Adult Mental Health Reform 2020 ARMHS Workgroup MEETING NOTES

November 7, 2012

START/END TIME: 3:00 p.m. – 5:00 p.m.

LOCATION: Room 5137, 444 Lafayette Road, St. Paul

Remote ITV sites: Brainerd, Crookston, Duluth, Park Rapids, Willmar

Co-conveners: Ruth Moser, DHS; Julie Pearson, DHS; Melinda Shamp, DHS

Facilitator: Charlie Peterson, MMB

Notes: Beth Bibus, MMB

Members in attendance (SC – Steering Committee; ITV – attended via ITV):

Shawn Anderson, Lake Country Associates (ITV); Julia Bachelder, Blue Meadows Family Resource Center; Ron Brand, Minnesota Association of Community Mental Health Programs (SC); Michael Clevette, Accend Services, Inc. (ITV); Claire Courtney, DEED (SC); Muriel Deegan, New Moon Homeless Supportive Housing; Jon Everett, Community Involvement Programs; Kirk Fowler, Ramsey County (SC);Denise Gudvangen, Northwestern Mental Health Center (ITV); Jeanne Grenvik, Family Support Services; Sheila Grism, Fraser; Patty Hollycross, NAMI & State Advisory Council; Denise Hammer, Northwestern Mental Health Center (ITV); Mary Jarvis, Goodwill/EasterSeals Mental Health Services; Joel Keller, Northern Pines Mental Health Center (ITV); Martha Lantz, Touchstone Mental Health; Don Lavin, Rise, Inc.; Rick Lee, Woodland Centers (ITV); Karen Lloyd, Health Partners (SC); Jamie Marxhausen, UCare; Maureen Marrin, Ombudsman for MH and DD (SC); Richard Oni, Progressive Individual Resources; Joyce Pesch, AMHI (ITV); Kathy Preive, Vail Place; Brian Sammon, Options Family & Behavior Services and TBI Advisory Committee; Grace Tangjerd Schmitt, Guild, Inc.; Lura Solie, MHP/CPSS; Terry Schneider, South Metro Human Services; Patricia Siebert, MN Disability Law Center (SC); Nan Stubenvoll, DHS (SC); Ahsley Trepp, Tasks Unlimited; Cary Zahrbock, Optum

AGENDA ITEM AND DISCUSSION 1. Welcome, agenda review, and introductions Discussion

Workgroup members introduced themselves and their role.

In today’s meeting, the group will review the themes identified at the last meeting, hear from providers about ways to provide extra services within/alongside an ARMHS framework, and discuss consumer experiences and outcomes.

2. Review of meeting notes and themes identified Discussion of notes

Members reviewed the notes from the previous meeting; no changes were identified. The group discussion of the minutes included:

• Minutes are posted on the Adult Mental Health Reform 2020 website. When the last meeting notes were posted, Ruth Moser sent workgroup members an email with a link to the site—if members do not receive an email or if the link doesn’t work, email Ruth Moser at ruth.moser@state.mn.us A member asked what would happen with questions and ideas raised at the previous meeting, such as the proposal to review what other states are doing in this area. These questions and suggestions can be used to shape future agendas or to create recommendations from the group.
Review of themes identified

Melinda Schamp reviewed some of the themes DHS staff identified from the previous meeting and synthesized them into several groups of non-covered services:

• Family / Natural Supports / Psychoeducation: Where support network is unfamiliar with mental health/models of treatment. • Parenting/Family: Rehab interventions with adults with SMI in the role of parent & where children are present during sessions. • Employment-related Services: Not all ARMHS clients are eligible for VRS. VRS often can’t cover long term employment supports. EBP: IPS is beneficial in attaining employment for Adults with SMI. • Coordination of Care: Reimbursement for pulling together key documentation and getting info from physicians and others. These are critical parts of treatment, but not reimbursed for this. • Use of Phone, email, texting with the Person, Family, Service Providers (ex: Phone Coaching): Phone contacts are necessary, but not always covered. EX: Person may need reassurance and practice of communication skills before a meeting with a doctor. Other situations: use of coping skills in managing symptoms of the MI more immediately. • MA Codes being used in association with documentation: Examine what MA codes other states are using related to documentation and increments of service (units). [It’s possible that expansion of use of codes may allow other necessary services to be covered.] • Clinical Supervision: Often, clinical supervision occurs more than a minimum of one time per month. [Supervision happens more than what costs are reimbursed.] • Transportation: Providers serve people in multiple counties. Transportation includes:

o Transport of provider to client. Travel time reimbursement does not cover gas in the tank.

