Region 1 South Crisis Care System
System of Care Overview
Policy and Procedures
Illinois Department of Human Services
Division of Mental Health
Jackie Manker, LCSW
Associate Director
Community Services
June 6, 2012
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Materials for today
Region 1 South Crisis Care System Policies and
Procedure Chapter of Provider Manual
Calendar
Presentation Slides
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Objectives of OVERVIEW
 Understand the flow of new Crisis Care System
 Understand key policies
 Understand procedures
 Understand any interim policies and procedures
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CRISIS CARE SYSTEM
15 Community Hospitals
Emergency Department Presentation
Psychiatric Crisis
2 EDs with
Behavioral Health
Assessment Capacity
13 EDs No
Behavioral Health
Assessment Capacity
CMHC
ED-based
Eligibility & Disposition
Assessment
Region
1 South
Crisis
Care
System
ACCESS
Authorization
Region 1 South
Uninsured
Community
Population
Clinical
Disposition
Is Consumer eligible
Crisis Care
Alternatives?
Non
Medicaid
Benefit
Package
NO
YES
CHIPS
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DMH
Hospital
Post discharge
referral and linkage
DMH
Crisis
Residential
DMH
Acute
Community
Services
Community Stabilization
DASA
Residential
Crisis
Stabilzation
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DHS/DMH Intent
To replace services previously provided by Tinley
Park Mental Health Center with a re-balanced
system and services that are:
 Community-based
 Recovery oriented
 Trauma informed
 Outcome validated
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Services
Eligibility and Disposition Assessments (EDA)
Community Hospital Inpatient Psychiatric
Services (CHIPS)
Mental Health Crisis Residential
DASA Residential Crisis Stabilization
Acute Community Services (ACS)
Transportation
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Eligibility
Individual presents in Region 1 South E.D.
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Region 1 South Area
City of Chicago South of 67th Street
South Suburban Cook County
Kankakee County
Will County
Grundy County
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Region 1 South Area
City of Chicago South of 67th Street
South Suburban Cook County
Community Hospitals to be Served
Roseland Community Hospital
St. Bernard Hospital
Franciscan St. James Health
Metro South Medical Center
Advocate South Suburban Hospital
Palos Community Hospital
Little Company of Mary Hospital
Advocate Christ Medical Center
Ingalls Memorial Hospital
Kankakee County
Will County
Grundy County
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Riverside Medical Center
Provena St. Mary’s Hospital
Provena St. Joseph Medical Center
Silver Cross Hospital
Adventist Bolingbrook Hospital
Morris Hospital
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General Eligibility determined by E.D.
Uninsured with no other resources
Preliminary diagnosis of mental illness or
mental illness and substance use disorder
No acute medical illness or excluded medical
condition
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When all criteria are met,
E.D. calls for an
Eligibility and Disposition Assessment
conducted by a
DMH funded evaluator
assigned to that E.D.
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Region 1 South
Area
City of Chicago South of 67th
Street
South Suburban Cook
County
Kankakee County
Will County
Grundy County
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Community Hospitals to be
Served
Assigned Eligibility &
Disposition Assessment
Agency
Roseland Community Hospital
Human Resource Development Institute
St. Bernard Hospital
To Be Determined (TBD)
Franciscan St. James Health
Metro South Medical Center
Advocate South Suburban Hospital
Grand Prairie Services
Palos Community Hospital
Little Company of Mary Hospital
TBD
TBD
Advocate Christ Medical Center
Advocate Christ Medical Center
Ingalls Memorial Hospital
Ingalls Memorial Hospital
Riverside Medical Center
Provena St. Mary’s Hospital
Helen Wheeler Mental Health Center
Provena St. Joseph Medical Center
Silver Cross Hospital
Adventist Bolingbrook Hospital
Will County Behavioral Health
Morris Hospital
Grundy County Health Department
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EDA EVALUATORS
Minimum credential of Qualified Mental
Health Professional (QMHP)
Available 24/7
Respond within (1) hour of call
Confirms general eligibility
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EDA EVALUATOR
Conducts clinical evaluation and documents
on DMH Uniform Screening and Referral Form
(USARF)
For individuals with suspected substance use,
also assesses using ASAM Patient Placement
Criteria
Completes level of care assessment using the
Level of Care Utilization System (LOCUS)
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EDA EVALUATOR
Determines if individual meets 2 clinical criteria
for Region 1S CCS
 Diagnosis of:
Schizophrenia (295.xx)
Schizophreniform Disorder (295.4)
Schizo-affective Disorder (295.7)
Delusional Disorder (297.1)
Shared Psychotic Disorder (297.3)
Brief Psychotic Disorder (298.8)
Psychotic Disorder NOS (298.9)
Cyclothymic Disorder (301.13)
Major Depression (296.2x, 296.3x)
Obsessive-Compulsive Disorder (300.30)
Anorexia Nervosa (307.1)
Bulimia Nervosa(307.51)
Post Traumatic Stress Disorder (309.81)
Bipolar Disorders (296.0x, 296.4x, 296.5x, 296.6x, 296.7, 296.80, 296.89, 296.90)
 LOCUS Score of 4 or greater
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EDA EVALUATOR
Individual does NOT meet clinical criteria
Inform ED physician/staff
Provide any alternative treatment
or service recommendation
e.g. DMH Non-Medicaid benefit package
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EDA EVALUATOR
Individual does meet clinical criteria
Evaluator determines individual is a resident of Region 1
South geographic area
No – refer to Madden Intake
Yes – recommend level of care and
service needs
•
•
•
•
•
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CHIPS
Mental Health Crisis Residential
DASA Residential Crisis Stabilization
ACS
Transportation
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EDA EVALUATOR
 Is the individual willing?
