NC Community Mental Health and Occupational Therapy

1. NC Community Mental Health and Occupational Therapy Therapeutic Solutions of NC, LLC Tomeico Faison, OTR/L, Manager November 12, 2013

2. Objectives • Participants will become familiar with current NC community-based mental health services for persons and families with mental illness/es • Participants will recognize and understand the current and potential roles of occupational therapists in NC community mental health

3. About Therapeutic Solutions • Opened by Tomeico Faison in 2003 • Provides assessment, treatment and consultative services to clients in the Triangle and surrounding areas • Services focus on functional participation in meaningful activities of daily living • Mental illness, developmental disabilities, low vision • Group homes, psychiatric facilities, clinics, home environments, community-based agencies

4. Community Mental Health Service Credentials • QP-Qualified Professional • 4 year degree and 2 years of human service experience; masters degree preferred • Qualifications vary nationally • Relevance to OT: AOTA MH Document • AP-Associate Professional-2 year degree or less-no longer utilized • Other Terms: QMHP and QDDP same as QP and Q

5. Other Team Members • Therapists-MSW, LPC, LMFT • Teachers • Department of Social Services (DSS) • Department of Juvenile Justice (DJJ) • Natural Support Persons (family members, friends, religious associates) • CLIENT!!

6. Community Mental Health Services in NC • ACTT Team • Multi-systemic Therapy • Peer Support • Community Support-obsolete • Community Support Team-adults • Residential Services • Mobile Crisis • Intensive In-home services-Family • PSR • MCO • Other Services: http://www.ncdhhs.gov/mhddsas/providers.htm

7. ACTT TEAM • “The Assertive Community Treatment Team, or ACTT, is a community mental health service that offers treatment and support to adults who are homeless or at risk for homelessness, and have a history of incarceration or hospitalization.  The program offers individuals professional support while they continue to live and work or volunteer in their community.” • http://nc.eastersealsucp.com/services/mental-health-crisis-services/

8. Multi-systemic Therapy and Intensive In-Home • MST and Intensive In-Home, provides high-intensity family-based counseling for adolescents with court involvement or at risk for out-of-home placement due to delinquent behaviors.  Services include in-home counseling, case management and crisis support. • http://nc.eastersealsucp.com/services/mental-health-crisis-services/

9. Peer Support Services • “Peer Support Services (PSS) is a community-based service for adults age eighteen (18) and older who have a mental illness or a substance abuse disorder. PSS is provided by a Certified Peer Support Specialist who has self-identified as a person in recovery from mental illness or substance abuse issues and is committed to his or her own recovery. PSS provides structured, scheduled activities that promote recovery, self-determination, self-advocacy, and enhancement of community living skills.” • http://www.ncdhhs.gov/mhddsas/comm_support/handoutsworkdoc/psss-draft-8-28-09.doc

10. Community Support • No longer utilized • Issues and concerns regarding service provision, documentation, credentials and billing

11. Community Support Team-Adults • “The community support team is a community mental health service that assists adults in developing coping skills, improving self-monitoring of symptoms and behaviors, and enhancing independence in daily activities.  The team works in both one-on-one situations and family-based interventions.” • http://nc.eastersealsucp.com/services/mental-health-crisis-services/

12. Residential Services • “Residential Supports provide services for individuals to live in group homes, shared apartments or independently in the community.  Typical supports include personal assistance for daily living activities, skills training, and specialized services to assist individuals in accomplishing their personal goals.” • http://nc.eastersealsucp.com/services/mental-health-crisis-services/

13. Mobile Crisis • “Team of individuals that respond to crisis on the community level, providing community based training, person centered supports, that may enable an individual to be able to stay in the natural setting( home).” • http://nc.eastersealsucp.com/services/mental-health-crisis-services/

14. Psycho-Social Rehabilitation PSR • For some, recovery from mental illness is a long and especially challenging road. For people with Severe and Persistent Mental Illness (SPMI). PSR utilizes evidence-based practices to empower individuals with the skills they need to serve as active members of their community. PSR staff members work with people in a group setting where positive peer support is part of the healing initiative. Group sessions are designed to increase self-confidence, maintain mental stability, develop employment opportunities, and seek out increased community interaction

15. Switch from LME to MCO • As a result of legislation passed in the summer of 2011, the state’s mental health agencies were compelled to make a transition from service coordination agencies to managed care organizations (MCOs), which essentially act as small insurance companies. These MCOs receive a set monthly payment for each client and have to provide services for everyone under their care using that pot of money.

16. Local Management Entity- (LME) Managed Care Organization (MCO )Happened (January 1, 2013)

17. Sample Referral Process • Make referral based on qualifications for service • Intake form completed (Diagnostic Assessment) • Intake form given to director or assistant director • Intake given to a team lead and assigned to the corresponding team • Family contacted and meeting set-up

18. Referral Process Continued • Person Centered Plan (PCP) completed while meeting with the family • Complete inpatient treatment report (ITR) completed and sent to insurance agencies for approval (example-Health Choice, Value Options-medicaid, IPRS-state funding-alternative for people without insurance) • Services approved or denied typically within one week

19. Authorization Process for Services • Typically in order to receive an authorization for these services you would have to complete the following and submit it to the MCO for approval; ( PCP, Mental Health Assessment, and discharge plan)

20. Monitoring of Service Provision • NC TOPPS: State regulation of service provision • https://nctopps.ncdmh.net/ci1011/index.asp

21. Collaborative Relationships • OT and Community Mental Health • Referral Example from Psych Hospital to the Community • Referral from Community-based agencies to OTs • Endorsed Provider Database: • http://www.ncdmh.net/endorsedprovider/pub • liclogin.htm

22. Areas of Interest for OT’s • PSR Programs and Recovery Programs • (WRAP at Freedom House) • CST (Adults with challenges with independent living). • Quadrant IV Clients-transitioning into adulthood • Tenancy Support-support services to help persons remain in their community-based setting

23. Occupational Therapy’s Role • Increase the person’s ability to live as independently as possible in the community while participating in meaningful activities

24. Occupational Therapy’s Role • Home/Health Management • Community Mobility/Skills • Computer Technology Skills • Time/Routine Management

25. Service Reimbursement • Medicaid and Medicare • Medicaid up to age 21 and prior approval required • Medicare B-limited number of visits-doctor’s order required, must have a change in previous level of function and demonstrate good rehab potential • Private pay • Sliding fee scale

26. Carolina Center for Medical Excellence Contact Information • CCME provides education, leadership and services in review and quality care improvement and program management for healthcare providers in the Carolinas. CCME also conducts research to measure, monitor, and improve health care and provide education services for health professional and physicians to earn required credit hours. (This the prior approval company for OTs that want to bill Medicaid)

27. Marketing, Marketing, Marketing! • Brochures and business cards • Presentations-private companies and associations • Social networking • Free services: Volunteering and students • Collaborative projects to meet social needs

28. Questions/Comments • Contact: therapeuticsolutions@hotmail.com • 1201 Aversboro Rd Suite H201 Garner, NC 27529 • 919-239-4805 (office)

29. References • Correria, C.J., Benson, T. A., Carey, K.B. (2005). Decreased substance use following increases in alternative behaviors: A preliminary investigation. Addictive Behaviors, 30, 19-27.

30. Websites • http://www.ncdhhs.gov/mhddsas/comm_support/handoutsworkdoc/psss-draft-8-28-09.doc • http://nc.eastersealsucp.com/services/mental-health-crisis-services/