Download - Crisis Behavior Resources for Support Coordinationrwjms.rutgers.edu/boggscenter/projects/documents/CrisisBehavior... · Crisis Behavior Resources . for Support Coordination . 1

Crisis Behavior Resources for Support Coordination

1

The New Jersey Department of Human Services Division of Developmental Disabilities

Definitions 2

What is considered an Emergency?

Emergency… 3

… means that the eligible person is homeless or in imminent peril.

Homeless… 4

…means that the individual has no place to live or the individual’s living arrangement will end on a certain date within 30 days or he/she has no other living arrangements after that date.

Imminent peril… 5

…means a situation which could reasonably be expected to cause serious risk to the health, safety or welfare of the individual receiving services or another person in the current living arrangement.

*Imminent peril does not exist if the Division can put supports into the living arrangement which eliminates the serious risk to the individual

Request for Intensive Case Management 6

Y

An intensive CM will visit the individual within 48 business

hours

SC Unit submits request to Intensive Unit Director

Reviewed by SC Unit Designee and/or Mentor

Support Coordinator (SC)

Has the assigned SC exhausted all service

options?

Consult with Statewide Intake/Intensive Unit

Director

YES

NO

Adult Protective Services (APS) 7

APS programs have been established in each county in NJ to receive and investigate reports of suspected abuse, neglect, and exploitation of vulnerable adults living in a community setting.

The purpose of APS is to stabilize a crisis situation using the least intrusive methods while respecting an individual’s rights to self-determination.

Making a Referral to APS 8

The referral should be made by the person with first-hand information and made directly to the county in which the individual resides.

The referral information should include: o Individual’s name, address, phone number o DOB, Social Security number o Diagnoses – medical and/or mental health needs o Family members/support systems (services/agencies

involved) o A specific allegation of abuse, neglect, or exploitation

Limits to APS Services 9

An APS worker is not authorized to: o Remove an individual from his or her own home

without a court order o Force an individual to accept services o Move an individual to an alternative living situation

without his or her agreement or a legal representative’s agreement.

Unusual Incident Reporting (UIR) 10

DDD Circular # 14 establishes policies and procedures related to incident reporting.

SCs are required to report suspected or know abuse,

neglect, and/or exploitation immediately. Contact your Regional Office to report any unusual

incidents using the phone numbers found on Support Coordinators Guide to Unusual Incident Reporting.

Division of Disability Services (DDS) 11

Office of Information and Assistance Services Office of Home and Community Services Special Projects and Initiatives Statutory Advisory Boards and Councils

Contact Information Telephone: 888-285-3036

www.state.nj.us/humanservices/dds

Personal Preference Program (PPP) 12

PPP offers an alternative way for individuals to receive their Medicaid Personal Care (PCA) services.

PPP vs. PCA Using a monthly allowance, PPP individuals work with a

consultant to develop a Cash Management Plan that is used to identify the services needed and the workers/agencies they want to hire to provide the services.

Personal Preference Program (PPP) 13

PPP allows the individual to: o Choose the services they want o Hire people that they know/trust o Schedule services to meet their needs o Exercise greater control over their lives

Additional PPP Uses 14

Additional possible uses of PPP monthly allowance: o Purchasing services from an agency o Making home modifications that increases the

individual’s ability to live more independently (i.e., ramp or chair-lift)

o Purchasing equipment, appliances, technology, or other items that increase independence (i.e., microwave oven or washing machine)

How to Apply for PPP 15

Inform families to contact their Medicaid HMO Care Manager to inquire about PPP Services

Division of Disability Services (DDS) Toll Free, 1-888-285-3038, Option 2 Direct, 609-292-7800

ACCESSING FAMILY SUPPORT SERVICES

16


Family Support Service Descriptions 17

DDD evaluates requests for Family Support based on an individual’s need, the services and supports already

available, and the availability of DDD resources. Most services are limited and some may not be available in

specific geographic locations.

RESPITE: Services provided to individuals unable to care for themselves that are furnished on a short term basis because of the absence or need for relief of those persons who normally provide care for the person.