 Individual is NOT willing to engage?
Does he/she meet criteria for involuntary
hospitalization?
Yes – proceed with process
No – explain outcome of assessment,
recommend level of care to individual, ED
physician/staff and others of
individual’s choice
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EDA EVALUATOR
Individual is willing to Engage
 Inform ED physician/staff of recommended level of care
 ED physician/staff concur
 Evaluator calls the ACCESS line for
• Authorization
• Available services
• Authorization number
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Service Authorization
Illinois Mental Health Collaborative for Access
and Choice
• DMH’s Administrative Service Organization (ASO)
Toll free ACCESS Line (866) 359-7953
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Service Authorization
Clinical Care Managers (CCM) available 24/7
Evaluator provides information
• Demographics
• Clinical presentation
• Recommended disposition
CCM reviews for medical necessity
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Service Authorization
When medical necessity is present for
recommended level of care, the CCM:
• Provides authorization number
• Provides location and contact information for
service provider
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EDA EVALUATOR
Evaluator
• Contacts service provider to make referral.
• Makes needed transportation arrangements using
authorization number.
• Ensures required documentation is complete and
copy to ED and accepting service provider (USARF,
LOCUS, ASAM, disposition and recommendations).
• Confirms linkage occurred within 24 hours.
• Registers individual in DHS/DMH consumer
registration system.
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Hospital-Based EDA Evaluator
(Advocate Christ and Ingalls Memorial)
 All previous elements required PLUS
• Physician conducts evaluations
• May provide active treatment if applicable (e.g. extended
observation, Medication administration/monitoring, crisis
intervention)
• DMH will provide training on registration
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Service Authorization
Alternative Level of Care
If the CCM would propose a different level of
care based on medical necessity or capacity
• Evaluator discusses alternatives with ED
physician/staff
• If in agreement, authorization and referral process
is initiated
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Service Authorization
If Not in agreement:
 Collaborative CCM provides clinical presentation,
treatment recommended and capacity to Madden
Intake.
 Madden Intake physician reviews information and
discusses with ED physician.
 Madden Intake physician considers option and
determines most appropriate level of care and
informs both CCM and ED physician.
 CCM contacts Evaluator with determination and
authorizes services as appropriate.
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Disposition Options
Community Hospital Inpatient Psychiatric
Services (CHIPS)
DMH funded, short-term (less than 6 days),
inpatient at community hospital.
Serve those experiencing psychiatric crises
and exhibit acute behaviors or symptoms
requiring inpatient setting.
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CHIPS
Individual has symptoms consistent with a
diagnosis of one of the following mental
illnesses:
Schizophrenia (295.xx)
Schizophreniform Disorder (295.4)
Schizo-affective Disorder (295.7)
Delusional Disorder (297.1)
Shared Psychotic Disorder (297.3)
Brief Psychotic Disorder (298.8)
Psychotic Disorder NOS (298.9)
Cyclothymic Disorder (301.13)
Major Depression (296.2x, 296.3x)
Obsessive-Compulsive Disorder (300.30)
Anorexia Nervosa (307.1)
Bulimia Nervosa(307.51)
Post Traumatic Stress Disorder (309.81)
Bipolar Disorders (296.0x, 296.4x, 296.5x, 296.6x, 296.7, 296.80, 296.89, 296.90)
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Hospitals with CHIPS Contracts
Advocate Christ Medical Center, Oak Lawn
Ingalls Memorial Hospital, Harvey
MacNeal Hospital, Berwyn
Mt. Sinai Hospital, Chicago
Riverside Hospital, Kankakee
St. Anthony’s Hospital, Chicago
St. Bernard Hospital & Health Care Center, Chicago
Provena St. Mary’s, Kankakee
University of Illinois Hospital, Chicago
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Mental Health Crisis Residential
 DMH funded, short-term 24/7 continous supervision
and treatment in a provider controlled facility.
