Philadelphia Mobile Psychiatric Rehabilitation Services Performance Standards October 30, 2014
Mobile Psychiatric Rehabilitation Services: Performance Standards Table of Contents Page I. PURPOSE 1 II. SCOPE OF SERVICES 1 A. Objectives 2 B. Mobile Services 2 C. Group Services 3 D. Billing and Documentation for Groups 3 E. Service Eligibility 3 F. Service Outcomes 4 III. MPRS PLANNING AND DELIVERY 4 A. Assessment 4 B. Individual Rehabilitation Plan 6 C. Individual Rehabilitation Plan Update 7 D. Daily Entries / Progress Notes / Documentation 8 E. Continuing Support Planning 9 IV. MPRS PROVIDER AGENCY STRUCTURE 10 A. A MPRS provider agency should have: 10 B. Team Composition 10 C. Staffing Patterns 10 D. Authorization 11 E. Certificated Psychiatric Rehabilitation Practitioner Certification 12 V. SUMMARY OF PRACTICES 12
VI. MPRS STAFF QUALIFICATIONS and MPRS-REQUIRED TRAININGS 13 A. Elements of Job Description 13 B. Signed and Dated Job Description 13 C. MPRS Director Qualifications 13 D. MPRS Specialist Qualifications 14 E. MPRS Worker Qualifications 14 F. MPRS Assistant Qualification 14 G. Peer Specialist Supervisor Qualification 14 H. Evidence of Completed Psychiatric Rehabilitation Training 14 I. Evidence of Certified Peer Specialist Training 15 VII. STAFFING REQUIREMENTS 15 A. Criminal History Background Check 15 B. Academic Degree Verification 15 C. Staff Meets Minimum Job Qualifications 15 D. Presence of Completed Resume/CV/Application 16 E. Presence of Employment Verification and/or Performance Evaluations 16 F. Evidence of Completed CBH Mandatory Trainings 16 G. Cardiopulmonary Resuscitation Certification and First Aid Training 16 H. Recovery and Resilience Training 16 VIII. CONTINUOUS QUALITY IMPROVEMENT 16 IX. PARTICIPATION IN ONGOING QUALITY REVIEWS 17
Mobile Psychiatric Rehabilitation Services: Performance Standards I. PURPOSE The purpose of the Mobile Psychiatric Rehabilitation Services (MPRS) Performance Standards is to describe a service that supports recovery through skill-building activities, so that individuals achieve success and build capacity in the living, working, learning and social communities of their choice. The Commonwealth of Pennsylvania issued Regulations for Psychiatric Rehabilitation Services (PRS) in the Pennsylvania Code under Title 55 Chapter 5230. The PRS State Regulations establish the minimum requirements needed to obtain an operating license for MPRS and are applicable to all counties across the State of Pennsylvania. The MPRS Performance Standards provide a blueprint for the delivery of MPRS in Philadelphia County and reflect the core values and principles of both the City of Philadelphia Department of Behavioral Health and Intellectual disability Services (DBHIDS) Practice Guidelines (PG) and the Commonwealth of Pennsylvania Code Chapter 5230 Psychiatric Rehabilitation Services. Performance Standards are intended to serve as a tool to promote continuous quality improvement and progression towards best practice performances, increase the consistency of service delivery, and to improve outcomes for individuals. II. SCOPE OF SERVICES MPRS are voluntary, community-based, and conducted face to face. They focus on helping individuals with mental health and co-occurring challenges develop skills of their choice and access appropriate resources. These services strive to provide the same opportunities that are available to the general community. Individuals must lead the planning, development and management of the activities that will help them to achieve their goals. The role of the provider agency is to collaborate with both the individual participating in services - and their other supports - in identifying goals, developing individualized skills necessary to achieve these goals, and obtaining supports required to maintain these skills. MPRS may be delivered to individuals who have housing subsidies under various voucher programs (i.e. PHA, Bridge, PHFA, etc.). It should be noted that there are some housing subsidies that require a service component. However, it is strongly encouraged that all individuals participate in community support services. MPRS are person-directed, holistic, collaborative, strengths-based, culturally sensitive, trauma-informed and evidence-based. The primary goal of MPRS is to assist an individual in developing skills to use in the communities of their choice. MPRS incorporate lessons learned throughout Philadelphia communities and broaden the services available to an individual. MPRS Performance Standards Page 1
A. Objectives The objectives for MPRS include, but are not limited to, the following: To provide assertive outreach and initial engagement to individuals who are eligible for this service and/or who are referred for this service [PG-Domain 1]; To assess, with the individual, the person s needs and preferences in terms of skills and supports he/she wants to develop [PG- Domain 2]; To educate the individual about behavioral health challenges and recovery techniques [PG- Domain 3]; To collaborate with the individual who leads the development of his or her rehabilitation plans [PG- Domain 3]; To collaborate with the individual in achieving and maintaining rehabilitation goals, as well as how to reconnect with services after discontinuation if needed [PG- Domain 3]; To collaborate with the individual in assessing and utilizing resources in their community (e.g., natural supports, self-help groups, vocational & educational specialists, etc.) [PG- Domain 4], and; To collaborate with the individual in developing skills needed [and desired] to live, work, learn and socialize in the environments of their choice. [PG- Domain 4]. B. Mobile Services MPRS staff must spend a majority of their time working with individuals outside of the home setting. Staff should accompany participants into the community to promote the transfer of new skills into the natural environment. The goal of such involvement outside the home is to enhance the individual s community inclusion by: (1) increasing the individual s skills and use of community resources and (2) supporting participation in community activities which the individual can continue to use in support of their recovery. The method for achieving this goal must be indicated in each participant s Individual Rehabilitation Plan (IRP), as well as in the daily entries/progress notes for that individual. MPRS cannot occur simultaneously with other Medicaid-reimbursable behavioral health services, with the exception of service coordination or linkage meetings. Services are provided individually in the community on a one staff to one individual ratio (1:1), unless a group service (see below) is deemed appropriate to the individual s goals. MPRS Performance Standards Page 2