Summer Camp (day): Day Camp is set in a licensed camp facility designed to provide respite to families during the summer months.

Services provided include assistance in daily living skills and recreation.

Summer Camp (overnight): Overnight Camp is set in a

licensed camp facility designed to provide overnight respite to families during the summer months.

Services provided include assistance in daily living skills and recreation.


After Work Program: provides activities and assistance with daily living skills at a site based facility typically Monday through Friday between the hours of 2:30 and 6:00 pm.

Trained Caregiver: a respite worker trained by the Division who provides in home respite services based on the individual’s needs.

Home Health Aide (Respite): a respite worker trained by a Division contracted entity to provide in home respite services based on the individual’s needs.


Community Care Residence Provider (CCRP): a person licensed to operate a Community Care Residence under N.J.A.C. 10:44B.

This service provides out of home overnight respite in a Division licensed setting. Depending on the structure of the home and the qualifications of the CCR Provider, individuals who are non-ambulatory, require nursing care, or have other needs can be served in this setting.

Out of Home Respite in an agency setting (overnight or

day time): services typically take place at a site based facility or in the community.


In Home Respite through a Contracted Agency: services are provided in the individuals’ home through a DDD contracted provider.

Out of Home Respite at a Hotel: overnight respite services provided in a hotel and based on the individual’s need.


Non Respite Services: Assistive Technology: an item, piece of equipment, or

product system that is used to increase, maintain, or improve the functional capabilities of an individual.

o Communication devices, mobility aids, computer software

Environmental Modification: physical adaptations to the private residence of the individual or the individual’s family which are necessary to ensure the health, welfare and safety of the individual or to enable the individual to function with greater independence in the home.

o Ramps, grab-bars, bathroom modifications, widened doorways


Vehicle Modification: adaptations or alterations to an automobile or van that is the individual’s primary means of transportation in order to accommodate the special needs of the person.

o Wheelchair or scooter lift, assist handles, exterior access device controls

Conversation to Assess the Need for Family Support Services

24

All available generic services must be sought prior to requesting services through Family Support

What generic resources are available to support the individual and have those services been fully explored?

Does the individual receive Personal Care Attendant (PCA) Services through Medicaid? These services assist an individual with Activities of Daily Living (ADL).

If so, are the services provided by an agency or the Personal Preference Program (PPP)? PPP allows the individual and family more choice of who provides the necessary care.

Conversation to Assess the Need for Family Support Services

25

Does the individual have any behavioral or medical needs? Respite Services: What time periods would be most helpful?

Weekend (include time of day) Weekdays (include time of day) In-Home or Out of Home (day time or overnight)

If out of home overnight respite is requested (30 day advanced notice).

Specific dates and limitations on how far the family is willing to travel to drop off the individual at the respite location.

How to Make a Request 26

After generic resources have been explored, requests for Family Support Services are made by the family to the Support Coordinator

SC sends an email outlining the request to the Regional Family Support Contact. The request should include a justification of why the service is needed, PCPT, & NJISP. 30 day advance is needed for all Respite Requests.

The Regional Contact reviews the request. Based on the review, additional provider specific documentation may be needed for the SC to obtain.

If the requested service is deemed necessary and is available, the Region will complete the referral. The Regional Contact will advise the SC about the status of the referral.

Processing Requests 27

Once the referral is sent to the provider, it is reviewed to ensure that the provider is able to meet the individual’s needs. If so, the family is contacted by the provider to complete the intake process. DDD is notified by the provider when the service starts or of lack of response from the family.

The Family Support Contact will notify the Support Coordinator of any issues with the referral or when the service is scheduled to start.

REGIONAL PSYCHOLOGIST

28


Regional Psychologist Roles 29

What we do: Consultation Attend IDT meetings Input to case management

Review behavior plans Participate in human rights &

behavior management committees Diagnostic evaluations Intelligence & adaptive testing Complete referral forms for

guardianship & in some cases complete guardianship evaluations

Provide expert testimony in court Recommendations for supports

needed based on psychological needs Psych/sexual assessments

What we do not do: Therapy Group therapy Personality testing Write behavior plans Train or monitor agency staff

How to Access a Regional Psychologist 30

Send a completed Clinical Services Referral Form to the Regional contact listed on the “Referral Process for DDD Regional Clinical Services & Family Support” based on the county where the individual needing assistance resides.