• Grand Prairie Services is the current provider.
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Mental Health Crisis Residential
 Individual’s symptoms require psychiatric stabilization services.
 Individual has symptoms consistent with a diagnosis of one of the
following diagnosis.
Schizophrenia (295.xx)
Schizophreniform Disorder (295.4)
Schizo-affective Disorder (295.7)
Delusional Disorder (297.1)
Shared Psychotic Disorder (297.3)
Brief Psychotic Disorder (298.8)
Psychotic Disorder NOS (298.9)
Cyclothymic Disorder (301.13)
Major Depression (296.2x, 296.3x)
Obsessive-Compulsive Disorder (300.30)
Anorexia Nervosa (307.1)
Bulimia Nervosa (307.51)
Post Traumatic Stress Disorder (309.81)
Bipolar Disorders (296.0x, 296.4x, 296.5x, 296.6x, 296.7, 296.80, 296.89, 296.90)
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DASA Residential Crisis Stabilization
 Short term (5-10 days) residential treatment that targets:
• Stabilization of problems related to biomedical, emotional,
behavior, or cognitive conditions as described in ASAM
Dimensions 1-3.
• Diagnosis of mental illness and substance use disorder.
• Planned regimen of care of at least 3 hours of treatment
services per day.
• Must link with Acute Community Service provider upon
discharge.
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DASA Residential Crisis Stabilization Providers
The Haymarket Center, Chicago
Healthcare Alternative Systems, Chicago
The South Suburban Council on Alcoholism &
Substance Abuse, East Hazel Crest
The Women’s Treatment Center, Chicago
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Acute Community Service (ACS)
Any services and supports needed by the individual to
continue stabilization from crisis.
Grant funding allows the provider ultimate flexibility in
determining type, amount, frequency, etc., including
medication
Services must be initiated within 24 hours of discharge from
ED
Services must be initiated within 48 hours of discharge CHIPS,
crisis residential, or SOH, and those discharged from DASA
residential with co-occurring disorder.
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Acute Community Service (ACS)
Individual eligible for services up to 12 months of initial
assessment
Provider agrees to serve all referred individuals
Provider required to assist individual with application for
medical assistance
Provider required to register each individual through
DHS/DMH information system
Individuals will be referred to provider in their geographic
proximity but will have choice if requested
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Acute Community Care Service Providers
Region 1 South Area
City of Chicago South of 67th Street
Bremen, Thornton,
South Suburban Cook Rich, Bloom
County Township
Lemont, Calumet,
Palos, Worth, Orland
Acute CCS Provider
Human Resource Development
Institute
Metropolitan Family Services
Grand Prairie Services
Metropolitan Family Services
Kankakee County
Helen Wheeler Mental Health Center
Will County
Will County Behavioral Health
Cornerstone Services
Grundy County
Grundy County Health Department
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Madden Mental Health Center Services
Will serve as safety net when other services
are not appropriate or available.
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Madden Mental Health Center Services
When an individual presents with the following, Madden may
be consulted for consideration of DMH admission.
• History indicating need for extended inpatient treatment
• Presents challenges in discharge placement from inpatient
setting, such as being homeless
• Co-occurring substance use disorder requiring medical
observation that exceeds the capability of available community
inpatient psychiatric services
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Madden Mental Health Center Intake
Responsible for managing the referrals to DMH
hospitals to ensure available capacity
For individuals from Region 1 Central who
presents at one of the four DMH contracted
CHIPS hospitals, Madden Intake may choose to
utilize CHIPS, Mental Health Crisis Residential or
SA Residential Crisis Stabilization beds when
appropriate and needed to manage DMH hospital
capacity
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Transportation
 DMH will purchase transportation services
between Emergency Departments, CHIPS
hospitals, MH Crisis Residential and DASA
Residential Crisis Stabilization
 Individual must meet all eligibility criteria
 The Authorization number received from the
Collaborative will serve as authorization for
transportation
 Transportation provider must respond within 60
minutes of request
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Region 1 South Crisis Care System
System of Care Overview
Policies and Procedures
Thank you!!
Questions??
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