Motivational Support Program Protocols

Motivational Support Program Protocols PURPOSE: The purpose of the Motivational Support Program (MSP) is to enhance integration across the behavioral health and child welfare systems. POLICY: South Florida Behavioral Health Network (ME) will support the Child Welfare Initiative through the ongoing developing and refinement of the Motivational Support Program (MSP). These policies will reflect the changes to the Child Welfare (CW) Initiative and will engage Our Kids, Inc. (CBC lead agency), South Florida Behavioral Health Network (SFBHN- ME), and the Regional DCF Substance Abuse and Mental Health Program Office (SAMH) as an integral part of CW integration. This program is regionally designed to meet the unique needs of the Southern Region. SFBHN s Child Welfare Integration Coordinator will have oversight responsibilities over the MSP including, but not limited to, the following activities: 1. Engagement and retention of child-welfare involved families in behavioral health treatment; and 2. Maintaining children s safety and, when possible, preventing children from receiving an out-of-home placement or working toward reunification. MSP services will be subcontracted to an ME network provider. MSP shall consist of a Master s Level Supervisor who will manage and oversee the Motivational Support Specialists (MSS). MSS will provide ancillary support to the CBC/Intensive Family Preservation Services (IFPS) provider/full Case Management Agency and SAMH treatment provider in order to ensure that unsafe and conditionally safe families are engaged and retained in treatment. The MSP shall engage and retain child-welfare involved families in behavioral health treatment as its primary goal. The program will assist in keeping families together by preventing at-risk children from receiving an out-of-home placement or assist in facilitating the expedited reunification of children in out-of-home care with their parents/caretakers. During the initial part of the CPI investigation, the DCF CPI is the Primary Worker. Once the case has been transferred to the CBC (Our Kids), the Our Kids subcontracted provider staff (the Intensive Family Preservation Services/IFPS Provider or Full Case Management 1

Agency) assigned to the case is the Primary Worker. The primary worker is identified in the Florida Safe Families Network (FSFN). The MSP shall track the consumer s initial engagement and adherence to treatment recommendations. The MSP shall achieve this by developing and maintaining an open line of communication between the MSS and the behavioral health treatment provider. PROCEDURE: In accordance with the State contracts with the ME and CBC, the integration of Child Welfare and SAMH will be achieved through the coordination of care by the MSP and stakeholders in the Southern Region. The DCF SAMH Program Office, CBC, ME and DCF Child Protective Investigators (CPIs) will be active participants in the planning, development, and implementation of this program. The MSP s population of focus will be those consumers that are identified by the DCF CPI as unsafe and conditionally safe as defined in the Southern Region s Protocol for Family Preservation Services and Court Intervention. This program will also offer immediate response to those cases that are considered urgent at the CPI level. Urgent cases are those identified as having a dependency hearing the following day or those cases which have urgent issues, such as the death of a child, wherein behavioral health issues are relevant, and there is a written request from the CPI Program Administrator for the family to be assessed by the MSS. See attached MSP PA Referral Form. In all other unsafe, conditionally safe, very high risk, and high risk cases, the referral to MSS will be done by the CBC, if one is deemed appropriate, based on the information gathered during the initial intake call. Cases determined by the CPI to be safe but have low and moderate risk factors will be staffed with the CPI s Unit Supervisor if the CPI has concerns about the behavioral indicators present. If the concerns persist, the Unit Supervisor will request Technical Assistance (TA) to be held with the CPI, the SFBHN Child Welfare Integration Coordinator, SAMH/DCF and the MSS. The MSP staff will be available in each HUB (South, Central and North) a minimum of two hours, two times per week, for a total of six hours to discuss any case the CPI deems to be safe but have low or moderate risk factors. In cases where the CPI identifies mental health issues and there are indicators that the consumer and/or family needs immediate assessment, the PA will contact the Mobile Crisis Team clinician, dedicated to assist the CPI, for further assessment. The services of the Mobile Crisis Team will be available to address the urgent but non-life threatening needs of 2