o Transport for clients to needed services.

o NPMHC developing a transit service which isn’t funded through ARMHS.

o Example of rural/urban provider difference (provided by Shawn Anderson via email):

§ Rural Provider – recipient lives 30 miles away, travel takes 32 minutes, provider is reimbursed $13.50 from MA. Provider pays staff for a half hour (estimated $10 with benefits) AND 38 cents a mile ($12.16) for mileage. The provider’s cost is $22.16, a loss of $8.66 on the one-way trip.

§ Urban Provider – recipient lives 5 miles away, travel takes 32 minutes, provider is reimbursed $13.50 from MA. Assuming they pay their staff the same $10 and reimburse the same 38 cents a mile ($2.25 for the 5 mile trip). The provider’s cost is $12.25, resulting in a profit of $1.25.

§ In this example, the rural provider experiences a round-trip LOSS of $17.32, while the urban provider has a GAIN of $2.50 for the same service. When multiplied by hundreds of appointments per month, this difference becomes significant. Rural providers are disproportionally impacted by the “per minute” billing system currently in place.

• Evidence-based Practices such as IDDT, IMR, etc.: Provider organizations are encouraged to implement EBPs (EX: IMR). Need to bring in IDDT in conjunction with ARMHS. EX: Harm reduction theory & techniques. Costs are not covered. Training & intensive additional supervision are necessary to implement.

Workgroup members identified additional themes and discussed the identified themes:

• Cost neutrality is difficult to define in this arena. • Billable hours—an ARMHS worker can’t generate revenue if they are on leave. The revenue stream stops unless someone can fill in (and that’s not always possible). One provider noted that they can bill about 27 hours out of a 40 hour week. The rates aren’t enough to cover what’s being done. Other aspects of clinical supervision are not billable: a director has to be part of that supervision, but we can’t bill those hours. These are significant costs when margins are so narrow. • We should use this process as a way to look beyond the way we have done rehab. Do we have it structured the way we want? Can ARMHS be provided differently? We should not try to fit our ideas into the current regulation or try to pigeon hole everything into the existing model. We should look at 15 minute increments; we should look at things creatively. • If we look at the whole sequence of the interactions with the client, we can see a huge number of things that are not reimbursable: engaging, building a relationship, doing functional assessments, figuring out how the individual’s condition affects their daily living—the rehab plan is based on this, but that’s not reimbursable. Deciding whether a client is suitable for a particular program is not reimbursable (determining eligibility is different than deciding what’s suitable or appropriate). And as you move through the rehab process with a client, even more services are not reimbursable: consultation, advising another person about how to help accommodate the client, etc. All of these are important and legitimate activities for rehabilitation. • Codes may be available to cover some of these to access additional reimbursement—this will be a topic at the next meeting.
Options for ARMHS Service Redesign

Based on the discussion at the last meeting and ideas from DHS, Julie Pearson outlined several options for service redesign:

Increase ARMHS rate for current services

Increase ARMHS rate and add services through additional codes

Increase ARMHS rate and add services through 1915(i)

Eliminate ARMHS and create new service under 1915(i)

At the next meeting, Robin Cooper will present information on 1915(i). 1915(i) offers opportunities for a rehab option.

Workgroup members discussed these options. Discussion points included:

• Another possible option is to keep rates the same and add services. With the possibility of a $1 billion deficit, it might not be a good option to ask the legislature for rate increases. • Members requested information on 1915(i) in advance of the next meeting. DHS will send via email. • It may be useful to look beyond ARMHS more broadly, especially in some areas like employability. There are unique issues, interfacing with several agencies—it’s not just an ARHMS issue. We need to look at financial models that can get people to work. Perhaps there can be an area of specialization for these types of services. • DHS is open to all options: specialization, EBP, all kinds of alternatives are possible. We’re not limited to the options presented. • One way to test whether what we’re doing is successful is whether we’ve got a model that would make supportive employment or other options more viable and possible.
3. Presentation about Intensive Community Rehabilitation Services (ICRS) model Presentation

Melinda Schamp reviewed information about ICRS with the group. The Adult Mental Health division has looked at ICRS as a way to respond to unmet service needs through different funding sources. This workgroup might get some ideas for ARMHS by hearing from these providers. ICRS is a way to bring together services for people who may need more than ARMHS, but who are in a less severe situation than would call for ACT or who are in a geographic area with no ACT team.

