NORTHPOINTE BEHAVIORAL HEALTHCARE SYSTEMS
POLICY TITLE: Emergency Services
PAGE: 1 of 4
MANUAL: Clinical
SECTION: Emergency Services
ORIGINAL EFFECTIVE DATE: 10/2/95
BOARD APPROVAL DATE: 9/26/13
REVIEWED/REVISED DATE: 12/10/15
CURRENT EFFECTIVE DATE: 12/10/15
REVISIONS TO POLICY STATEMENT:
YES
NO
OTHER REVISIONS:
YES
NO
APPLIES TO:
Any person identified in an acute mental health emergency.
POLICY:
It is the policy of Northpointe Behavioral Healthcare Systems to provide immediate accessible intervention services
to individuals experiencing an acute mental health related crisis. In accordance with MDCH standards, emergency
intervention services are available 24 hours a day, 7 days a week. The ACT Team provides services 24 hour a day,
7 days a week for their ACT service recipients.
PURPOSE:
To establish procedures in order to prevent or reduce the debilitating consequences of emergent mental health
problems commonly associated with a developing crisis, environmental stressors and/or mental/emotional
instability while minimizing the potential risk of harm to the individual or others.
PROCEDURES:
I.
Hours of Operation
A. NorthCare Access Screeners, Support Staff or Customer Service Representatives will forward all
requests for emergency intervention from persons who phone, walk in or are referred by another
community agency or individual, to the designated Emergency Service Worker who will triage each
referral. Each outpatient site will provide emergency services during regular business hours. At all
other times, requests for emergency services will be handled by the after-hours, on-call service.
B. Crisis calls are conducted either over the phone or emergency assessments are completed in
person at an NBHS location, hospital, jail or other safe community site.
II.
Staffing
Daytime and after-hours on-call systems will both be staffed by qualified providers, who have successfully
completed Northpointe’s emergency services training and practicum. Staff will be on call at the location
they are assigned or as delegated by there supervisor according to agency need.
III.
After-Hours On-Call Procedures
A. The coverage time includes evenings after regular business hours as well as 24 hour coverage on
weekends and holidays.
B. The designated worker on-call is responsible for notifying changes in the on-call schedule with
the following services:
1. The Answering Services
2. Agency staff
3. CSR’s will make changes in online schedules.
C. If an emergency service is made with an individual who is currently in treatment, then the
individual’s primary provider shall be informed of this contact at the beginning of the next
business day.
D. Individual’s Plans and Crisis Alerts will be referred to, if applicable.
E. Primary providers, who have recommendations for how potential crisis situations with their
individuals should be handled, should document their recommendations on a “crisis alert form” in
ELMER and fax a copy to the after-hours service.
F. If any crisis procedures are put into place, they must be documented in the chart on the “Crisis
Alert Form”. The “Crisis Alert Form” will be used to communicate to all involved parties.
NORTHPOINTE BEHAVIORAL HEALTHCARE SYSTEMS
POLICY TITLE: Emergency Services
PAGE: 2 of 4
MANUAL: Clinical
SECTION: Emergency Services
ORIGINAL EFFECTIVE DATE: 10/2/95
BOARD APPROVAL DATE: 9/26/13
REVIEWED/REVISED DATE: 12/10/15
CURRENT EFFECTIVE DATE: 12/10/15
G. Emergency workers need to be available during all hours of their responsibility by phone
or pager. It is expected that all calls will normally be answered within a ten minute period
and an estimated time of arrival to screening site given. On Call staff are expected to
arrive at the screening site within an hour of notification. All preadmission screens should
have a decision made within 3 hours from time of request. The time of decision must be recorded
in ELMER. Any difficulties with communication should be shared with Northpointe’s
Crisis/Access Services Manager.
IV.
V.
Normal Business Hour Procedures
A.
The coverage time includes regular business hours from 8 a.m. to 4 p.m., or otherwise designated.
B.
The designated worker is responsible for notifying changes in the schedule with the following
services:
1. Agency staff
2. CSR’s will make changes in online schedules.
3. After Hours Service
C.
If an emergency service is to take place with an individual who is currently in treatment, attempts
should be made to discuss situation with the individual’s primary provider, and to review their
case file. The provider should also be made aware of the intervention that took place.
D.
Emergency workers need to be available during all hours of their responsibility by phone or
pager. It is expected that all calls will normally be answered within a ten minute period and an
estimated time of arrival to screening site given. On Call staff are expected to arrive at the
screening site within an hour of notification. All preadmission screens should have a decision
made within 3 hours from time of request. The time of decision must be recorded in ELMER.
Any difficulties with communication should be shared with Northpointe’s Crisis/Access Services
Manager.
Documentation Procedure
A. A Crisis Intervention form or a Pre-Admission Screening must be filled out and signed in ELMER for
each crisis, day-time and after hours. Distribute copies as indicated. The ELMER Emergency Services
Documentation Directives must be followed.
B. Emergency Screening forms will address (at a minimum):
1.
2.
3.
4.
Screen for any medical conditions.
Any referrals to emergency medical services.
Assessment of crisis and plan for intervention.
Any referrals to services to help in stabilizing the situation.
