Upload
mark-reinhardt
View
219
Download
0
Embed Size (px)
Citation preview
8/11/2019 2PSR Individualized Treatment Plan
1/43
PSR IndividualizedTreatment Plan
April-May 2005
8/11/2019 2PSR Individualized Treatment Plan
2/43
PSR Services
16.03.09.453 The goal of PSR services is to aid participants inwork, school, family, community or other issuesrelated to their mental illness. It is also to aidthem in obtaining developmentally appropriateskills for living independently and to preventmovement to a more restrictive living situation.
All services provided must be clinicallyappropriate in content, service location and
duration and based on measurable andbehaviorally specific and achievable goals.
8/11/2019 2PSR Individualized Treatment Plan
3/43
PSR ServicesWritten Individualized
Treatment Plan IDAPA 16.03.09.453.02 Services must support the goals of PSR which are
maximum reduction of mental disability and
achievement of the highest possible functioninglevel for that participant. For adults this means becoming independent or
maintaining the highest level of independence. For children this means learning or maintaining
developmentally appropriate role functioning.
8/11/2019 2PSR Individualized Treatment Plan
4/43
PSR ServicesWritten Individualized
Treatment Plan The individualized treatment plan identifies theissues, goals, areas of need, objectives and thetotal number of hours and types of servicesestimated to achieve all objectives based on theability of the participant to effectively utilizeservices.
The individualized treatment plan must bedeveloped by the participant, family, other
support systems and the provider agency. Must be documented by the provider agency.
8/11/2019 2PSR Individualized Treatment Plan
5/43
PSR ServicesWritten Individualized
Treatment Plan Must include the following:
An issue statement specifically describing theparticipant's behavior that directly relates to
the mental illness and functional impairmentthat was identified in the assessment
A statement which describes the participant'sgoals relative to the goals of PSR
8/11/2019 2PSR Individualized Treatment Plan
6/43
PSR ServicesWritten Individualized
Treatment Plan Must include the following: Overall goalsand concrete, measurableobjectivestobe achieved, including time
frames for completion. At least one objective is required for thefocus areas which will most likely lead to thegreatest stabilizing impact.
This should include at least one objective in
each of the two focus areas which qualify theparticipant for PSR.
8/11/2019 2PSR Individualized Treatment Plan
7/43
PSR ServicesWritten Individualized
Treatment Plan Must include the following: Tasks that are specific, time limited activities
and interventions designed to accomplish the
objectives in the plan and are developed by theparticipant and the provider. Each task description must specify the
anticipated place of service, the frequency ofservices, the types of service and the person
responsible to assist the participant in thecompletion of tasks.
8/11/2019 2PSR Individualized Treatment Plan
8/43
PSR ServicesWritten Individualized
Treatment Plan Must include the following: Documentation of who participated in the
development of the individualized treatment
plan. The participant must take part in the
development of the plan. The adult participant or guardian must sign the
plan or documentation must be provided whythis was not possible, including refusal to sign.
8/11/2019 2PSR Individualized Treatment Plan
9/43
PSR ServicesWritten Individualized
Treatment Plan Must include the following:
For a minor child participant, the parent
or legal guardian must sign the plan. A copy of the plan must be given to the
adult participant and the guardian or tothe parent or legal guardian of the child.
8/11/2019 2PSR Individualized Treatment Plan
10/43
PSR ServicesWritten Individualized
Treatment Plan The individualized treatment plan
must be developed within 30 calendar
days from the initial face to facecontact between the provider agencystaff and the participant, or theparent or legal guardian of a minorchild.
8/11/2019 2PSR Individualized Treatment Plan
11/43
PSR ServicesWritten Individualized
Treatment Plan An individualized treatment plan review by theprovider agency staff and the participant mustoccur at least annually.
During the review, the staff and participant reviewany objectives which may be added or deleted fromthe plan.
Input from other participants in the plan includingservice providers must be considered.
Other attendees of the review may be chosen bythe participant/parent/guardian and the agencystaff.