a person who requires an assessment for mental health. information: (305) 774-3616 or (305) 774-3617. Mobile Crisis Team contact PROTOCOL: Definitions: 1. UNSAFE: A child is unsafe when there is a danger threat within a family/home, they are vulnerable to that threat, the caregiver s protective capacities are insufficient to manage the threat of danger, and no intervention can substitute for the caregiver s lack of protective capacity. 2. CONDITIONALLY SAFE: One or more safety threats are present and identified at the completion of the Structured Decision Making Assessment, but protective safety interventions (sufficient safety plan) have been taken that substitute for the caregiver s lack of protective capacity. Based on these protective interventions, the child(ren) will remain in the home. 3. RISK: Risk is the probability that maltreatment will occur in a family within the next 12 to 18 months unless interventions are provided by the agency. Risk is categorized as low, moderate, high or very high, as determined by the Florida Safety Decision Making Methodology tool administered by the CPI. Note: There are no definitions in the SNR Family Preservation Services Protocol (06.19.13 revision) for high risk/very high risk. SFBHN s Child Welfare Integration Coordinator will work in collaboration with the CBC Lead Agency and community stakeholders to facilitate the full implementation of the MSP in an effort to improve family engagement in substance abuse and mental health treatment and decrease child welfare involvement. The Child Welfare Integration Coordinator will be employed by SFBHN (ME) and will act as the liaison between the CBC, DCF, SFBHN subcontracted providers, and the MSS. In an effort to facilitate the full implementation of this protocol, SFBHN will provide DCF CPI s with training on substances and the effects of misusing them during the pre-service training program. Thereafter, additional training on the same topic will be provided to CPI s as needed on a quarterly basis. To promote collaboration and to provide additional information on services available within the community, SFBHN will also schedule meet and greet sessions with the providers and the CPI s at each hub. Moreover, SFBHN will 3

provide telephone consultation on linkages to services and community placement to CPI s, as needed. Referrals to MSP: Referrals to the MSP may be submitted through two sources: the CBC and the DCF CPI Program Administrators. CBC Referrals: During the Our Kids, Inc. (CBC Lead Agency) Initial Intake call, information will be shared by the DCF CPI to determine if a referral to the MSP is appropriate. Our Kids Intake staff will refer a family to MSP for screening of behavioral health needs within three (3) calendar days of the need being identified and when appropriate, MSP will link to recommended treatment services. If while receiving services from the IFPS Provider or the Full Case Management Agency either believes that a referral to MSP is warranted, the IFPS Provider or Full Case Management Agency will inform the CBC so that the CBC can generate a referral to MSP. Referrals to MSP will include the results from the urinalysis test conducted by the DCF CPI during the initial part of the investigation, if appropriate, and will include the required response time from the MSP, based upon the urgency of the case. Referrals must also include any prior FSFN or criminal history pertaining to substance misuse or mental health issues. DCF CPI Referrals: DCF CPI Program Administrator or the Our Kids Intake Director will refer a family identified as urgent. Urgent cases are those identified as having a dependency hearing the following day or those cases which have urgent issues, such as the death of a child, wherein behavioral health issues are relevant and there is a written request from the CPI Program Administrator for the family to be assessed by the MSS. Referrals by the CPI Program Administrator to the MSP must include any prior FSFN or criminal history pertaining to substance misuse or mental health issues (see attached MSP PA Referral Form). The MSS will need to respond to and administer a urinalysis to all urgent cases within 24 hours of receipt of referral from the CPI Program Administrator. The Motivational Support Supervisor (MS Supervisor), who is responsible for the day-today operations of the MSP, will receive referrals from the DCF PA and from the CBC via the secure e-fax system. The MSP Supervisor will assign an MSS to the referred case, and the assignment will be shared with the referral source and their supervisor via email. The MSS will utilize FSFN to regularly update the consumer s progress. The MSS shall input all direct contact information into FSFN within 48 hours following contact with the consumer and will select one of the following categories to identify the consumer s progress: Definitions of Progress in Treatment Categories: Excellent: Parent is demonstrating actions that are evidence of significant progress toward achieving changes in behavior and/or one or more 4

protective capacities. Parent is demonstrating considerable commitment of time and energy. Adequate: Parent is demonstrating actions that are evidence of beginning progress toward achieving changes in behavior and/or one or more protective capacities. Parent is demonstrating acceptable level of commitment of time and energy. Not Adequate: Parent is demonstrating minimal actions that do not reflect a sufficient commitment of time or energy to achieve the necessary changes in behavior and/or one or more protective capacities; OR parent is ready and willing to participate in treatment or ameliorative services but progress is not being made based on one of the following: service availability/ accessibility is not of sufficient intensity. No Progress: Parent is demonstrating behaviors that are a significant indication that the parent has not made any commitment of time or energy to achieve the necessary changes in behavior and/or one or more protective capacities; has dropped out or is no longer attending treatment or ameliorative services; or has been discharged from treatment due to noncompliance. If Not Adequate or No Progress is identified on the SAMH note, the FSFN system will send an automated e-mail alert to the Primary Worker assigned to the case, alerting them of the need for follow-up action. This will trigger another discussion with the Primary Worker, Children s Legal Services, the CBC/IFPS Provider, and the provider assigned to the case. If the case is found not to have any behavioral indicators, MSS will enter a SAMH note in FSFN with a narrative that specifies that no behavioral indicators were found. The case will be categorized as Adequate. MSS will also upload the approved screening tool designated by the ME into FSFN. During the initial part of the investigation, the DCF CPI is the Primary Worker. Once the case has been transferred to the CBC (Our Kids), the Our Kids subcontracted provider staff assigned to the case is the Primary Worker (in voluntary cases, the Primary Worker would be the IFPS Provider and in dependent/court cases, the primary worker would be the Full Case Management Agency). While the case is being transferred from DCF CPI to the CBC, the DCF CPI is identified as the Primary Worker until the transfer of the case is complete. The MSS will ensure that screening and linkage to behavioral health services are completed within the required time frames. 5