REGIONAL BEHAVIORIST

31


Regional Behaviorist Consultation 32

Behavioral Provide recommendations for behavioral services Continue with follow through from a previous nursing or psychological

referral Provide information regarding diagnoses and expected behaviors that may

be evident in individuals with that diagnosis Provide behavioral strategies/recommendations Review behavioral plans for quality and effectiveness

All plans must have a fade out program included

Training (in some cases) Caregivers (including but not limited to parents and staff)

Regional Behaviorist Consultation 33

Transitions Change of home Change of day program

*If an individual is working with an agency that has a behaviorist on staff, they are expected to access support from that staff, not a regional behaviorist

What Regional Behaviorist do not do 34

Provide ongoing intervention Provide direct care (such as 1:1 ABA) Write behavior plans

How to Access a Regional Behaviorist 35

Send a completed Clinical Services Referral Form to the Regional contact listed on the “Referral Process for DDD Regional Clinical Services & Family Support” based on the county where the individual needing assistance resides .

REGIONAL NURSE

36


Regional Nurse Roles 37

Case management those determined to meet the criteria for long term placement (nursing

home level of care)

Long Term Care will assess for level of care (decline) and complete required Medicaid

paperwork

Clinical Services Referral Form will visit upon request for issues not limited to level of care needs,

wound issues, current hospitalizations, weight loss, diet, nutrition, etc.

Miscellaneous available as resource for medical questions or concerns

How to Access a Regional Nurse 38

Send a completed Clinical Services Referral Form to the Regional contact listed on the “Referral Process for DDD Regional Clinical Services & Family Support” based on the county where the individual needing assistance resides .

CASE STUDY #1

39


Case Study #1 40

Ryan was recently assigned to your agency. He has a DDRT score of 2-level of care, 4-behavioral, 3-medical. There is no service plan in place but a home visit is scheduled. You receive a call from Ryan’s caregiver informing you that Ryan has been admitted into the hospital for evaluation. 911 was called due to Ryan and his caregiver getting into an altercation that resulted in Ryan getting burned with hot coffee. Ryan calls you the following afternoon to inform you that he has been discharged and will be staying with a friend for the next few days until things calm down at home. What do you do?

Case Study #1 Suggestions 41

Complete and submit an UIR Contact APS Complete a face to face/home visit Develop an appropriate service plan Look into services: DP, PPP, HHA, SE, SCCAT, DDHA, etc. Follow up with the hospital’s social worker Follow up with caregiver Find out what the result was from the 911 call. Restraining

order? Charges pressed? Obtain contact information for friend Update case notes and monthly monitoring tools Read DDRT for information

STATEWIDE CLINICAL CONSULTATION & TRAINING

(SCCAT) PROGRAM

42

Community-Based Behavior/Crisis Resources

SCCAT 43

SCCAT has been a program with Trinitas Regional Medical Center since 2000 and provides crisis response and clinical interventions statewide.

Provides consultation, interventions and training to DDD provider agencies, families, and mental health service providers.

Clinical team includes master’s level clinicians, Social Workers, Licensed Professional Counselors, and is directed by a Clinical Psychologist

Services are for adults only

SCCAT 44

The team works in collaboration with the specialized 2D Trinitas unit and psychiatric screening centers to facilitate admissions when deemed appropriate by the clinical team.

Short-term case management clinical interventions typically lasting 4 weeks – 10 weeks.

The team conducts over 100 trainings to DDD provider agencies and 10 regional trainings annually.

Offices are located in Wall Township, Cranford, Parsippany and Voorhees.

