# Presentation: 151873

## Case Management, CDSS and the Mental Health and Wellness Program

- Valerie R. Cherry, Ph.D.
- Principal Mental Health Consultant

## Introduction To A Case Management Approach

- First, do not kill the messenger!
- We are on the same team
- Doubled or tripled workload—same hours
- Protect your license
- Protect your clients – our students

## CDSS

- Partner in employability
- MHC contributions to each phase—a new model for mental health care
- Many already implementing CDSS informally—need to formalize
- Use of PCDP

- JOB

- CTP

- CPP

- JOB

- CDP

- OAP

- JOB

- PCDP

## You Are A Consultant and Administrator

- Your program—CDSS, Disability, Meetings, TEAP, Education/Training, Wellness, Counseling and Direct Care
- Must develop TEAM Approach with case management

## Job Corps Case Management Nuts and Bolts

- Documentation-”if it isn’t written, it didn’t happen.”
- Most centers do more than documented
- Health record is a legal document and central to ROCA review
- Decreases liability
- Document your thought process—why you did NOT do something

## Job Corps Case Management Referral and Feedback System

- The PRH requires a written referral and feedback system for mental health treatment.  You will need to develop a two part form in which a referral for mental health treatment can be written by other disciplines on center, such as counseling or residential life.  On the second portion of the form, you would write a response that goes back to the referral source.  You can be somewhat general to protect confidentiality but provide enough _BEHAVIORAL INFORMATION_ so that referral sources believe there is follow-up to referrals; otherwise, referrals may stop.

## Job Corps Case Management

- Intake Notes
- , reason for referral, presenting problem, history of presenting problem, mental status exam, diagnostic impression, and a clear management plan.  The management plan will be multidisciplinary and describe various modes of treatment, including groups, TEAP counseling, medication evaluation, as well as off-center referrals

## Job Corps Case Management

- Progress Notes
- assessment, progress, and update on the _management plan_.  The notes should be written in the chronological portion of the health record so staff can track referrals and providers, treatment, and progress over time.
- SOAP

## Job Corps Case Management

- Management Plan
- After evaluation of the student's mental health problems, the CMHC should make a confidential entry in the **health record** and prepare a management plan.  The management plan should be tied to Job Corps program elements and specific staff members.  A career counselor is the ideal _case manager_ for an individual with academic or social problems

## Job Corps Case Management

- Management Plan
- The management plan should be designed to improve the student's mental health and to strengthen his/her performance in the vocational and educational programs; it should be very specific and realistically tied to the center program.
- Concise and Specific–Less than one page

## Job Corps Case Management

- Management Plan- Who is responsible?
- CMHC, TEAP Specialist,Counseling staff, and in some cases, selected health and/or academic/vocational instructors, are usually responsible for some aspects of the management plan.  The case manager monitors nonhealth staff involvement in the plan and may work with a teacher to monitor the student on performance goals.

## Job Corps Case Management

- Management Plan’s Best Friend-
- Personal Career Development Plan (PCDP)
- Throughout all periods of CDSS

## Behavioral Descriptors

- Student may have difficulty concentrating and is easily distractible
- Student may need assistance with anger management
- Student may be impulsive (acts before thinking)
- Student may look for a lot of attention through behavior and appearance

- Student may have difficulty with information presented orally
- Student may have inappropriate provocative behavior
- Student may have difficulty in social situations
- Student may need assistance with developing positive leisure activities

## WHYJob Corps Case Management ?

- At risk population
- Limited time on center
- Standard practice
- Expands the umbrella for the mental health and wellness program

## Off Center Treatment

- Documentation of compliance—no details
- Develop tickler system to monitor at least monthly
- If non-compliant, follow-up and document

## Medical Separations

- Majority should be medical separation with reinstatement (MSWR)
- Most conditions clear within 6 months
- Cannot predict course of illness—ADA issues
- Document specific symptoms and behaviors
- Do not do a medical for behavioral problems

## Psychotropic Medications

- Psychotropic medication monitoring
- Memo of understanding with psychiatrist
- Documented follow-up on center or off center

## Case Conferences and Core Meetings

- Document meetings
- Document phone consults with other disciplines on center-very
- Document phone consults with off center providers

