Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VII - Mental Health Manual › Subpart D - Nonresidential Agencies/Facilities/Services › Chapter 5221 - MENTAL HEALTH INTENSIVE CASE MANAGEMENT › CONSUMER RIGHTS › Appendix A - INTENSIVE CASE MANAGEMENT GUIDELINES

Current through Register Vol. 54, No. 28, July 13, 2024
Case management is a service which will assist eligible
						individuals with mental illness, including children with a serious mental
						illness or emotional disorder, in gaining access to needed medical, social,
						educational and other services. Activities undertaken by staff providing case
						management services shall include:
Linking with services
-Assisting the
						consumer in locating and obtaining services specified in the treatment or
						services plan, or both, including arranging for the consumer to be established
						with the appropriate service provider.
Monitoring of service delivery
-There
						shall be an ongoing review and written record of the person's receipt of, and
						participation in, services. Contact with the consumer shall be made on a
						regular basis to determine his opinion on progress, satisfaction with the
						service or provider, and needed revisions to the treatment plan. Contact with
						the consumer's therapist shall be made on a regular basis to determine if the
						person is progressing on issues identified in the treatment plan and if
						specific services continue to be needed and appropriate. A process shall be
						developed for resolution between staff members with levels of appeal to be
						pursued when there is clinical disagreement on the nature and extent of
						progress a particular consumer is making. Regular contacts shall be made with
						other public agencies serving the consumer and with parents, if the consumer is
						a child.
Gaining access to services
-Aggressive
						and creative attempts are required to help the person gain resources and
						services identified in the treatment or service plan, or both. This may include
						home and community visits and other efforts as needed. It does not preclude the
						consumer's therapist from accompanying the case manager on these visits. Home
						and community shall be defined broadly to include field contacts which may take
						place on the street, at the person's residence or place of work, psychiatric
						treatment facilities, rehabilitation programs and other agencies where support
						or entitlements are available to the recipient. (Medicaid may not be billed for
						case management services provided to eligible persons in hospitals, SNF, ICF
						and ICF/MR facilities for which Medicaid is being billed for treatment nor for
						persons in jail.)
Assessment and service planning
-A review
						of clinical assessment information and a general discussion with the consumer
						is required regarding unmet needs and plans for the future.
Problem resolution
-Active efforts to
						assist the person in gaining access to needed services and entitlements. Staff
						shall have easy access to communicate with the county administrator for the
						purpose of obtaining assistance in resolving issues which prevent a person from
						receiving needed treatment, rehabilitation and support services. On a systems
						level, this may include providing information to help plan modifications to
						existing services or implement new services to meet identified needs and
						providing information to help plan modifications for accessing resources.
Informal support network building
-Contact with the person's family, not family counseling or therapy, and
						friends, with the permission and cooperation of the adult person, to enhance
						the person's informal support network.
Use of community resources
-Assistance to
						persons in identifying, accessing and learning to use community resources
						appropriately to meet his daily living needs shall be provided as needed. This
						may include the use of public transportation, the library, stores and the like.
						This will be done by making a referral to an appropriate service provider,
						creating such a resource if it does not already exist, in providing assistance
						directly to the consumer if no other resources are available to provide
						instruction.
PENNSYLVANIA CASE MANAGEMENT SERVICES FOR CHILDREN AND
						ADOLESCENTS WITH SEVERE EMOTIONAL DISTURBANCE AND THEIR FAMILIES
A.
Core Values for the System of Care.
1. The system of care should be child-centered, with the
						needs of the child and family dictating the types and mix of services
						provided.
2. The system of care should be community-based, with the
						focus of services as well as management and decision-making responsibility
						resting at the community level.
B.
Principles of Services for Children &
						Adolescents in Pennsylvania.
1. Children and adolescents deserve to live and grow in
						nurturing families.
2. Children and adolescents' needs for security and
						permanency in family relationships should pervade all planning.
3. The family setting should be the first focus for
						treatment for the child or adolescent. Out-of-home placement should be the last
						alternative. Young children should not need to be in a State hospital to
						receive appropriate mental health treatment.
4. Communities should develop a rich array of services
						for children and their families so that alternatives to out-of-home placement
						are available, such as home-based services, parent support groups, day
						treatment facilities, crisis centers and respite care.
5. Parents and the child should participate fully in
						service planning decisions.
6. The uniqueness and dignity of the child or adolescent
						and his family should govern service decisions. Individualized service plans
						should reflect the child or adolescent's developmental needs which include
						family, emotional, intellectual, physical and social factors. The older
						adolescent's right to risk should be considered. Children and adolescents
						should not need to be labeled in order to receive necessary services.
7. The community service systems which are involved with
						the child and family should participate and share placement, program, funding
						and discharge responsibilities.
8. The primary responsibility for the child or adolescent
						should remain with the family and community. Pre-placement planning should
						include a discharge plan.
9. Case management should be provided to each child and
						family to ensure that multiple services are delivered in a coordinated,
						time-limited and therapeutic manner which meet the needs of child and
						family.
10. Each child should have an advocate.
The Pennsylvania Child and Adolescent Service System
						Program (CASSP) guidelines which follow form the foundation for intensive case
						management services for children and their families:
1. The major thrust of the case management service shall
						be the commitment to permanency planning for each child and adolescent with
						severe emotional problems.
2. The relationship of the case manager with the family
						shall be one of a partnership, embodying the concept of "parents and
						professionals as partners."
3. The process of providing case management services to
						children and adolescents and their families shall be based on the developmental
						needs and phases of the children and adolescents as they progress to
						adulthood.
4. The case manager will first utilize the normalizing
						community services as resources in serving the child and family rather than
						"specialty services."
5. The case management services shall be delivered in the
						context of a systems approach, recognizing that case management services shall
						be integrated with the other child-serving agencies and systems serving the
						child.
6. The case manager needs to view the family as the
						primary care giver and recognize the family as the primary resource in the care
						and treatment of their children.
7.The role of the case manager most often will be that of
						teacher and consultant to the family.
This appendix cited in 55 Pa. Code §
													5221.31 (relating to
						  responsibilities of providers).