ICRS:

• DHS issued an RFP to providers to develop ICRS teams using state funding. 6 organizations were selected: Carlton County, Central MN Mental Health Center, Grant County, Northwestern Mental Health & Sanford Medical Center, Touchstone Mental Health, and Zumbro Valley Mental Health. • The intent is to utilize state funding in alliance with other Medicaid reimbursable services within the organization—a way to fill in existing gaps. ICRS is for people with severe mental illness. • The program looks at developing ways to track noncovered services that are necessary to work with people to sustain community life instead of needing a higher level of service (or returning to a higher level of service.) The data will help DHS with evaluation and future efforts. • ICRS uses components of ACT: a team approach, expectation that an MHP will serve as team lead, expectation that there is a major level of severity of need, a transition situation, frequent service content (even every day). • ICRS is different from ACT in terms of staff-to-client ratios: in ICRS, it’s 1:14. In ACT, it’s 1:10 (or 1:8 in specialty or rural teams).
Example of ICRS program: Touchstone Mental Health

Martha Lantz from Touchstone Mental Health described the ICRS program they have in place. They were looking not only to fill a gap between ARHMS & ACT but also to allow for more intensive case management within current the CMS system. Touchstone’s ICRS program provides integrative rehabilitation service to about 100 adults (18+) in Hennepin County with serious and persistent mental illness (most have a MICD commitment). The average age is about 48. The program uses referral criteria for case management as outlined in statute.

Consumers must meet 2 of these requirements:

• Coexisting substance abuse disorder • Pose a risk of harm to self or others • Exhibit socially disruptive behavior with high risk of criminal justice involvement • Reside in a supervised residence but are assessed to be appropriate for a more independent setting with intensive rehabilitation service model • At risk of placement in a supervised community residence • Persistent and recurring difficulties performing activities of daily living • Persistent and recurring difficulties performing practical tasks without significant assistance from others • Residing in substandard housing, is homeless, or is at imminent risk of becoming homeless • Unable to obtain or maintain consistent employment • Significant difficulties carrying out homemaker roles

They also generally meet one of these criteria:

• Recently discharged from extended stay in the state hospital (3 months or more) • High utilization of acute psychiatric hospitalization (6 or more per year) • High utilization of emergency room psychiatric services (6 or more per year)
The funding model for ICRS was workable—in the first 6 months, Touchstone met obligations. ARMHS services were reimbursed through Medicaid (if the client is eligible), uncovered services were covered partly through the state grant, partly through Hennepin County funds (which flow from the state’s AMH funding). Touchstone also uses its own fundraising to cover some services (such as healing touch).

Touchstone uses a team approach for the ICRS program: ARMHS/MH practitioners, plus case manager, plus psychiatrist, plus nurses. They clearly delineated case management services from ARMHS, all under one treatment plan. Consumers seem to like this—they know who they can go to for which role. Even though there are different contracts with the county (ICRS, case management), Touchstone considers it to be one team.

The statewide ICRS workgroup meets a couple of times a year to develop fidelity standards. The IRCS group started by looking at the ACT standards, and then modified them (for example: making a higher client to staff ratio).

ICRS teams meet 3 times a week. Each client is discussed at every team meeting. Touchstone designates 16 hours of psychiatry every week because team meetings take time, and there must be enough time for the psychiatrist to see the client. Similar to ACT, clients are not required to see Touchstone’s psychiatrist. Clients can use Touchstone’s psychiatrist as a consultant, as an addition to their own psychiatrist.

Some examples of ordinarily non-covered services that are covered by ICRS:

• Engagement and lost time (especially early in the process, it’s common for appointments to be canceled) • Transportation for clients: taking clients to the food shelf or other community resources, helping them move, or helping access shelter • Phone coaching, phone consultation for problem solving during crisis, phone calls to family • Supervision and consultation • Meetings • Accompanying clients to medical appointments—where nurses can help explain things to provider & client • Documentation is a huge piece: wellness assessment, data collection, data entry

Workgroup members asked questions about funding and costs of the IRCS program. Martha Lantz did not have detailed financial information at hand, but will bring more information to the next meeting. In general terms, IRCS costs about 50% of an ACT team. Touchstone has a sophisticated billing system and spent a lot of time developing strict criteria to facilitate ARHMS billing. Touchstone has a clear sense of how much ARMHS funding they will need. Even with the additional IRCS funding, not all of the services are covered, and Touchstone has to use private funding sources.