## Suicidal Students

- No suicide watches or hourly bed checks
- Too much liability—no harm contracts
- No resources for high level of care
- Consider MSWR—be conservative
- No releasing suicidal students to family members INSTEAD of evaluation at a hospital

## More Suicide Issues

- The myth of suicide contract
- All threats taken seriously
- Poetry or prose taken seriously
- Be conservative—do MSWR’s
- Better to be in court with civil rights for unlawful separation than with family of dead student for malpractice
- Suicide SOP and document all casework

## Summary of Suicidal 

- Behavior in PY03*

| Type of Incident | Number Reported | Percentage of Philadelphia’s Incidents |
| --- | --- | --- |
| Suicide Threat | 18 | 4.4% |
| Suicide Attempt | 14 | 3.4% |
| Suicides | 0 | 0% |
| Total Incidents Reported by Region | 409 | 100% |

- *Includes incidents occurring on July 1st, 2003 through April 23rd, 2004

## Percentage Breakdown by Method of Suicide Attempt in PY03*

- *Includes incidents occurring on July 1st, 2003 through April 23rd, 2004

## Summary of Suicidal 

- Behavior in PY02*

| Type of Incident | Number Reported | Percentage of Philadelphia’s Incidents |
| --- | --- | --- |
| Suicide Threat | 21 | 4.8% |
| Suicide Attempt | 10 | 2.3% |
| Suicides | 0 | 0% |
| Total Incidents Reported by Region | 437 | 100% |

- *Includes incidents occurring on July 1st, 2002 through April 23rd, 2003

## Summary of Suicidal Behavior: Comparison Between PY02 and PY03*

- *Data only includes incidents occurring between July 1st and April 23rd of each program year

## Personality Disorders

- Increase on center and more empowered with civil rights laws
- More difficult to separate medically
- More likely to refuse treatment and manipulate
- May create feelings of helplessness in staff

## Create Links with Behavioral or Disciplinary System 

- Refusal of medication and treatment—students must still abide by rules and regulations on center.
- No behavioral consequences for refusing medications—but consequences to students behavior as a result of refusing meds
- CSO must support health and wellness compliance

## Behavioral Consequences Influence Compliance

- Fail to keep appointments—consequences increase compliance
- Personality disorders—after refusal of treatment (documented) and continued behavioral problems, disciplinary separation
- CSO and behavioral contracts

## Standard Operating Procedures

- Your COP or SOP should reflect your actual procedures—decreases liability
- Centers in which the SOP looks great but actual procedures documented are very different
- Centers in which documentation great but no SOP’s that reflect this

## Informed Consent and Confidentiality

- Your role can be perceived as a therapy relationship, as defined by ethics and laws
- You are not exempt because you do “assessments”
- You are not exempt because you work for Job Corps
- As a licensed mental health professional, you are not construed as a “counselor”

## More Informed Consent

- Just Released–**Mental Health and Wellness Informed Consent Form** added to OASIS
- JCDC Notice 03-186 New Release of OASIS - April 12, 2004
- PRH Change Notice
- Chapter 1, Exhibit 1-1
- Chapter 6 - 6.12 , Authorizations

## Mental Health Programand CDSS

- CDSS—The new evaluation model
- Think of your duties as it relates to each phase of CDSS and write COP
- Implement “Transition Group” into and out of Job Corps
- You must formally implement the mental health and wellness program in the structure of CDSS or your role and program will be unclear
- Handout with examples

## Regional Office Help

- We are here to help provide support
- Possibility of quarterly teleconferences with RMHC
- Share information with regional office—avoid “keep them out of the loop”

## Resources

- http://www.jobcorpshealth.com
- http://www.jobcorpsdisability.com
- TAG-D Mental Health and Wellness ProgramRelease Date: March 24, 2003
- TAG-F Disability Resource ManualRelease Date: June 2002
- TAG-G Learning Disabilities and Attention Deficit Hyperactive DisorderRelease Date: June 2003
- TAG-H Mental Health DisabilitiesRelease Date: October 29, 2003 _[ ](http://www.jobcorpshealth.com/family_plan/html/index.htm)_
- TAG-L Trainee Employee Assistance Program (TEAP)Release Date: July 22, 2002