8/11/2019 2PSR Individualized Treatment Plan
12/43
PSR ServicesWritten Individualized
Treatment Plan Must be reviewed and signed by a
physician or licensed practitioner of thehealing arts at least annually indicatingservices are medically necessary.(licensed physician, physician assistant ornurse practitioner and clinical nurse
specialist with experience prescribingpsychotropic medication)
8/11/2019 2PSR Individualized Treatment Plan
13/43
PSR ServicesWritten Individualized
Treatment Plan Once the date of a plan is established ( physiciansignature date unless past due), that date continuesto be the annual date of the plan.
Any subsequent plans must be received by the MHAon or before the expiration date of the plan.
If a subsequent plan is not received on or beforethe expiration date of the current plan, servicesthat are provided in the interim will not be
reimbursed.
8/11/2019 2PSR Individualized Treatment Plan
14/43
PSR ServicesWritten Individualized
Treatment Plan The eligible participant will be allowed tochoose whether or not he desires toreceive PSR services and who the
providers of services will be to assist inaccomplishing the objectives stated in theplan.
Documentation must be included in theparticipant's file showing that the
participant has been informed of his rightsto refuse services and choose providers.
8/11/2019 2PSR Individualized Treatment Plan
15/43
Individualized Treatment Plan
Authorization Requirements Required documentation (16.03.09.451.03):
Participant demographic information
Comprehensive assessment
Written individualized treatment plan
Adult services- rehabilitation outcome data(MH Profile Form)
Children's services- CAFAS/PECFAS
8/11/2019 2PSR Individualized Treatment Plan
16/43
Changes in Plan Hours or
Service Type Must be approved by the MHA. A clear rationale for the change in
hours or service type must beincluded with the request.
8/11/2019 2PSR Individualized Treatment Plan
17/43
Changes to Plan Objectives
451.06 Include recommendation and rationale inthe next 120 day review.
Substantial changes requiring immediatechanges in the plan need to be submittedto the MHA for approval. The requestmust include the recommendation and
rationale for the change.
8/11/2019 2PSR Individualized Treatment Plan
18/43
Minor Changes toIndividualized Treatment Plan
Tasks 451.07 Submit amended plan to the MHA detailing
the necessary and specific changes to theplan so long as there is no change in hoursor types of services.
If no response received from the MHAafter 10 working days proceed to
incorporate those specific changes.
8/11/2019 2PSR Individualized Treatment Plan
19/43
PSR ServicesWritten Individualized
Treatment Plan PSR services that must be specifically identifiedon the Individualized Treatment Plan Pharmacological Management Individual PSR Group PSR Collateral Contact Nursing Service Psychotherapy
Occupational Therapy
8/11/2019 2PSR Individualized Treatment Plan
20/43
PSR Individualized Treatment
Plan Client Name
Social Security Number
Healthy Connection Physician Medicaid Number
Healthy Connections Number
CAFAS Score- Children only Provider Agency Completing the Plan
8/11/2019 2PSR Individualized Treatment Plan
21/43
PSR Individualized
Treatment Plan Date of Amendment- when applicable Amendment comments- Justification
and description of what is beingamended in the plan
8/11/2019 2PSR Individualized Treatment Plan
22/43
8/11/2019 2PSR Individualized Treatment Plan
23/43
PSR Individualized
Treatment Plan Diagnostic Summary- Indicate Primary Diagnosis with (P)
Axis I: Clinical Disorders, Other Disorders That
May Be a Focus of Clinical Attention Axis II: Personality Disorders, Mental Retardation Axis III: General Medical Conditions Axis IV: Psychosocial and Environmental Problems Axis V: Global Assessment of Functioning (GAF)
scores for both current and highest past GAF
8/11/2019 2PSR Individualized Treatment Plan
24/43
PSR Individualized
Treatment Plan Duration of Principal Diagnosis Select one
Less than one year On to two years
More than two years
8/11/2019 2PSR Individualized Treatment Plan
25/43
PSR Individualized
Treatment Plan Functional Areas Identified as Deficits inthe Assessment
Must be documented and justified in theassessment Health/Medical - Housing
Social Interpersonal - Family
Vocational/Educational - Community/Legal Basic Living Skills - Financial
8/11/2019 2PSR Individualized Treatment Plan
26/43
PSR Individualized
Treatment Plan Functional Areas Areas identified in the assessment to be
addressed in the plan Psychiatric 2 functional areas identified in the
comprehensive assessment Health/Medical - Housing Social Interpersonal - Family Vocational/Educational - Community/Legal Basic Living Skills - Financial
8/11/2019 2PSR Individualized Treatment Plan
27/43
Issues Issues- identified for each functional area Brief summary statement that specifically
describes the participant's behavior thatdirectly relates to the mental illnessandfunctional impairment
Should also describe their strengths
8/11/2019 2PSR Individualized Treatment Plan
28/43
Goals
If you dont know where you are going, youwill probably end up somewhere else.