SCCAT Referral Process 45

Criteria for Referral Individual should be experiencing a psychiatric crisis Individual is anticipated to have a major difficulty with transition or daily

functioning Individual is being discharged from a state hospital or developmental

center in the foreseeable future Provider agency is having difficulty with the Individual and is in need of

training/consultation Individual has presented or is expected to present to a psychiatric

emergency service Referral Sources: DDD, Support Coordination Agencies, Psychiatric Emergency Services, DDD

Provider Agencies, Division of Mental Health and Addiction Services (DMHAS), and Families

SCCAT Referral Process 46

What to Expect: Immediate response/assessment 24 hour crisis response Short-term intervention/treatment Brief Psycho-education for individual & follow up referral for on-going care Face-to-face crisis response after hours and on weekends After hours intakes for crisis situations that are in need of immediate

clinical response

Referral Process Steps 47

Call the intake line at 888-393-3007 24 hours Speak with an intake clinician or on-call clinician (if after hours) Be prepared to share demographic, medical, and clinical background

information A crisis clinician will be contacted and you should expect a call back

within minutes The clinician will discuss more in-depth information regarding the

presenting problem as well as other providers involved with the individual

A clinician will provide an immediate face to face assessment within 2 hours (i.e., individual is available to be seen at a reasonable location and time)

If it is not an immediate crisis, an appointment will be arranged as soon as possible

SCCAT Will Provide Support To 48

DDD Case Management/Support Coordinators: Provide crisis response when an individual presents with a

behavioral crisis that jeopardizes the safety or may result in the loss of residential or program placement

Assess situation, develop and oversee an action plan in order to lessen crisis acuity

Refer individuals to relevant providers for further stabilization (e.g., ISDT)

Assist CM/SC in identifying potential problem situations with individuals and developing a plan to address them

Case conferences at local DDD offices


DDD Service Providers: Work alongside with providers to develop realistic plans, goals and

behavioral strategies based upon agencies’ resources and consistent with agencies’ philosophy and mission

Ongoing follow up to monitor the plans and strategies Help agencies develop their capacity and expertise in order to best

support individuals with challenging behaviors 24-hour crisis assessment and support

Families and Caregivers: Help families to access relevant mental health and behavioral services Educate families to recognize signs and symptoms of disorders and

assist in development of response plan Work with families on crisis support and behavioral interventions


Screening Centers and Psychiatric Hospitals: Clinical response 24 hours a day to assist in evaluation and disposition

of MI/ID individuals Serve as a liaison between screening centers and DDD, provider

agencies, family, and treating practitioners while advocating for appropriate placement and ancillary services

Assist in discharge planning including link-up with community-based providers and practitioners

Facilitate community reintegration Mental Health Agencies and Partial Care Programs: Assist in treatment planning and establishing accurate diagnoses Provide treatment recommendations Assist in arranging psychiatric consultations for medication treatment

INTEGRATED SERVICE DELIVERY TEAM (ISDT)

51


Integrated Service Delivery Team (ISDT) 52

Trinitas Regional Medical Center -Department of Behavioral Health and Psychiatry

Community Outreach-Integrated Service Delivery Team (ISDT) consists of Licensed Clinical Social Worker (also Program Director) Licensed Clinical Psychologist M.A. & B.A. level clinicians

Office locations in Cranford, Wall Township and Voorhees

Services Provided 53

Intensive Clinical Case Management Initial Evaluations with Recommendations Attend IDTs Consult with local ERs and Inpatient units (including the Trinitas’ 2D unit)

Psychological and Behavioral Assessments/Strategies Provide ongoing consultation/recommendations (e.g., assist with

development or revision of behavioral plans, consult with agency behaviorists

Develops behavioral strategies with agency staff, ongoing follow up on effectiveness of strategies

Counseling to the individual in the home or other community site, working on coping skills, anger management, adjustment, etc.