1) Upon contact with the consumer, MSS will complete the ME approved screening tool (based on information gathered during the face to face contact with the consumer) within three (3) business days of the receipt of the referral. Within the same time frame, MSS will also administer a urinalysis to all unsafe and conditionally safe cases. 2) For those consumers who did not respond and/or comply to contact attempts, the MSS will enter a SAMH note into FSFN and identify the appropriate category, based upon the response by the consumer, by COB on the third business day. 3) This entry into FSFN will result in an alert notifying the Primary Worker (CPI or CBC/IFPS Provider/Full Case Management Agency), who will follow up with the family and take action, as appropriate. 4) For those consumers for whom an ME approved screening tool was completed and treatment was indicated, linkage to behavioral health services will occur within 48 hours of the need being identified. All appointments with the behavioral health service provider should be scheduled so that the consumer can be seen within seven (7) business days, if possible. If MSS is unable to accomplish this within these time frames, attempts to schedule the appointment and justification for why it was not accomplished should be documented in the consumer s record. The MSS will enter a SAMH note into FSFN and identify the appropriate category, based upon the response by the consumer, by COB on the third business day. 5) For those consumers with behavioral health indicators, the MSS will complete the Case Management assessment and Service Plan within 30-days of the completion of the ME approved screening tool. The Service Plan should include all tasks the MSS will undertake to link the consumer to services and monitor the consumer s engagement in services, as well as the MSS s efforts to work closely with the IFPS provider or Full Case Management Agency. MSP Screening: The MSS Supervisor, when encountering systemic barriers to implementation of services and/or coordination across stakeholders, will contact the SFBHN Child Welfare Integration Coordinator for assistance. In addition, the MSS Supervisor will ensure that the MSP staff documents the families progress in services into FSFN. The MSS, upon receipt of referral, will secure an SFBHN Consent to Release Information from the consumer and will attach this consent as part of the referral packet to the behavioral health provider. If the consumer refuses to sign the Consent to Release Information to MSS, then FSFN will be updated to indicate such. The MSS will maintain an open line of communication with all relevant stakeholders (CPI, CBC Lead Agency, CBC Full Case Management Agency, CBC Intensive Family Safety 6

Preservation Provider, and the ME CW Integration Coordinator) in order to coordinate care. The MSS will utilize the approved screening tool designated by the ME to determine the need for behavioral health services for all referrals. The MSS will determine if there has been an ME approved screening tool completed within the previous 90 days and ascertain if a more updated screening is necessary. The MSS will ensure that an intake appointment is made within seven (7) business days to a behavioral health treatment provider for a full assessment and linkage to recommended treatment services when the screening identifies substance abuse or mental health indicators. For SFBHN Funded Consumers, the MSS will: a) Generate a referral in the SFBHN data system for consumers funded through the Department. b) Upload the approved screening tool designated by the ME into FSFN and to the data system within three (3) business days of its completion. c) Document the recommendations that are captured in the approved screening tool designated by the ME into FSFN. d) Submit a referral, within 48 hours, to a behavioral health treatment provider for assessment and linkage to treatment services, through the SFBHN data system. e) Ensure that an initial appointment for intake takes place within seven (7) business days of the receipt of referral from MSS, regardless of the consumer s ability to pay. f) Ensure that the consumer was financially assessed utilizing the sliding fee scale as specified in the SFBHN main contract with the network provider. g) Use reports received by the network behavioral health treatment provider to update FSFN monthly using the indicated categories noted above. See attached progress report form to be used by the behavioral health treatment provider to report the consumer s progress to the MSS. For Privately/Medicaid Funded Consumers: The MSS, upon receipt of referral, will secure a Consent to Release Information from the consumer and will attach this consent as part of the referral packet to the behavioral health provider. If the consumer refuses to sign the Consent to Release Information to MSS, then FSFN will be updated to indicate such. The MSS will: 7