C. Group Services Consistent with PRS State Regulation 5230.54, the ratio of staff to individuals in a group setting may not exceed a one staff to five individuals ratio (1:5). Further, group services delivered in the community shall be limited to individuals who have IRP goals that specify the need for that particular service in the community. Participation in group services is always the choice of the individual receiving MPRS. The decision of the individual is based upon their own interest in participating in groups in consideration of their needs and IRP goals. Goal-oriented, individualized notes must be written for each person utilizing a community setting. Consistent with PRS State Regulation 5230.54 (g), MPRS shall arrange for group discussion of the experience before and after service is conducted in the community. The group discussion shall occur in a setting that assures confidentiality. Some examples of group settings may include, but are not limited to, encouraging up to five individuals to: Plan an outing for individuals to practice newly developed skills, i.e. socialization skills. Develop a support group around a specific topic Develop a skills-building group around a specific topic D. Billing and Documentation for Groups As an example: One MPRS team member assists five individuals in a skill-building activity (such as grocery shopping) that is three hours long. This activity might involve developing money management, transportation and/or nutrition skills. The three hours must be divided across the five individuals when billing [similar to Targeted Case Management (TCM)]. Therefore, the provider agency cannot bill five times for the three-hour session. Individual documentation for each participant that attended is required. If one individual required more assistance and took more of the MPRS team member s attention, this should be reflected in documentation. E. Service Eligibility To be eligible to receive MPRS, an individual must meet the following criteria: Be 18 years of age or older Have a written recommendation for MPRS by a Licensed Practitioner of the Healing Arts (LPHA) within the scope of professional practice. The term LPHA is limited to a physician, physician s assistant, certified registered nurse practitioner, and licensed psychologist. Have a current behavioral health diagnosis of a serious mental illness, including, but not limited to, a diagnosis of schizophrenia, major mood disorder, psychotic disorder NOS, schizoaffective disorder or borderline personality disorder. MPRS Performance Standards Page 3
Have moderate to severe challenges in functioning in at least one of the following domains as a result of their behavioral health challenge(s): living, learning, working or socializing. The person chooses to participate in the service. Exception: As per PRS State Regulation 5230.31 (c)(1): Individuals who do not meet the serious mental illness diagnosis requirement may receive services when the following conditions are met: 1. The written recommendation of the LPHA includes a diagnosis of mental illness that is listed on Axis I in the DSM-IV-TR or ICD-9 or subsequent revisions. (For example, Post Traumatic Stress Disorder) 2. The written recommendation of the LPHA includes a description of the functional impairment resulting from the mental illness described above. F. Service Outcomes The following qualities have been documented in research studies and are among those DBHIDS encourages as outcome expectations for MPRS in the HealthChoices program. Increased community tenure Reduced psychiatric hospitalization(s) Evidence of improvement in skill-building Improved stability of housing status Quality of life Decreased misuse of recreational or illicit drugs Self-recognition of progress Heightened self-esteem Improved vocational and/or educational status Improved member satisfaction with behavioral health services received Improved participation to agreed-upon services Reduced involvement with criminal justice III. MPRS PLANNING AND DELIVERY A. Assessment Assessments are a comprehensive gathering of information regarding the individual s strengths, challenges, behavioral health needs, social environmental supports, priorities, and goals. Importantly, this information may be obtained through interviews with the individual and can include discussion with family members/significant others and other natural supports of the individual s choice. In addition, a review of clinical records, and contact with collaborating agencies may be used. MPRS Performance Standards Page 4
A comprehensive assessment will be completed upon each individual s admission to MPRS and every six months thereafter. A comprehensive assessment should be strengths-based, reviewed regularly, and must also identify and document the functional impairment of the individual. The intent of the strengths-based component is to identify an individual s strengths so that they may be utilized when developing skills in an area of need. Ongoing assessments must reflect the ongoing outcomes of an individual s previously identified goals and build on those. The assessment should be a collaborative process that identifies the strengths and needs upon which the IRP is based. In general, the assessment focuses on the skills and the resources the person needs to achieve a rehabilitation goal. A holistic assessment is the tool from which the goals of the IRP are developed. Consistent with PRS State Regulation 5230.61, an assessment of an individual shall (a) Be completed prior to developing an IRP. (b) The assessment shall be completed in collaboration with the individual and must: 1. Identify the functioning of the individual in the living, learning, working and socializing domains. 2. Identify the strengths and needs of the individual. 3. Identify existing and needed natural and formal supports, including other health care services and social service agencies. 4. Identify the specific skills, supports and resources the individual needs and prefers to accomplish stated goals, which may include, but is not limited to: Home Living: Cooking, cleaning, shopping, laundry, appropriate home maintenance, etc. Medication Management: Understanding purpose, need and appropriate self-administration of each medication as prescribed. Money Management: Budgeting, bill-paying, banking, past debts, etc. Managing Benefits: Social Security, Medicaid, Medicare, housing subsidies, utility assistance, etc. Transportation: e.g., Travel training Legal: Immigration, Name change, court-related issues including both civil and criminal Community Participation and Inclusion Self-care (Wellness, Health and Safety, such as): Personal hygiene, dressing and grooming, physician appointments, wellness and crisis/emergency planning Spirituality Vocational MPRS Performance Standards Page 5
