicable (to patient or program/facility) PROGRAM MONITORING STANDARD HIV/AIDS BUREAU (HAB) PERFORMANCE MEASURE: % OF NEW CLIENTS WITH HIV INFECTION WHO HAVE HAD A MENTAL HEALTH SCREENING FISCAL MONITORING STANDARDS Prepared by Germane Solutions QI Revised April 2015 7 P age

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