Third Time Is A Charm

PRESENTERS

APPENDIX 609 AND 610

Valerie Cherry, PhD- Lead and Region 2 Mental Health Specialist

Helena Mackenzie, PhD- Region 5 Mental Health Specialist

September 4, 2013

Brief Relevant Background

Only Potential Application Outcomes Enrollment Applicant Withdrawal Recommendations for Denial

New Information Direct Threat (DT) Cannot Meet Basic Health Care Needs (HCN)

Refer to more appropriate provider/program Consider for alternate center

Appendix 609 Individualized Direct Threat Assessment

Appendix 610Individualized Health Care Needs Assessment

Appendices 609 and 610 History

December 11, 2007 – Direct Threat Assessment Form via Program Instruction 07-16.

July 27, 2011- Updated and added “Appendix 609 Individualized Assessment of Possible Direct Threat” to PRH via Job Corps PRH Change Notice No. 11-03.

November 16, 2011- Added new “Appendix 610 Health-Care Needs Assessment” to PRH via Job Corps PRH Change Notice No. 11-09.

July 1, 2013 –Revised Appendices 609 and 610 via Job Corps PRH Change Notice No. 13-02.

Why Use Appendices 609 and 610 Forms?

Ensure recommendation for denial process is standardized and less likely to appear discriminatory.

Includes consideration of reasonable accommodation for applicants with disabilities.

Required forms in the Policy and Requirement Handbook (PRH).

Recommendations for Denial Center Level

Two Primary Reasons to Recommend Denial: Concern applicant is at significant risk of harming self or

others Complete Direct Threat Assessment (Appendix 609)

Believe Job Corps can not meet applicant’s health care needs Complete Health Care Needs Assessment (Appendix

610)

Third Reason to Recommend Denial: New Information

Revisit specific EAR

609 Direct Threat Assessment

A direct threat assessment should be completed whenever center believes that an applicant poses a direct threat to the health or safety of himself or others. Poses a significant risk of substantial harm

to the health or safety of the individual or others; and

Cannot be eliminated or reduced by reasonable accommodation or modification.

Assessment conducted by licensed clinician.

6

610 Health Care Needs Assessment

The Health Care Needs Assessment should be completed if there is a concern that the center cannot meet the basic health care needs of the applicant. The applicant’s health-care needs exceed those of basic care

and cannot be met by the center. The applicant’s health-care needs are manageable at Job Corps

as defined by basic health-care services in Exhibit 6-4, but require community supports and services which are not available near center. The center must document efforts to arrange for less frequent

treatment in home state and/or to secure community support near center and include this information in the health-care needs assessment

Assessment conducted by licensed clinician.

7

610 Health Care Needs Assessment

Health care needs beyond Job Corps basic health care responsibilities (PRH Exhibit 6-4)

Red Flags: Frequent recent ER visits Newly diagnosed or

uncontrolled health issue Symptoms/condition not

well managed in similar environment as Job Corps

Require extensive resources/intervention

609 Direct Threat Assessment Versus 610 Health Care Needs Assessment

609-Direct Threat Imminence:

Immediate safety concern Suicidal behavior Homicidal behavior Paranoid thinking Threat of assault

610-Health Care Needs May have safety issues

related to health needs, but threat is not imminent Mood swings Impulsive behavior Impaired judgment

Revisions to 609 and 610 Forms More User Friendly

New section 1(a) provides examples of potential harm to be selected in a check-box format.

Question 5 was expanded to consolidate information from the “Center Recommendation of Denial Form for Health-Care Needs, Direct Threat or Disability Status” to reduce redundancy and provide specific reasonable accommodation examples in a check-box format.

New Question 3 has been added to identify the functional limitations (specific symptoms/behaviors) of the applicant that are barriers to enrollment in a check box format.

Question 5 was expanded to consolidate information from the “Center Recommendation of Denial Form for Health Care Needs, Direct Threat or Disability Status” and provide specific reasonable accommodation examples in a check box format.

New Question 7 was added for centers to document their efforts to arrange less frequent treatment in home state and/or secure community support near center if recommending an applicant for a different center.

Appendix 609-Individualized Assessment of Possible Direct Threat

Appendix 610-Individualized Health-Care Needs

Mental Health Example of Appendix 610- Health Care Needs Assessment

Scenario

Appendix 610: Mental Health Example“Derrick D”

20-year-old male In reviewing health documentation, the HWM

identifies concerns on the applicant’s Health Questionnaire (6-53) and associated medical documentation

History of significant mental illness: psychiatric hospitalization five months ago, ongoing symptoms

HWM forwards the file to the CMHC for review and completion of a Health Care Needs Assessment (Appendix 610), if indicated.

Health Care Needs AssessmentAppendix 610

History and Present Functioning

File Review Team Meeting

Functional Limitations/Symptoms

Health Care Management Needs

If Recommending Different Center...

Direct Threat AssessmentAppendix 609

History of suicide attempts and expresses current suicidal thoughts with imminent risk.

Active hallucinations and/or delusional thinking which places them or others at imminent risk.

Significant history of sexual assaults in recency or increased violent episodes. Non-compliant with tx.

Homicidal thoughts

SAMPLE AVAILABLE FOR DOWNLOAD

ResourcesAvailable Downloads

PowerPoint presentation Word versions of appendices 609 and 610 Sample of completed appendix 609 and 610 Appendix 107-applicant file review guidance –

center process