214 R.I. Code R. 214-RICR-40-00-6.2

Current through December 3, 2024

Section 214-RICR-40-00-6.2 - CERTIFICATION STANDARDS FOR MENTAL HEALTH EMERGENCY SERVICE INTERVENTIONS

A. In order to be certified for emergency services, the Emergency Service Provider Organization (hereinafter, the Provider) must include a telephone crisis hotline, face-to-face interventions in the community and the means to develop and implement a follow up plan to access community-based and 24-hour services.

B. The Provider meets the standards established under each component.

C. Telephone Contact, Support and Follow up

1. The Provider maintains a telephone system for families that includes:

a. A phone line and a number which answered by a live voice twenty-four hours per day, seven days per week, 365 days per year. The answering service or Provider must have the capacity to ensure accessibility for callers who speak a language other than English.

b. The caller has telephone access to the Clinician within fifteen minutes of the initial call to discuss the crisis and to develop a follow up service plan based on the family's need and collaboration on next steps.

c. The Provider tracks all phone calls, measures and reports to the Department on the:

(1) Source of the call - parent, guardian, child or collateral party;

(2) Percentage of calls answered within fifteen minutes of the original request;

(3) Number of calls per month.

(4) Percentage of calls that resulted in a face-to-face intervention.

2. The Provider works with the Department, the Department of Human Services (DHS) and RIte Care to publicize the service throughout their service delivery area including in languages other than English in diverse communities.

D. The Provider establishes emergency service intervention policies and procedures that meet the following criteria:

1. Families, caregivers, health care professionals and others who are working with a child experiencing a mental health crisis have access to a Department-certified Mental Health Emergency Service Intervention Team that consists of the Clinician with back-up from a clinical supervisor/ administrator. The Clinician may consult with additional qualified treatment professionals, including a child- trained psychiatrist licensed to practice medicine in Rhode Island.

a. The Clinician provides face-to-face crisis counseling, evaluation of the current mental health emergency and the development of a follow up service plan for a family with a child experiencing a mental health crisis.

b. The face-to-face contact takes place within two hours of the family's request regardless of the time of day of the call.

c. The clinical supervisor is available to the Clinician and collateral providers for telephone consultation on the assessment and care planning and returns pages or phone calls within fifteen minutes of the request from the Clinician.

2. The family and the Clinician jointly determine the location for the face-to-face crisis intervention to accommodate family needs and preferences, provide for the timeliest and clinically appropriate setting to gather relevant information, increase the chances of de- escalating the crisis and protect the physical safety of all parties.

3. The Clinician meets with the child and family and, as part of the intervention, offers support, completes a crisis evaluation, assesses the child and family for risk to harm self or others and engages the family and collateral providers in the assessment and follow up service planning process.

4. The Provider follows up with families to make sure that the plan was implemented.

E. The Provider establishes policies and procedures to complete the emergency service intervention with follow up service planning including:

1. The Clinician works with the family to resolve the mental health crisis and to promote the health and safety of the child and the family. The Clinician collaborates with the family to identify services in the follow up plan that build on the family's strengths, needs, and preferences.

2. The Provider ensures all staff are familiar with the full range of community, residential and hospital-based services that can best match the family's needs, strengths and preferences.

3. The Clinician discusses the value of a Family Support Worker with the family and, if the family identifies the need for such support, makes arrangements for a follow up face-to-face visit or telephone call to the family.

4. The Clinician is also familiar with clinical eligibility criteria and authorization procedures of RIte Care.

5. The Clinician makes an appropriate referral to a program and/or service based on the child-family assessment and mutually identified needs. The Clinician and/or his/her organization also complete any pre-certification required by the third party payer or managed care organization.

6. The Provider ensures that the follow up service planning process includes:

a. The Clinician discusses the follow up that the family prefers and makes arrangements to contact the family and/or the referral source the following day to make sure that the follow up resource was available.

b. The Provider has a form that notes the legal guardian's signed agreement on the type of follow up in the encounter document or emergency evaluation that is part of the child's medical record.

c. The Provider is available to the child and family for follow up contact for seventy-two hours after the initial crisis intervention if other community resources are not immediately available.

d. The Provider establishes a complaint and grievance procedure if the family disagrees with the follow up service plan.