C. “Consent to treat” should be obtained from the individual being assessed (if not an active service
recipient and if able to sign an informed consent). Also, “Releases of Information” should be obtained
(again if individual can do so) to involve any significant persons/hospitals/agencies in the crisis
intervention.
The emergency services clinician who completes the pre‐admission screen shall secure the appropriate
release(s) of information (ROI) while arranging for the psychiatric admission. Clinicians will follow all
existing directives for securing the proper consent for the release of information for adults, adults with
guardians, and minor children.
The ROI shall be a two‐way release of information between the CMHSP/BOFR and the psychiatric
facility. Purpose of the release shall be for the coordination of services.
NORTHPOINTE BEHAVIORAL HEALTHCARE SYSTEMS
POLICY TITLE: Emergency Services
PAGE: 3 of 4
MANUAL: Clinical
SECTION: Emergency Services
ORIGINAL EFFECTIVE DATE: 10/2/95
BOARD APPROVAL DATE: 9/26/13
REVIEWED/REVISED DATE: 12/10/15
CURRENT EFFECTIVE DATE: 12/10/15
Information authorized to be released/received shall be those things necessary to facilitate treatment
and discharge planning and should include: Assessments, psychiatric evaluations, IPOS, behavior
plans, history and physical, medication reviews, physician’s orders, labs, consults, and discharge
instructions.
Additional ROIs between the CMHSP/BOFR and the individual’s primary care physician or health
plan shall be two‐way releases for the purpose of sharing pre‐admission screening information with the
PCP or health plan. If the individual does not have a PCP or if they are not enrolled in a health plan,
this must be documented in the record.
A copy of the ROI shall be faxed to the psychiatric facility, primary care physician or the health plan
and the original filed with the records department.
If the individual/guardian is unwilling or unable to consent for the release of information, the clinician
shall complete the ROI and note the individual/guardian’s refusal to sign the ROI and file it with the
records department. A copy of the refused ROI shall also be faxed to the psychiatric facility. The
hospital will be asked to secure the individual/guardian’s consent for the release of information upon
admission.
D. If the individual/guardian requests hospitalization and it is determined that medical necessity criteria is
not met, then an Action Notice must be given to the individual.
E. An initial Crisis and Diversion or Jail plan must be completed for every diversion. A copy of
physician’s discharge orders from the Emergency Department must be obtained, if the individual was
assessed at the Emergency Department and diverted. When a Diversion Plan is completed and it is
during normal working hours (M-F, 8-4) the emergency worker will assist the individual in making a
follow-up appointment with either NBHS or a community provider. These appointment dates/times and
contact person will be documented on the Diversion Plan. The referral lists for community providers
will be updated ongoing, but at least annually by Customer Service Representatives, and will be nonendorsing of those providers. Expectations are that referrals will be fair and equitable.
F. If the crisis occurred during non-business hours, on the next business day the WOD will follow up
with the individual and assist in making follow up appointments if the individual has not already done
so. These appointments will then be documented in ELMER via a Crisis Call document by the WOD.
All diversions will have a follow up Crisis Call or Face-to-Face appointment the next business day, to
be sure that the Crisis/Diversion Plan is being followed.
G. A Crisis Intervention service is completed for an Emergency in which a pre-admission screen is not
considered or appropriate.
VI.
Inpatient Admissions: General Procedures
A. If an individual is deemed appropriate for inpatient care, and has been screened for medical
conditions and is medically cleared, the emergency services worker will coordinate the
necessary arrangements for unit admission, including transportation to the facility. The
Northpointe Pre-Admission form must be completed, faxed to the admitting hospital, and
distributed as indicated on form.
B. Following all referrals of individuals with Medicaid, MI-Child or no insurance, for
inpatient care, the emergency services worker will authorize no more than one day or until
the next business day. A "Payment Authorization Form" will be completed by the
Crisis/Access Services Manager. All subsequent requests for extension of this period will
be reviewed and approved by NorthCare.
C. The Pre-Admission Screen in ELMER must have each individual’s case open in ELMER
and signed by the On-Call worker in order to generate an authorization number for the
NORTHPOINTE BEHAVIORAL HEALTHCARE SYSTEMS
POLICY TITLE: Emergency Services
PAGE: 4 of 4
MANUAL: Clinical
SECTION: Emergency Services
ORIGINAL EFFECTIVE DATE: 10/2/95
BOARD APPROVAL DATE: 9/26/13
REVIEWED/REVISED DATE: 12/10/15
CURRENT EFFECTIVE DATE: 12/10/15
admission.
VII.
VIII.
Involuntary Hospitalizations
A.
Northpointe Behavioral Healthcare Systems serves as the single point of entry for all
individuals within the catchment area seeking public mental health inpatient services. The
single point of entry concept is particularly important in regards to the involuntary
individual, as Northpointe needs to coordinate the petitioning process.
B.
Involuntary hospitalizations will be coordinated through the Probate Court.
Back-up Clinical Supervision System
Clinical supervisors are available for the purpose of case consultation.
CROSS REFERENCE:
Utilization Review - Pre-Admissions Screening/Data Collection Policy
Emergency Services for Children Policy