Educational Social Relationships and Activities: Reducing isolation, encouraging connection with peers, family, friends, associates and self-help or support groups both within and without the behavioral health system Family Relationships Self Development: Including leisure and recreational activities, learning new skills, hobbies and other enrichment activities Sexuality Substance misuse 5. Identify cultural needs and preferences of the individual. 6. Be signed by the individual and staff. 7. Be updated every six months and when one of the following occurs: (i) The individual requests an update (ii) The individual completes a goal (iii) The individual is not progressing on stated goals B. Individual Rehabilitation Plan The IRP is the vehicle an individual drives to meet his or her goals. In collaboration with staff, the IRP shall be led by the individual participating in services and developed from the individual s assessment. An individual chooses which supports to include during the development of his or her IRP. At the individual s discretion, natural supports (such as family and/or significant others) and formal supports (such as case managers, Certified Peer Specialists, MPRS staff, etc.), will participate in the development of that plan. The IRP shall be written in a manner easily understood by the individual participating in services. In addition, a copy of the IRP will be given to individuals so that they may assume ownership of their plan. Consistent with PRS State Regulation 5230.62, the initial IRP shall be completed by day 20 of participation, but no more than 60 calendar days after initial contact. The IRP shall include the following: Measurable goals and objectives designed to achieve specific outcomes; a copy of this document shall be given to the individual. Goals and objectives that are uniquely addressed by support services of the individual s choosing; goals and objectives that move beyond maintenance goals and reflect an individual s independence. MPRS goals and objectives that are distinct and different for each provider agency. This must be accomplished through collaboration between services and providers. MPRS Performance Standards Page 6
The responsibilities of the individual and staff. Action steps and time frame to achieve goals and objectives. The intended locations of service. Face-to-face interactions that must occur, at a minimum, on a weekly basis between MPRS staff and individuals participating in services, unless otherwise specified in the IRP, as requested by the individual. A plan for monthly linkage meetings, facilitated by the Case Manager (or the support of choice if the individual has refused TCM services) and with all supports present, including a MPRS staff representative to discuss the individual s progress and collaboration of services. A Plan for Service Coordination Meetings: If applicable, a plan for three service coordination meetings, facilitated by the Targeted Case Manager (TCM), (or the formal support of choice if there are no TCM services) as the individual moves into his or her Permanent Supportive Housing (PSH) apartment. - The first Service Coordination meeting is the Pre-tenancy phase - The second Service Coordination meeting is the Pre-move in phase (which occurs just prior to leasing an apartment) - The third Service Coordination meeting is the Post-move in phase The Tenant Service Coordinator (TSC) is required to attend the Pre-move in meeting, but may attend all three Service Coordination meetings If Service Coordination meetings are not occurring as required, this should be documented and reported to the TCM Specialist at 215-599-2150. Dated signatures of the individual, the staff working with the individual and the MPRS Director. C. Individual Rehabilitation Plan Update Consistent with PRS State Regulation 5230.62, the IRP shall be updated at least every 90 calendar days and when: (1) a goal is completed; (2) no significant progress has been made; and (3) and individual requests a change. Staff should review and reference the assessments with the individual at each IRP update. An IRP update shall include a comprehensive summary of the individual s progress that includes the following: Response to service. A summary of progress or lack of progress toward the goal in the IRP. A summary of changes made to the IRP s goal and objectives. Dated signature of the individual, signifying informed participation and agreement with the goals and objectives. Documentation of the reason if the individual does not sign. Dated signature of the MPRS staff working with the individual, including the MPRS Director. MPRS Performance Standards Page 7