Psychological testing (on case by case basis if needed) to assist in providing clinical recommendations or referrals to treatment providers

Services Provided 54

Behavioral Skills Training Provide Group Home staff trainings and sponsor trainings specific to

the individual’s needs and/or psychiatric diagnoses (e.g., training a sponsor on how to work with individual’s behavior, training an agency on how to work with individuals with Borderline Personality Disorder)

Family Support-crisis support, behavioral interventions in the home, referral and advocacy

Assist in linkage to psychiatric treatment and mental health services

Crisis Management/Support including 24-hour on-call

ISDT Referral Process 55

Cases are referred from DDD or Support Coordinators through DDD for Hunterdon, Ocean, Monmouth, Middlesex, and Mercer counties (Lower Central Region)

SC makes a direct referral to ISDT for Somerset, Union & Essex Counties (Upper Central Region)

SCCAT may request DDD to refer a case to ISDT for longer-term management.

Criteria for referrals includes dual diagnosis (MI/ID) In addition, multiple hospitalizations, discharge from DC

and/or long-term psychiatric hospital, severe behavioral problems, and/or risk of losing placement (either residential/vocational/educational)

ISDT Referral Process 56

Upon receipt of referral form from DDD an initial assessment is scheduled, usually in the setting where the majority of issues exist.

A comprehensive report is written including the decision of whether case will be opened or not. Either way, a series of recommendations are made.

Time frame of response depends upon the number of referrals received at any given time. It is often based on a first come first serve basis or priority level if necessary. Response comes within 1-2 days of receiving the referral.

Discharge 57

Once most intensive case management goals are met, a case is typically closed

Individual is stable, no longer at risk of losing placement, behavior has improved, fewer hospitalizations, etc.

When case is closed, a discharge summary is written and sent to the DDD case manager

ISDT sets up other supports and/or makes referrals before discharge

DEVELOPMENTAL DISABILITIES HEALTH

ALLIANCE (DDHA)

58


Developmental Disabilities Health Alliance (DDHA) 59

Provides an integrated approach of using resources available through DDD, Medicaid, and the Division of Mental Health Services (DMHS) to address the needs of individuals with developmental disabilities who are medically fragile or have mental illness.

Coordinates a range of treatment services, which includes assessment, evaluation, skills training, medical, neurological and/or mental health treatment, clinical case management and crisis intervention.

DDHA Eligibility Criteria 60

Individuals who: • have been discharged from Developmental Centers to

community settings • have been brought back to NJ through “Return Home New

Jersey” • who are at-risk of losing their community living

arrangement; and/or • reside in their own home and are in jeopardy of needing an

alternate living arrangement.

DDHA Program Services 61

Assessment – The Team will gather all information on the individual and, after obtaining informed consent and appropriate release for the sharing of confidential information, speak with providers/caregivers. A clinical interview will be conducted.

Further individualized assessments will be coordinated as

needed such as medical evaluation, neurological evaluation, mental health evaluation, and functional assessment.


On-site Intervention – Services will be provided on-site in the individual’s environment through this program as needed/requested. Services can also be provided at office locations.

Behavior Skills Training – Emphasis is placed on using appropriate social and communication skills, coping strategies, problem solving, and managing aggressive and self-injurious behavior through various treatment modalities


Social Skills Training – Emphasis is placed on getting along with others, knowing how to talk and listen to others and doing things with others. DDHA will work with residential and/or day program providers in developing behavioral skills strategies.

Staff Training – Training will be provided in collaboration with existing DDD-funded programs to residential, day program staff and caregivers on medical, neurological, mental health and behavioral issues. Training can be held on-site at the residence or day program.


Interagency Support and Consultation – The Team will work cooperatively with providers to monitor individual’s concerns and not duplicate treatment. The Team will participate in case conferences and treatment planning with provider agencies.

Systems Integration – The Team will facilitate linkage to existing services including those provided by NJDDD, NJ DMHS, NJDMAHS and Medicaid HMOs. The Team will act as a liaison between the individual and these service providers.


Health Care Services: The Team will coordinate activities between the developmental disabilities system and the health care system in order to ensure adequacy of outpatient, inpatient, and emergency care. This will include Medicaid, Medicare, Medicaid HMOs, and commercial insurers.

Mental Health Services: The Team will coordinate activities between the developmental disabilities system and the mental health care system in order to ensure adequacy of outpatient, inpatient, and emergency care.