Lawrence J. Peter
8/11/2019 2PSR Individualized Treatment Plan
29/43
Goals
Broad general statements
Express the participant's desires,
what they want to change Written in their words
Tied to discharge criteria
8/11/2019 2PSR Individualized Treatment Plan
30/43
Goals
Goals can reflect Life goals
Service or treatment goals Quality of life goals
8/11/2019 2PSR Individualized Treatment Plan
31/43
Goals
Directed towards recovery
Responsive to need
Strengths based Written in I want to statements
8/11/2019 2PSR Individualized Treatment Plan
32/43
ObjectivesMeasurable, objective steps to
accomplish the goal
Short term, time limited with timeframes for completion
8/11/2019 2PSR Individualized Treatment Plan
33/43
Objectives Immediate focus of treatment but not adescription of the intervention
Focus on positive changes in behavior,
improving functioning, attaining new skillsnot just decreasing symptoms or stoppinga behavior
Written in The participant will
statements Specify one change at a time
8/11/2019 2PSR Individualized Treatment Plan
34/43
Objectives Reasonable Measurable
Appropriate to the treatment setting Achievable
Understandable to the participant
8/11/2019 2PSR Individualized Treatment Plan
35/43
Objectives Time specific Written in behaviorally specific
language Responsive to the participants needsand recovery goals
Appropriate to the participants age,development and culture
8/11/2019 2PSR Individualized Treatment Plan
36/43
Objectives At least one objective for every goal Keep the plan manageable
8/11/2019 2PSR Individualized Treatment Plan
37/43
TasksThe services, interventions, andactivities that will be provided by the
treatment team Assist the participant achieve theirgoals and objectives
8/11/2019 2PSR Individualized Treatment Plan
38/43
Tasks Describe the services to be delivered Specify
Who What Where When- frequency, intensity, duration
Why
8/11/2019 2PSR Individualized Treatment Plan
39/43
PSR Individualized
Treatment Plan Expected End Date Dates may vary depending on the
objectives and tasks needed toaccomplish the goals
8/11/2019 2PSR Individualized Treatment Plan
40/43
PSR Individualized
Treatment Plan Type, Frequency & Hours Summarize totals by service code
H2017 (RHIP)1hr/1x/wk
52 hrs/ yr
8/11/2019 2PSR Individualized Treatment Plan
41/43
PSR Individualized
Treatment Plan Signatures- must be hand written, withcredential and date also hand written
Participant/guardian
PSR professional that wrote the plan
Physician
Others involved in the plan development
8/11/2019 2PSR Individualized Treatment Plan
42/43
PSR Individualized
Treatment Plan Service Plan Authorization Form Provider/Region
Client Name Provider Number
Agency Phone Number
Agency FAX Number
8/11/2019 2PSR Individualized Treatment Plan
43/43
ReferencesTreatment Planning for PersonCentered Care: The Road to Mental
Health and Addiction RecoveryNeal Adams and Diane M. GriederElsevier Academic Press 2005