Successive rehabilitation plans must utilize MPRS processes that include goals, objectives and measurable outcomes which specifically address the individual s identified need(s). D. Daily Entries / Progress Notes / Documentation Each MPRS provider agency shall maintain a record for each individual. The record must be organized, legible (as stipulated in Pa. Code [1101.51.e.1.i] of General Provisions 1101), contain identifying data and up-to-date information relevant to the individual s goals. All documentation must clearly reflect staff interventions related to the individual s goals and objectives. Please note: If an individual is enrolled in MPRS and a Community Integrated Recovery Center (CIRC) program, then the individual must have distinct and different goals within each service. Documentation within the progress notes must clearly identify these differences. Consistent with PRS State Regulation 5230.63, every MPRS provider agency shall include a progress note for the day service was provided in an individual s record which documents the following: Date of service Time and duration of service; start and end clock times must be documented Location(s) of service Type of interaction: This term refers to the MPRS activity provided such as whether the activity was an individual or group interaction, and whether the activity included such elements as assessment, goal planning, skills teaching, modeling, practicing, searching for community resources, etc. Interventions implemented in the context of the individual s MPRS goals and objectives Only face-to-face interactions are billable, however other types of interactions should still be documented The individual s response to the service and progress or lack of progress toward goals and objectives The need for goal continuance shall be documented Plan for the continuation and collaboration of services All linkage or service coordination meetings or attempts to hold linkage or service coordination meetings should be documented. Note that MPRS staff can only bill if the individual is present at the linkage meeting. Signature of the individual, or if the individual does not sign, document the reason Signature and date by the staff providing the service MPRS Performance Standards Page 8
E. Continuing Support Planning Consistent with PRS State Regulations 5230.71 and 5230.72, a continuing support plan shall be led by the individual, in collaboration with staff. Documentation of continuing support planning shall include, but is not limited to, the following: Rationale for transitioning the individual from the service, including assertive attempts to engage or re-engage the individual if the individual is being discharged due to disengagement in services. Service(s) provided. Outcomes and progress of MPRS goals. Referral or recommendations for future services. Connection to community supports and resources. A Crisis Management Plan, initiated at the start of services. Information about Wellness Plans, such as the Wellness Recovery Action Plan (WRAP). A Re-engagement Plan, which includes phone numbers for: o The Tenant Service Coordinator at: Resources for Human Development (RHD): 215-324-7615 Horizon House: 215-386-3838 Northwestern Human Services (NHS): 215-242-8461 o Project Home/MPRS Program Manager: 215-235-3110 ext. 5640 o Targeted Case Management (TCM) Unit: 215-599-2150 o BHSI (Behavioral Health Special Initiative): 215-546-6435 o CBH (Community Behavioral Health) Member Services: 1-888-545-2600 o Office of Supportive Housing Clearinghouse: 215-686-6232 Signature of the individual and an opportunity to provide feedback. Evidence that the individual received a contact sheet of their resources. This may require that the contact sheet is mailed to the individual s last known address. A disengagement summary, signed by the MPRS Director, completed no more than 30 days after disengagement. MPRS Performance Standards Page 9
IV. AGENCY STRUCTURE A. A MPRS provider agency should have: A focus on supporting individuals to maintain and thrive in the housing of their choice. The ability to provide mobile supports, assisting individuals where they live and in the communities of their choice. The ability to provide flexible supports, so that services increase or decrease in intensity as the individual s needs change. B. Team Composition At a minimum, a MPRS provider agency must reflect the team composition indicated below: A MPRS Director shall supervise staff 25% of the Full Time Equivalent (FTE) staff complement must meet the qualifications of a MPRS Specialist within 1 year of initial licensing. One or more MPRS Specialists; a MPRS Specialist may perform supervisory functions as delegated by the MPRS Director, consistent with approved job descriptions for the two positions. Though not required, a team may employ one or more Psychiatric Rehabilitation Workers, Psychiatric Rehabilitation Assistants and Certified Peer Specialists (CPS). [See MPRS Staff Qualifications for each position] For CPS-licensed programs, if the team incorporates one or more CPSs, a trained CPS Supervisor must also be a member of the MPRS team. For continuity of team service, it is recommended that the CPS Supervisor also have MPRS credentials. [See MPRS Staff Qualifications and MPRS Required Trainings]. C. Staffing Patterns All MPRS staff in supervisory positions must be full-time employees 50% of all MPRS staff must be full-time employees A MPRS provider agency must have a minimum of one FTE MPRS staff for every ten individuals served A MPRS provider agency must serve individuals during evening and weekend hours MPRS Performance Standards Page 10
DBHIDS encourages a team approach in order to guarantee consistent coverage of services, accommodate staff absences, and appropriately match staff skills and knowledge to individuals IRP goals. Peer Support is a separate and distinct service and is not MPRS. When a CPS is employed in any MPRS staff role (MPRS Assistant, Worker, Specialist or Director) the CPS must meet the applicable requirements for the position and must deliver MPRS, not Peer Support. If a MPRS provider agency would choose to embed a CPS in the MPRS agency to offer Peer Support Services, those services would not be compensable as MPRS. D. Authorization MPRS are to be billed for in 15 minute increments; 1 unit equals 15 minutes of MPRS MPRS are authorized initially for 1000 units per six months, per individual; however, additional units can be requested as justified by need in the individual s comprehensive assessment and IRP. For provider agencies having CPS-licensed programs, CPS Services are authorized for initially for 1000 units per six months, per individual; however, additional units can be requested as justified by need in the individual s comprehensive assessment and IRP. Please note: A CPS may work with several individuals within a single day; however that CPS may only spend up to four hours per day with each individual with whom s/he works. [See CPS Guidelines]. A MPRS provider agency shall initiate contact within business five days and conduct face-to-face contact within ten business days of Authorization. E. Certificated Psychiatric Rehabilitation Practitioner (CPRP) Certification At a minimum, 25% of the FTE staff complement within a MPRS provider agency must be certified through the Psychiatric Rehabilitation Association (PRA) as psychiatric rehabilitation practitioners within 2 years of initial licensing. MPRS Performance Standards Page 11