DDHA Referral Process 66

Individuals will be referred through the designated DDD Regional staff. Priorities for admission will be: • Individuals currently in DDD community settings who are at

risk of losing their residential placement or day program due to medical, mental health or behavioral problems.

• Individuals with medical, mental health or behavioral problems who are not at immediate risk of losing their placement but the provider agency needs consultation and assistance in managing the individual’s behaviors.

DDHA Referral Process 67

• Individuals who need linkage to medical or mental health treatment and follow-up.

• Individuals currently residing in their Own Home, who without behavioral supports/Intervention will need an Alternate Living Arrangement

DDHA Discharge Criteria 68

• The individual is no longer at risk of institutionalization. • The individual is no longer at risk of loss of placement in a

residence, day program or own home. • Appropriate medical, mental health and/or behavioral

follow-up is in place. • The identified behaviors and issues have been stabilized

and are manageable in the placements.

SOCIAL/EDUCATIONAL/ RESIDENTIAL/VOCATIONAL

(SERV)

69


SERV Behavior Specialist 70

SERV Behavior Specialists provide intensive in home behavior support services to DDD individuals residing within the following five counties:

• Mercer • Middlesex • Monmouth • Ocean • Hunterdon

Behavior Specialists work with families to teach behavioral modification skills in the home setting that reduce the occurrence of the target behavior while increasing positive replacement behaviors.

Types of Referrals: Mobile Crisis (MCRS) 71

4-week intervention/ Severe Behaviors Intake/Assessment Baseline Data/Observation Skills Training/Treatment Planning Behavior Plan/Implementation Outcome Measures/Follow up observation

Types of Referrals: Home-Based(HBS) 72

Home-Based Referral is an eight week behavioral intervention

Behaviors that warrant a HBS referral are less severe than a MCRS referral

A resource used for skill building and addressing minor behaviors

Types of Referrals: Crisis 73

Crisis referrals are placed by support coordinators directly to the crisis hotline.

A behavioral crisis is an intense episode when parents and caregivers are unable to gain instructional control over the individual’s behaviors.

In order to access this service the individual must be in the home setting at the time the call is placed.

The family will be immediately contacted after the support coordinator provides the Behavior Specialist with all pertinent information.

If the family needs a home visit to deescalate the behavioral episode Behavior Specialists will arrive to their home within two hours.

SERV Referral Process 74

Crisis Hotline – 609-240-3738 All Home-based referrals must be placed through Dr. Jessica

DiMarco (DDD) Referral packets are mailed directly by Dr. Di Marco to:

SERV Achievement Centers 20 Scotch Road

Ewing, New Jersey, 08628 SERV Access Department - Karin Jobe, Access Coordinator -

1-800-987-7378

CASE STUDY #2

75


Case Study #2 76

Christina was assigned to your agency several months ago. She has a DDRT score of 2-level of care, 4-behavioral, 1-medical. Mom is requesting residential placement due to Christina’s aggressive behaviors and the home being in foreclosure. No services are in place besides day program. Christina’s natural supports have recently changed due to her older brother getting married and moving out. Christina is also in need of a communication device but mom reports that she does not have any money to purchase one. What do you do?

Case Study #2 Suggestions 77

Research& utilize behavioral resources – DDHA, SCCAT, ISDT, Research & utilize Medicaid services – PPP, HHA, PASP Follow up on day program/ day services Follow up with family support Save up SSI funds to purchase a tablet (suggest purchasing a

used or refurbished one) Reach out to County Services to see if they have any resources

that can be utilized Encourage the family to have medications checked by her PCP

or psych Discuss with family reasons why Christina would not be

moving with the family if their home becomes foreclosed Update case notes and monthly monitoring tools

Thank you! 78

http://proverbs226.org/wp-content/uploads/2014/10/question1.jpg

Download - Crisis Behavior Resources for Support Coordinationrwjms.rutgers.edu/boggscenter/projects/documents/CrisisBehavior... · Crisis Behavior Resources . for Support Coordination . 1

Top Related