Example of ICRS program: Northwestern Mental Health Center

Denise Gudvangen & Denise Hammer from Northwestern Mental Health Center discussed their ICRS program. They concurred with Touchstone’s list of other services that are not typically reimbursed. Northwestern Mental Health Center’s ICRS program is somewhat similar to Touchstone’s, but on a smaller scale. Details about the program include:

• They have 2 teams/hubs: Crookston and Thief River Falls. Team leaders meet weekly to coordinate. • In Polk County, the program has 2 MHPs who act as practitioners, a nurse for 8 hours a week, and a contracted psychiatrist. The Crookston program serves around 26 people at a time. • The program bills the grant and ARMHS and targeted case management for the program. • There is no ACT team in this area; sometimes the IRCS program takes clients who would be more appropriately served by ACT. • Individuals are Locus Level 3, people who have been referred by the county or by staff at Northwestern Mental Health Center. • The IRCS team coordinates with the county or with the case worker at Northwestern Mental Health Center to keep in them involved and to keep the client engaged with the case worker for when they move off of ICRS. • Northwestern Mental Health Center uses preexisting resources in the IRCS program, using team experience to help the client. The focus is to have the team communicate about what’s going on with the client – ICRS teams are talking to each other all the time, community support staff are also involved. (This is not reimbursable, but it’s crucial to clients.) • Practitioners in the IRCS program are also qualified and sometimes do psychotherapy for those who aren’t able to get into the mental health center. • Northwestern Mental Health Center’s IRCS program is unique in that they provide 24-7 access to IRCS for the client. An IRCS team member is on-call all the time to help with skills or coaching. If the IRCS team member needs to go out to meet the client, they’ll do that or ask the designated on-call practitioner for the Center to go out.
4. Presentation on adult mental health grant funded community based services Presentation and Discussion Ruth Moser provided information on various grant-funded services. Information from the presentation is in the Attachment section below (Section 7). A copy of the presentation is available via email—contact Ruth Moser at ruth.moser@state.mn.us. The information presented is from The Adult Mental Health Initiative grant plans and was intended to give the workgroup some ideas about additional community based services being offered. Perhaps some of these services could be transferred/incorporated in a redesigned ARMHS. Sometimes these programs might have mixture of funds: grants, plus Medicaid. The same staff person may be performing multiple roles/functions; it’s the accounting perspective that’s different. There is a contractual relationship between county, DHS adult mental health, and the provider. At the next meeting, the group will talk about the budget and current spending for various services. One workgroup member noted that grants are not clean cut pots of money from a management standpoint—it’s not as though we can just pull the money and move it somewhere else. There may be unintended consequences from moving things that are proven to work in community and funding them or contracting them differently. 5. Consumer Experiences/Outcomes Discussion

At the previous meeting, workgroup members were asked to review their recent consumer surveys to identify themes and information that may be of use in developing ARMHS. The intent is to bring more consumer perspectives to the process: what works for people? what are people looking for?

At the last meeting, workgroup members asked for information from DHS’s data about treatment outcomes (hospitalization, employment, etc.). DHS hopes to have this at the next meeting.

Melinda Schamp asked Shawn Anderson from Lake Country Associates and Michael Clevette from Accend Services to get the group started with examples from their organization’s consumer surveys.

Lake Country Associates does an annual survey and adjusts programs and staff training accordingly. Examples:

• In last year’s survey, consumers said they lacked improvement in anger management skills. Lake Country Associates asked their clinician to hold an anger management group on a regular basis. • Employment is a big deal in this area (Park Rapids), and consumer survey results are very poor on this issue. Lake Country Associates has tried staff training, teaching skills (within ARMHS context), and the organization works closely with voc rehab. • People consistently people report low satisfaction in transportation as well. This is a rural community, with limited bus system (weekday hours). There’s a very limited amount we can do about this under ARMHS, but the organization has developed separate programs.