V. SUMMARY OF PRACTICES Effective and meaningful participation in service planning and delivery is a hallmark of MPRS. Demonstration of these key elements is a critical part of the functioning of each program. a) MPRS shall assist an individual to develop, enhance and retain skills and competencies in living, learning, working and socializing so that an individual can live in the environment of choice and participate in the community. b) The individual involved in MPRS should lead their own IRP, have a clear understanding of the plan and be able to articulate, in their own words, their current goals and objectives. c) MPRS shall use the MPRS process in delivering MPRS. The process shall consist of three phases: (1) Assessing Phase. I. Initial engagement; developing a relationship and trust; II. Individual s desire for services III. Completing mutual assessment of needs through shared decision-making IV. Goal Setting (2) Planning Phase I. Prioritizing needed and preferred skills and supports II. Planning for resource development and collaboration of resources III. Documenting the above utilizing an IRP (3) Intervening Phase I. Developing new skills II. Supporting existing skills; looking at recovery capital III. Overcoming barriers to using skills IV. Identifying or modifying an individual s resources to pursue a goal d) MPRS shall ensure that the following practices are included in programming and staff training and in agency and individual record maintenance. 1) Creating a culturally competent, recovery-oriented environment, consistent with rehabilitation principles. 2) Engaging an individual in MPRS. 3) Assessing individual strengths, interests and preferences for MPRS with an individual. 4) Developing strategies to assist an individual in identifying, achieving and maintaining valued roles. 5) Developing an IRP with an individual. 6) Helping an individual increase awareness of community resources and identify preferred options for the rehabilitation process. 7) Educate an individual about behavioral health challenges, wellness and living in recovery. 8) Providing direct or indirect skills development. 9) Assisting an individual in identifying, developing and utilizing natural supports. MPRS Performance Standards Page 12
10) Reaching out and re-engaging an individual who discontinues service participation. 11) MPRS shall be provided to an individual as long as such services do not occur simultaneously with other Medicaid-reimbursable services. a) MPRS contact shall begin within five business days and face-to-face contact within ten business days after Authorization. b) MPRS shall collaborate and coordinate with other service agencies with the consent of the individual. 12) MPRS shall follow Philadelphia Guidelines for Evidence-based Practices (EBP) and best practices of the specific MPRS approach identified in the MPRS agency service description. 13) MPRS may be offered in the community, as is consistent with an approved MPRS agency service description. [See Mobile Services]. VI. MPRS STAFF QUALIFICATIONS and MPRS-REQUIRED TRAININGS A. Elements of Job Description: MPRS are a complex service involving a great variety of tasks. Supporting participants long-term success involves providing and/or organizing a highly flexible, individually tailored set of services and supports for each person. Each day s work can be different from the next. Persons working on MPRS teams are ones who enjoy variety; they need to be good at improvising and coming up with creative solutions to situations due to each individual s uniqueness of choice, needs and circumstances. B. Signed and Dated Job Description Evidence of a job description for each staff, with minimum degree and experience required, signed and dated on the date of hire by both the employer and the employee. C. MPRS Director Qualifications A MPRS Director must have one of the following set of qualifications to direct a MPRS team: (1) A bachelor s degree and CPRP certification (2) A bachelor s degree and at least three years of work experience in mental health direct service, two years of which must be work in MPRS. CPRP certification must be attained within two years of hire as a MPRS Director. MPRS Performance Standards Page 13
D. MPRS Specialist Qualifications An MPRS Specialist shall have one of the following: (1) A bachelor s degree and two years of work experience in behavioral health direct service, one year of which must be work experience in MPRS. CPRP certification shall be attained within two years from the date of hire. (2) CPRP certification E. MPRS Worker Qualifications A MPRS Worker shall have one of the following: (1) A bachelor s degree. (2) An associate s degree and one year work experience in mental health direct service. (3) A CPS certificate and one additional year paid or volunteer work experience in mental health direct service. (4) A High School diploma or General Education Degree (GED) equivalent, plus two years experience in human services, which must include one year of direct mental health service. F. MPRS Assistant Qualification A MPRS Assistant shall have a high school diploma or GED and six months experience in human services. G. Peer Specialist Supervisor Qualification For provider agencies having CPS-Licensed programs, supervisors of Peer Support Services are required to complete a DBHIDS approved Peer Supervisory orientation/training course within 6 months of assuming the position of Peer Specialist Supervisor. [See Team Composition]. H. Evidence of Completed Psychiatric Rehabilitation Training MPRS staff must be able to demonstrate competency in psychiatric rehabilitation principles, values, and practice. As such, all staff are required to complete the following trainings: Six (6) hour of face-face training by a MPRS Director or Specialist designated as a supervisor in the MPRS model or approach is required before new staff can work independently Twelve (12) hours of orientation to psychiatric rehabilitation within one (1) year of the program starting. Eighteen (18) hours of training per year is required with the focus being on psychiatric rehabilitation. The 12-hour orientation course counts towards the 18-hour annual training requirement. In addition, 12 of the 18 hours of required annual training must focus on psychiatric rehabilitation or recovery practices or both. MPRS Performance Standards Page 14