a) Generate a referral and submit directly to the Private/Medicaid provider. b) Document the recommendations that are captured in the approved screening tool designated by the ME into FSFN. c) Submit a referral to a behavioral health treatment provider for assessment and linkage to treatment services. d) Use reports received by the behavioral health treatment provider to update FSFN monthly using the indicated categories noted above. See attached progress report form to be used by the behavioral health treatment provider to report the consumer s progress to the MSS. Treatment Follow-Up: The behavioral health treatment provider shall notify the MSS, through the SFBHN data system notification process, when a consumer attends the scheduled initial intake appointment. The behavioral health treatment provider shall submit monthly written progress reports (by the 15 th of the following month) to the MSS regarding the consumer s progress and participation in treatment services so that the MSS can enter tracking information into FSFN (within 48 hours of receipt), utilizing the four categories outlined above (i.e., excellent, adequate, not adequate and no progress ). The behavioral health treatment provider shall notify the MSS, within 24 hours, through the SFBHN data system, when a referred consumer presents with any crucial issues such as non-compliance with appointments, positive urinalysis, and/or lack of progress issues.. The MSS will enter the consumer s lack of participation into FSFN and will attempt to reengage the consumer in behavioral health services. The MSS will resubmit the referral for recommended treatment services, as appropriate, and document in FSFN. In instances when the treatment provider is unable to clinically meet the consumer s needs, the treatment provider will link him/her (within 2 business days) to another behavioral health provider that is able to meet his/her treatment needs. The referring treatment provider will notify the MSP within one (1) business day of this occurring. The MSS will engage the SFBHN Child Welfare Integration Coordinator for assistance with the referral, if necessary. 8

The MSS will contact the new behavioral health treatment provider within 24 hours of the notification to ensure that an initial intake appointment is scheduled within the required seven (7) business day timeframe. The MSS will notify all stakeholders of the change in behavioral health treatment provider and the new date of intake, and update FSFN within 48 hours of occurrence. SFBHN subcontracted behavioral health treatment provider: The MSS will submit a referral for assessment and linkage for behavioral health treatment services. For consumers who are funded through SFBHN, the MSS will submit the referral through the SFBHN data system and continue with coordination of care, as described above. SFBHN providers are required to adhere to the assessment and linkage to services time frames, as specified in their contracts. The behavioral health treatment provider shall review the approved screening tool designated by the ME, completed by the MSS, to determine the type of assessment that will be conducted. The behavioral health treatment provider shall follow the Substance Abuse Treatment Protocol when there is an indication of substance use/abuse on the approved assessment tool designated by the ME, and the Mental Health Protocol when there is no indication of substance use/abuse on the ME approved assessment tool. Substance Abuse Treatment: Assessment: a) The provider will complete and transfer the approved assessment tool designated by the ME to the MSS within twenty (20) calendar days of admission into outpatient substance abuse treatment. b) The provider will complete and transfer the approved assessment tool designated by the ME to the MSS within five (5) calendar days of admission into residential substance abuse treatment. c) The MSS will then upload the approved assessment tool designated by the ME and add the treatment recommendations into FSFN. Drug Testing: a) The provider will conduct weekly random drug testing commencing on the date of admission. 9

b) The provider will conduct, at minimum, one drug test per week during the first 2 weeks of treatment. c) The provider will conduct random drug testing based upon clinical need, as identified in the treatment plan, after the first 2 weeks of treatment. d) The provider will conduct drug testing at intervals identified and required by dependency court for the court involved when the intervals are greater than those identified above. e) The provider will communicate the results of drug screenings to the MSS until the case has been closed by Our Kids/IFSP Provider. Mental Health: Assessment: a) The behavioral health treatment provider must schedule an intake appointment within seven (7) business days of referral from the MSS. b) The behavioral health treatment provider will complete a Bio-psychosocial assessment, upon completion of the intake process, to determine the type and frequency of services that the consumer needs. In addition, the behavioral health treatment provider will submit the completed Biopsychosocial assessment to the MSS within one (1) business day of its completion. c) The behavioral health treatment provider must link the consumer to recommended services based on the needs identified in the Bio-psychosocial Assessment and notify the MSS, within one (1) business day, via email. 1. Should the recommended services include Residential services, the MSS will follow the required Utilization Management protocols to access these services. 2. The behavioral health treatment provider will utilize the assistance of the MSS, who will engage SFBHN for residential placement assistance, if necessary. d) The MSS will then upload the Bio-Psychosocial Assessment and add the treatment recommendations into FSFN. Discharge from Behavioral Health Treatment: 10

a) The treatment providers must notify the MSS and submit a Discharge Summary upon completion of behavioral health treatment. This Discharge Summary must classify the consumer s progress in treatment, utilizing the categories outlined above. b) The MSS will upload the Discharge Summary into FSFN, identify the treatment progress category, and close the case in the MSP, unless otherwise indicated by the SFBHN Child Welfare Integration Coordinator. c) The MSP will provide reports to the Department, as indicated in Attachment I of the ME s contract. d) MSP will only be required to track MSP cases and enter notes into FSFN up to 90 days from admission into MSP. The MSP will track cases for longer than 90 days when a case requires MSP intervention to ensure that the adult caregiver is engaged in behavioral health treatment for the wellbeing of the child. 11