Accend Services also does an annual survey—it’s not a satisfaction survey, though that’s a possibility for later. They use interns from UMD to do face-to face interviews with current clients, using 7 open-ended questions. Accend has found that responses to these open-ended questions are far more helpful than Likert-scale responses. Accend uses the information to adjust services and to train staff—staff training is a big emphasis at Accend. Michael Clevette prepared a summary of results, which was emailed to the group. Among the themes from the most recent survey:

• Clients expressed having good relationships with and appreciation of practitioners. • Clients are being hard on themselves. Accend did staff training to help clients see rehab as a patient process. • Clients viewed reassessment and review as interruptive instead of an essential element of rehab. Accend now emphasizes that the progress review is a natural process and a celebration of success.

At Accend, they view the required elements of ARMHS as part of the treatment process, not just compliance pieces. The treatment process starts with setting client goals, then identifying barriers to goals, developing measureable skills and measurable goals, with the ultimate end being function and status improvement.

The workgroup discussed other and related consumer feedback:

• Employment: Several workgroup members expressed that employment is always at the top of the list when we ask what clients need. People need different forms of support to be employed. People should not be forced to work, but employment has to be encouraged as part of rehabilitation. If people are working, they are using other services less—increasing employment services would be cost neutral (or better). • Consumer goals: a person’s goals may not fit neatly under the “medically necessary” label or fit under the rehab model (for example: finding a girlfriend), but these are critical to their treatment plan. Providers often have the person start with identifying their personal goals and then identify what is preventing the person from achieving those goals (and that’s the rehabilitation piece). A member noted that this discussion again highlights how much of the client’s needs are not currently part of the reimbursable treatment plan. • Engagement in the process: a client’s participation in their plan is a benefit in itself—using community resources, engaging in self-advocacy. • In this workgroup, we can look beyond the rehab model—we are trying to identify and address unmet needs. We should see what ways we can maximize access to resources, ways to complement different types of interventions. Can we pull in or expand resources? Improve medical education? Integrate with other educational processes? • Peer support: very relevant to ARMHS. It has a two-fold function: 1) employment for a person who has received services and 2) enhanced service to the current client. • Crisis planning: creating that plan with the consumer before a crisis is important.
6. Next steps and workgroup Discussion

The workgroup’s next meeting will be on Monday, December 17, 2012 from 2:00 – 4:00 p.m. in room 5134 at 444 Lafayette. The group will discuss funding for services, there will be a presentation on 1915(i), and there will be a presentation on Medicaid codes.

DHS will send information on 1915(i) in advance of the meeting.

At the January meeting (Wednesday, January 30 from 1:00 – 3:00 p.m.), the group will develop recommendations for the Steering Committee.

Updated information about the AMHR 2020 steering committee and workgroups is located at the DHS website: http://www.dhs.state.mn.us/dhs16_171741

7. Attachment Adult Mental Health Grant Funded Community Based Services

Information below is from Ruth Moser’s presentation.

County and AMHI Plans

• County grants are limited to SPMI

• AMHI Grants include regional cooperatives

o Include ICRS

o Crisis Response Services

o Replicate ARMHS for individuals not eligible for MN Health Care Programs

o Some ARMHS Providers provide these services

County and Adult MH Initiative Grant Plans

• Grant plans identify services and supports based on allowable service categories

• Range of Community MH Services and Supports are defined by DHS

• Examples of services and supports and are presented here to review the range of services and supports that are currently offered through the public system

Information and Referral

• Provision of information about social and human services

• Assistance to make contact with a resource that can respond to needs or problems.

Community Education and Prevention Activities

• The goals are to increase the understanding and acceptance of problems, increase awareness of the availability of resources and services, and improve skills in dealing with the high-risk situations.

• Consumer liaison positions to plan and participate in community activities/forums to educate general public on mental health. (example: Day on the Hill)

• Positions to act as resource for consumer run organizations to develop and become self-sufficient.

• Ongoing contact with consumers to promote development of natural supports

• Support consumer involvement in regional meetings and trainings such as conference fees, mileage reimbursement and stipends for attendance. (MH Forums, LAC meetings, Chamber of Commerce forums, Mayo Clinic collaborative, NAMI activities)

• Distribution of literature, executing marketing campaigns, and providing trainings and educational opportunities are organized throughout the year.

Websites

• Reallifeconversations.com, the anti-stigma site, provides information on mental health and suggested strategies for local organizations and businesses.

• REAL LIFE STORIES series: averaged 485 unique visitors per month in 2011 and 346 per month the first six months of 2012. The number of visitors increases when new stories are posted. 6 new stories planned for 2013.

Outreach

• Services designed to locate adults within the community who have or may have serious and persistent mental illness, inform them of available community support services, and assure that they have access to those services.