I. Evidence of Certified Peer Specialist Training For provider agencies having CPS-Licensed programs, Certified Peer Specialists will collaborate with the services furnished under MPRS. Peer Specialists are required to complete a DBHIDS approved Peer Specialist Certification training before providing Peer Support Services. Additionally, Peer Specialists are required to complete 18 hours of continuing education per year with 12 hours specifically focused on Peer Support or recovery-oriented practices, or both, to maintain a Peer Specialist Certification. [See CPS Guidelines]. VII. STAFFING REQUIREMENTS Each MPRS provider agency shall maintain a file for every staff. Specific documentation to be reviewed includes: A. Criminal History Background Check Evidence of a CURRENT (updated every two [2] years) Child Abuse Clearance. Evidence of a CURRENT (updated every two [2] years) Criminal History Background Check. Evidence of a CURRENT (updated every two [2] years) FBI clearance for staff who reside outside the Commonwealth of Pennsylvania, or who have relocated outside of the Commonwealth within 12 months. Evidence that the action taken by the provider agency on the outcome of the criminal history background check(s) is congruent with its Human Resources policy and procedures of the same. B. Academic Degree Verification Evidence of a verified copy of original academic degree(s) or college/university transcripts. Verification requires an authorized staff signature, date and the phrase, Original Seen, legibly written on the copied document. Evidence of degree verification for all foreign trained staff by an accredited educational agency, such as the World Educational Services (WES) or the Education Commission on Foreign Medical Graduates. C. Staff Meets Minimum Job Qualifications Evidence that the employee meets the minimum requirements for the position, as delineated in the job description. MPRS Performance Standards Page 15
D. Presence of Completed Resume/CV/Application Files must contain either a resume/cv or an employment application to confirm whether staff member meets the minimum job requirements. E. Presence of Employment Verification and/or Performance Evaluations Files shall contain evidence of verification of two (2) prior employers and an initial performance evaluation or most recent performance evaluation, as stipulated in the provider agency s Human Resources policy. F. Evidence of Completed CBH Mandatory Trainings MPRS staff members are required to complete CBH mandatory trainings within 90 days from the date of hire. These include, but are not limited to: Fire Safety & Prevention Disaster Training Suicide Precautions Management of Escalation Infection Control Cultural Awareness LGBTQI G. Cardiopulmonary Resuscitation (CPR) Certification and First Aid Training Each MPRS program must ensure that 50% of staff holds current CPR certification. Up to 40% of the staff of each program may be trained in Citizen CPR (hands only). At least 10% must be trained in traditional CPR. H. Recovery and Resilience Training It is expected that all MPRS staff persons understand the principles and application of the Practice Guidelines. (DBHIDS Practice Guidelines 2011) VIII. CONTINUOUS QUALITY IMPROVEMENT Each MPRS provider agency shall establish and implement a written Quality Improvement (QI) plan that meets the following requirements: A. Provides for an annual review of the quality, timeliness and appropriateness of services, including the following: 1) Outcomes for PRS. 2) Individual record reviews. 3) Individual satisfaction. 4) Use of concurrent review for continued stay and exceptions to admission. 5) Evaluation of compliance with the MPRS description. MPRS Performance Standards Page 16
B. Identifies reviewers, frequency and types of review and methodology for establishing sample size. C. Each MPRS provider agency shall document that individuals served participate in the QI plan development and follow up. D. Each MPRS provider agency shall prepare a report that: a) Documents analysis of the findings on an annual basis. b) Identifies actions to address annual review findings. c) The report is available to the public. The PRS agency is required to maintain a copy of the annual QI report at the facility, and make it available to the public (i.e. stakeholders) on request. IX. PARTICIPATION IN ONGOING QUALITY REVIEWS The Philadelphia Department of Behavioral Health and disability Services shall provide a collaborative evaluation process for MPRS Providers, identifying their strengths and areas for improvement. This includes determination of staff knowledge and implementation of MPRS, Practice Guidelines and overall recovery practices. Additionally, this may include, but is not limited to: Continuous Quality Improvement (CQI) requirements, Consumer Satisfaction Team (CST) reporting, instruments for community inclusion, the Housing Transformation Assessment and Support (HTAS) process, the Network Inclusion Criteria (NIC) through the Network Improvement and Accountability Collaborative (NIAC) and other reviews stipulated by the Department. Regardless of the tool used, the results from each evaluation will be shared and fed into other evaluation processes. There should be consistency in the results across all of the tools and evaluation processes. These processes are designed to help providers improve their services. The City of Philadelphia DBHIDS is committed to ensuring that its network of providers delivers quality services to its members. To this end, it shall be the policy of DBHIDS to offer individualized technical assistance (TA) to DBHIDS contracted or funded provider/programs. TA is a collaborative, proactive process in which organizational capacity is strengthened to improve clinical effectiveness and to promote quality of services. TA shall be delivered up to one year in a variety of modes, and in alignment with DBHIDS Practice Guidelines. MPRS Performance Standards Page 17