F. Standards for Child - Family Competency

1. In order to be certified to provide emergency service interventions, the Provider must establish a policy for the recruitment and/or training of emergency service staff. Staff must possess the following clinical skills:

a. Child interview skills, including assessment of child's coping skills, determining the locus of control and evaluating the risk of the child to harm him/herself or others based on intent, means and opportunity based on the developmental level and cognitive ability.

b. Crisis de-escalation and diffusion of the behavioral health emergency, engaging both the child and the family in the intervention, gathering important information to make the best decision on follow-up care, partnering with the families on the follow-up plan and confirming with the families that the plan has been implemented.

c. Family interview skills, including assessment of the family's coping skills and their ability to manage crisis.

d. The ability to assess family supports and global risks based on the environment of supports and obstacles in which the family lives.

e. The ability to incorporate family strengths and skills into the risk assessment and follow up plan.

f. Skill in partnering with parents using family-centered language in planning follow-up services that match the needs of the child and family.

g. Diagnostic formulation according to DSM IV-R criteria and child-specific risk criteria.

h. Age appropriate crisis interventions designed to reduce immediate symptoms of behavioral health risk.

i. Application of diagnostic formulation to determine the child's behavior as a Serious Emotional Disturbance, the immediate risk factors of the child's potential to harm him/herself or others and the child's and family's strengths as factors in managing the crisis.

j. Skill in applying differential interventions for families from diverse cultural, linguistic and ethnic backgrounds, ability to work effectively with interpreters and clinical skills to provide interventions within a cultural context.

2. In order to be certified, the Provider must confirm in writing that staff who provide child emergency service interventions possess knowledge of:

a. Age appropriate behavior, attitude and conceptualization;

b. Appropriate roles of parents with children based on age and behavior and culture;

c. Indications and side effects of psychiatric medications that are commonly prescribed for children and adolescents and how such medications are metabolized based on race, ethnicity and age;

d. The full range of legal status categories of children involved with the Department and the rights of children and families to consent to or refuse treatment;

e. How children and families of diverse cultures view sharing information, behavioral health and social services and emergency/crisis situations;

f. Informal supports and extended family support as valid interventions; and

g. Matching services to the assessed needs of the child and family based on SOC principles for an array of community- based services in a range of cultural contexts.

3. In order to be certified as a Provider, the organization must provide ongoing training, consultation, support and updated information to staff who provide emergency service interventions. The Provider ensures a minimum of ten hours of training per year on best and promising practices in children's behavioral health and monthly updates on the changing network of managed care programs and community resources including:

a. The types of RIte Care and third party payers, the behavioral health benefit packages and the behavioral health provider network of each insurance company.

b. The eligibility and/or admission criteria for the children's behavioral health treatment programs.

c. A list of contact names and phone numbers for the community providers of children's behavioral health treatment, advocacy, support and collateral services.

4. The Provider has an identified subject matter expert on the SOC referral process and how to obtain access to social service, housing, employment and other Medicaid-funded services.

5. The Provider ensures all staff have knowledge of culture-specific services, the linguistic capacity of community services and the ability to work effectively with an interpreter of sign language and/or spoken language.

6. The Provider identifies a clinical subject matter expert who can provide training and consultation to the emergency services staff based on his/her expertise on the current best practice interventions in the field of children's behavioral health.

G. Program Monitoring and Quality Improvement

1. The Provider collects encounter data on emergency service interventions monthly as described herein.

a. Complete and forward mandated forms and reports to the Department.

b. Provides aggregate report to the Department monthly.

2. The standardized report includes aggregate data of emergency service interventions that capture the age, gender, ethnicity, status with the Department, child's living arrangement, insurance coverage, time of day, day of week, location of intervention and type of disposition.

3. The Provider develops an internal process to review complaints from the family or other parties involved in the intervention.

4. The Provider has a process, consistent with the DHS Fair Hearing process, of resolving disagreements with the family around the follow up service plan.

H. The Provider is credentialed by and contracts with all RIte Care HMO's and is knowledgeable of the authorization procedures required to access services identified in the follow up service plan.

I. The Provider has an established training protocol in children's behavioral health that includes an annual plan to address the best practices and current findings related to working with children with serious emotional disturbances and their families in a culturally and linguistically competent manner and from an individual and family systems perspective.

214 R.I. Code R. 214-RICR-40-00-6.2