• Give consumers a place to develop social connections and build a sense of community

• Have speakers monthly to share health information

Project Community Connect

• We have a great variety of community resources available to attendees, including mental health and substance abuse. Primarily targeted at homeless or persons at risk of homelessness each year.

• This event is a great resource to folks new to the system and in need of outreach. Immediate needs include medication, health care, food, clothing and housing.

Transportation

• Transportation for clients to attend CSP activities and health care appointments

• City bus passes; assistance with auto repairs, maintenance, gas (non-medical); mental health transports to acute care facilities

• License tabs, vehicle repair, and gas – as a mechanism for preventing a mental health crisis.

Peer Support Services

Non-clinical, recovery-focused activities encouraging empowerment, self-determination, and decision-making provided by a Certified Peer Specialist.

Mental Health Crisis Services

• Face-to-face assessment

• Intervention services

• Health Navigator

• Rapid Access to Psychiatry

• Psychiatric Transportation

• Mobile Crisis

Volunteer, member or peer-led groups:

• Empowerment Workshop, Mind/Body/Spirit, and Cultural Exchange

• Creative writing, relaxation, community outings

• Illness Management and Recovery (IMR) and Grieving Mental Illness

• Non-Violent Communication.

Community Support Program Services

• Housing specialists assist people in finding, securing and supporting people in their housing

• Financial Workers embedded in Social Services to assist people in attaining and maintaining public assistance benefits

• Assistance with job applications, finding and maintaining employment, and securing a stable financial situation.

• On-site Physician Assistant and Public Health Nursing Services to address health and wellness issues at mental health drop–in centers

• Assisting an individual in the identification of hopes and wishes to develop options for social networks

• Linking and coordinating with other natural supports, and resources such as food, clothing, spiritually, culturally, housing and medical needs.

• Provide modeling and strategies for engaging with resources to foster relationship building

• Outreach activities such as home visits, health and wellness checks, and problem solving

• Connecting people to resources to meet their basic needs

• Finding, securing, and supporting people in their housing

• Attaining and maintaining health insurance benefits

• Assistance with job applications, finding and maintaining employment, and securing a stable financial situation

• Fostering social supports (including peer support)

• Educating about mental illness, treatment and recovery

• Assistance to develop relationships with landlords to problem solve

• Assistance with moving, seeking furniture and household goods.

• Home visits, health and wellness checks, and problem solving

• Peer support warm line

• Job coaching and supportive counseling. Staff also acts as an advocate with employers when problems arise on the job.

• Advisory Board membership

• Basic ILS, self esteem building, anxiety reduction techniques, social skills training

Clubhouses

• Providing groups and other educational opportunities surrounding health and wellness, nutrition, exercise, and medication.

• Educate consumers surrounding health and wellness, nutrition, exercise and medication.

• Reviewing financial services mail with consumers, filling out application and renewal paperwork

• Opportunity to practice social skills and develop soft skills for other employment.

Drop In Centers

• Clients socialize informally, or take part in a game, craft or activity.

• Bingo and pizza, special events such as MN Twins baseball game, MN State Fair and picnics and parties.

• Peer led support group

• Volunteer projects

Supported Employment [Must be based on EBP]

• Systematic yet flexible support provided to locate and maintain competitive employment in the community.

• Assist individuals to utilize employment interests, education, experience and skills to allow the individual to make decisions about their career goal

• Assist the individual in seeking appropriate employment, provide on-going follow-up with employer.

Basic Living/Social Skills and Community Intervention

• Services provided to rehabilitate and enable enhance psychiatric stability, social competencies, personal and emotional adjustment, and independent living and community skills, including Adult Rehabilitative Mental Health Services (ARMHS) and other rehabilitative treatments.

• Visits to consumer’s home to ensure health and safety; art supplies; client outings; homemaker; mentoring

• Direct-support services to individuals returning to the community from hospitalization or to prevent hospitalization, manages medications, referral & access to other resources, coordination of services, and monitoring of symptoms.

Emergency Response Services

Response services available on a 24-hour, seven-day-a-week basis for persons having a psychiatric crisis, a mental health crisis, or emergency. Emergency response services include telephone hot lines and similar services.

Adult Outpatient Medication Management

• Prescription, medication education

• RNs and LPNs are available for clinic and community-based services, including medication set-ups, injections, education, support, consultation, and triage.


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