Mobile Psychiatric Rehabilitation Services (MPRS): Performance Standards MPRS STANDARDS GLOSSARY APPENDIX A Assessment Axis I A comprehensive gathering of information regarding the individual s strengths, challenges, behavioral health needs, social environmental supports, priorities, and goals. The tool from which the IRP is built. One of the five dimensions relating to different aspects of the diagnosis of a psychiatric disorder or disability as organized in the DSM-IV-TR or subsequent revisions Axis I specifies clinical disorders, including major mental disorders BHSI CBH CIRC Community Integration or Community Inclusion Continuing Support Planning CPR CPRP CPS CSS CQI CST Culturally Competent/ Culturally Sensitive DBHIDS DSM-IV-TR Evidence-based Practice or Service Behavioral Health Special Initiatives Community Behavioral Health Community Integrated Recovery Center The opportunity to live in the community and to be valued for one s uniqueness and abilities like everyone else (Salzer, 2006). Planning for discontinuation of a PRS service to an individual Cardio-Pulmonary Resuscitation Certified Psychiatric Rehabilitation Practitioner Certified Peer Specialist: A person who has successfully completed the Departmentapproved training in peer support services Community Support Services Continuous Quality Improvement Consumer Satisfaction Team The ability to provide service in a manner that shows awareness of and is responsive to the beliefs, interpersonal styles, attitudes language and behavior of an individual and family who are referred for or are participating in services. Department of Behavioral Health and Intellectual disability Services Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision Service delivery practice identified, recognized and verified by research and empirical data to be effective in producing a positive outcome and supporting recovery
Mobile Psychiatric Rehabilitation Services (MPRS): Performance Standards MPRS STANDARDS GLOSSARY APPENDIX A Face-to-Face FTE Formal Support Functional Impairment GED Goal HTAS ICD-9 Interventions IRP Individual or Participant Linkage Meeting LPHA Medicaid MPRS Contact between two or more people that occurs at the same location, in person Full-time Equivalent: 37.5 hours per calendar week of staff time An agency, organization or person who provides assistance or resources to others within the context of an official role. The loss or abnormality of the ability to perform necessary tasks. General Equivalency Diploma The purpose of the rehabilitation service as identified by the individual; a goal is designed to achieve a measurable outcome desired by the individual Housing Transformation Assessment and Support: A Services Quality Improvement Vehicle International Classification of Diseases, Ninth Edition Actions taken by formal staff that assist an individual in achieving his or her PRS goals. Individual Rehabilitation Plan: A document that describes the current service needs based on the assessment of the individual and identifies the individual s goals, interventions to be provided, the location, frequency and duration of services, and staff who will provide the service. A person, 18 years of age or older, who has a functional impairment resulting from mental illness, who uses PRS. Linkage meetings are regular meetings of members of the individual s support team (e.g. Residential staff, MPRS staff, CPS, Case Mangers, Family members, Other supports) that occur at least once per month. The Linkage Meeting includes the individual. The purpose of the meeting is to discuss the individual s progress with the objectives contained in the Unified Services Plan (PGP) related to the Service Coordination Meetings and any other new relevant issues and concerns regarding the individual s well-being. Licensed Practitioner of the Healing Arts (i) an individual licensed by the Commonwealth to practice the healing arts (ii) The term is limited to a physician, physician s assistant, certified registered nurse practitioner and licensed psychologist Also referred to as Medical Assistance; coverage through the Department of Public Welfare Mobile Psychiatric Rehabilitation Services: Voluntary, community-based, recovery-oriented services, conducted face-to-face, which focus on helping individuals develop skills of their choice and access appropriate resources.
Mobile Psychiatric Rehabilitation Services (MPRS): Performance Standards MPRS STANDARDS GLOSSARY APPENDIX A NA Natural Support NHS NIAC NIC Objective Outcome Narcotics Anonymous A person or organization selected by an individual to provide assistance or resources in the context of a personal or non-official role. Northwestern Human Services; A MPRS Provider Network Improvement and Accountability Collaborative Network Inclusion Criteria A productive step taken by an individual toward achieving a specific PRS goal An observable and measurable result of PRS Project Home PG A MPRS Provider Practice Guidelines: The Practice Guidelines are meant to help providers implement services and supports that promote resilience, recovery, self-determination and wellness in children, youth, adults and families. The strategies offered are examples of the types of activities and services that providers can implement. The guidelines apply to all treatment providers and individuals who are reimbursed for working in a provider organization at all levels of care. However, they are not intended to encapsulate all possible services or supports that promote recovery and resilience. The Philadelphia DBHIDS PRACTICE GUIDELINES can be found at: http://dbhids.org/practice-guidelines Domain I: Assertive Outreach and Initial Engagement Domain II: Screening, Assessment, Service Planning and Delivery Domain III: Continuing Support and Early Re-intervention Domain IV: Community Connection and Mobilization PRA PRS PSH RHD Recovery Psychiatric Rehabilitation Association Psychiatric Rehabilitation Services: Recovery-oriented services offered individually or in groups, which is predicated upon the principles values and practices of the ICCD, USPRA or other Nationally recognized professional PRS association. Permanent Supportive Housing Resources for Human Development; A MPRS Provider Recovery is the process of pursuing a contributing and fulfilling life regardless of the difficulties one has faced; it involves not only the restoration, but also continued enhancement of a positive identity as well as personally meaningful connections and roles in one s community.
Mobile Psychiatric Rehabilitation Services (MPRS): Performance Standards MPRS STANDARDS GLOSSARY APPENDIX A Recovery Capital Service Coordination Meeting TCM TCM TSC TSL Trauma-informed Care WRAP The personal strengths and resources possessed by an individual Services Coordination Meetings address the need to appropriately, efficiently and successfully support each Housing Services Participant as s/he transitions from a supportive living program to a living arrangement which promotes greater independence and selfdetermination. Targeted Case Management: Serves individuals who live in the community and who have serious and persistent mental health challenges. It also serves persons with co-occurring conditions such as the use of Alcohol and Other Drugs (AOD), as well as other special populations defined by the Pennsylvania Department of Public Welfare Health Choices Initiative. Targeted Case Manager: A Targeted Case Manager is a member of a case management team that assists individuals to make full use of their natural community supports and all available behavioral health services which will enable individuals to live stable, healthy and safe lives in the community of their choice. CSS Tenant Service Coordinator: Primary role is to coordinate communication and issue resolution between Support Services Provider, individual Tenant and related Landlord, and the Clearinghouse. To serve as point of contact for Clearinghouse Tenant Service Liaison (TSL) for all tenants served by the support services provider agency. Clearinghouse Tenant Services Liaison: Primary role is to develop and maintain relationships with Landlords, Property Developers and Property Managers and serve as Central Point of Contact to ensure access to units and successful tenancy system wide Trauma survivors experiences can help shape their responses to outreach and services. Trauma-informed care approaches individuals with histories of trauma by first acknowledging that history. It is a treatment framework that involves understanding, recognizing, and responding to the effects of all types of trauma. Trauma Informed Care also emphasizes physical, psychological and emotional safety for both PRS participants and providers, and helps survivors rebuild a sense of control and empowerment. Wellness Recovery Action Plan
Mobile Psychiatric Rehabilitation Services (MPRS): Performance Standards STATEMENT OF INDIVIDUAL RIGHTS APPENDIX B (1) An individual has the right to be treated with dignity and respect and to be free from physical and mental harm. (2) An individual has the right to receive MPRS in a culturally respectful and nondiscriminatory environment. (3) An individual has the right to receive MPRS in the least restrictive setting that fosters recovery and promotes growth. (4) An individual has the right to access competent, timely and quality service to assist with fulfillment of a goal. (5) An individual has the right to express a goal that is individualized and reflects informed choice concerning selection, direction or termination of service and service plan. (6) An individual has the right to choose a service based upon individual need, choice and acceptance and not dependent on compliance or participation with another treatment or rehabilitation service. (7) An individual has the right to keep and use personal possessions in a manner that is reasonable to the service and location. Any necessary limitations shall be clearly communicated and defined, universally applied and documented. (8) An individual has the right to offer an opinion and belief. (9) An individual has the right to file a complaint related to MPRS and to have the complaint addressed. (10) An individual has the right to have the assistance of a personally chosen representative or advocate in expressing a complaint. (11) An individual has the right to be able to contribute to, have access to and control release of the individual s record. (12) An individual has the right to have information and records concerning service treated in a confidential manner as required under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the Act of August 21, 1996 (Pub. L. No. 104-191, 110 Stat. 1936). (13) A MPRS Agency shall: (a) Assure compliance with the MPRS Statement of Individual Rights. (b) Develop and implement a written procedure for assuring compliance with the MPRS Statement of Individual Rights. (c) Post the MPRS Statement of Individual Rights in an area with high visibility within the facility housing the MPRS administrative records. (d) Notify an individual verbally and in writing of his or her rights and include a signed acknowledgement of rights in the individual s record. (e) Develop the Individual Rehabilitation Plan in compliance with individual rights.
CORE PRINCIPLES & VALUES Defining Psychiatric Rehabilitation: Psychiatric rehabilitation promotes recovery, full community integration and improved quality of life for persons who have been diagnosed with any mental health condition that seriously impairs functioning. Psychiatric rehabilitation services are collaborative, person directed, and individualized, and an essential element of the human services spectrum and should be evidence based. They focus on helping individuals develop skills and access resources needed to increase their capacity to be successful and satisfied in the living, working, learning and social environments of their choice. The following Core Principles and Values are meant to further describe key elements of psychiatric rehabilitation practice. In addition, all psychiatric rehabilitation service providers should be guided by USPRA s Code of Ethics, Multicultural Principles and Language Guidelines. All people receiving services should request that all services they receive reflect USPRA s Core Principles and Values, Multicultural Principles, definition of psychiatric rehabilitation and the Language Guidelines. Principle 1. Psychiatric rehabilitation practitioners convey hope and respect, and believe that all individuals have the capacity for learning and growth. Principle 2. Psychiatric rehabilitation practitioners recognize that culture is central to recovery, and strive to ensure that all services are culturally relevant to individuals receiving services. Principle 3. Psychiatric rehabilitation practitioners engage in the processes of informed and shared decisionmaking and facilitate partnerships with other persons identified by the individual receiving services. Principle 4: Psychiatric rehabilitation practices build on the strengths and capabilities of individuals. Principle 5. Psychiatric rehabilitation practices are person centered; they are designed to address the unique needs of individuals, consistent with their values, hopes and aspirations. Principle 6. Psychiatric rehabilitation practices support full integration of people in recovery into their communities where they can exercise their rights of citizenship, as well as to accept the responsibilities and explore the opportunities that come with being a member of a community and a larger society. Principle 7. Psychiatric rehabilitation practices promote self determination and empowerment. All individuals have the right to make their own decisions, including decisions about the types of services and supports they receive. Principle 8. Psychiatric rehabilitation practices facilitate the development of personal support networks by utilizing natural supports within communities, peer support initiatives, and self and mutual help groups. Principle 9. Psychiatric rehabilitation practices strive to help individuals improve the quality of all aspects of their lives; including social, occupational, educational, residential, intellectual, spiritual and financial. Principle 10. Psychiatric rehabilitation practices promote health and wellness, encouraging individuals to develop and use individualized wellness plans. Principle 11. Psychiatric rehabilitation services emphasize evidence based, promising, and emerging best practices that produce outcomes congruent with personal recovery. Programs include structured program evaluation and quality improvement mechanisms that actively involve persons receiving services. Principle 12. Psychiatric rehabilitation services must be readily accessible to all individuals whenever they need them. These services also should be well coordinated and integrated with other psychiatric, medical, and holistic treatments and practices.