COPE Community Services, Inc.
Arizona State Hospital (ASH), Level I Protocol
INTRODUCTION: The purpose of this protocol is to provide pre-admission, admission, continued stay and discharge procedures for ASH
Pre admission to ASH:
1. Before considering an ASH placement, the assigned Clinical Care Coordinator will request a peer review prior to an ART meeting. The peer review may consist of a member of COPE’s UM team, the assigned Clinical Care Coordinator, a representative from CPSA’s Member Services, the site supervisor, the inpatient and outpatient psychiatrist/nurse practitioner.
2. Staff at the peer review will make recommendations that the case manager can take to the ART meeting.
3. Participants at the ART meeting will review the recommendations/options and make a final decision. Note: A final decision to refer an individual client to ASH should not be made without input from COPE’s outpatient attending and Medical Director.
4. If the decision is made to refer the client to ASH, the site supervisor and the Clinical Care Coordinator notify the UM Director the day of the ART meeting or as soon as a final decision has been made. This should be documented on a staffing note indicating the outcome of the ART final decision.
5. The site supervisor will contact UM staff (Jennifer Warfield) to obtain the most current ASH forms.
6. The site supervisor is responsible for the completeness, timeliness and accuracy of all submitted ASH documentation. The case manager, outpatient psychiatrist, and the site supervisor will complete the entire ASH packet with 24 hours of the final ART meeting and deliver the packet to Jennifer Warfield. The Clinical Care Coordinator is responsible for compiling the inpatient documentation. .
***A COMPLETE ASH referral packet must be prepared and dated for the same day the packet will be delivered to CPSA. Refer to the Network Justification for AzSH Placement referral and CPSA Provider Manual 3.14.11 for items included in the referral packet along with the order the documents should be submitted.
The assigned Clinical Care Coordinator will:
1. Review the content of the ASH referral packet for completeness once received from the outpatient treatment team.
2. Coordinate with the Medical Director for a Certificate of Need (CON), form 3.14.3. and IBNR the first 30 days of admission for Title 19 and Title 21 clients.
3. Complete a Prior Authorization (PA) Request form 3.14.3.
5. Coordinate with COPE’s hospital liaison to collect all required inpatient paperwork, if applicable. Make a copy of the packet to keep on file and hand-deliver the completed packet to CPSA.
6. Re-submit an updated CON and updated information from inpatient or outpatient (i.e. medications, psychiatric progress notes, etc) to Dianne Roberts at CPSA should the client not be admitted within two weeks from date of referral to ASH.
7. Re-submit a monthly updated PA to Dianne Roberts at CPSA if a client has not been admitted to ASH within one month from date of referral to ASH.
Admission and Continued Stay:
Once the client is admitted to ASH, the case manager is responsible to:
1. Participate in the first ASH ART meeting within the first ten (10) days of admission to ASH.
a) It is the responsibility of the ASH social worker to arrange this ART.
b) The purpose of this ART is to address specifically what symptoms or skill deficits are preventing the client from participating in treatment in the community and the specific goals/objectives of treatment at the Arizona State Hospital. It should also address the discharge plan for reintegration into the community. The client’s specific needs for treatment and placement in the community, including potential barriers to discharge and successful return to the community, should be identified and discussed.
c) The ASH service plan, developed at the ART meeting, will have all participant signatures. COPE case management staff will document the details of the ART meeting in a service note.
2. Participate in monthly ART meetings.
a) Meeting times and dates will be provided, in advance, by CPSA.
b) Document progress towards service plan goals, including tentative discharge plans, thoughts on ancillary services, and any referrals made.
c) Obtain a copy of the ASH treatment plan with all participant signatures.
3. Relay all preliminary discussions when client is being considered for placement on the discharge ready list to the COPE UM Director, or designee and client’s psychiatrist.
a) Consideration for placement will be when treatment plan goals have been achieved as indicated on the hospital treatment plan. Other contributing factors are listed in the DBHS/CPSA, “Practice Improvement Protocol 17, Arizona State Hospital: Effective Utilization and Collaboration.”
b) The ASH social worker will submit a request to place the client on the ASH Discharge Ready List.
c) The COPE Psychiatrist will accept or deny placing client on the discharge ready list in writing through the UM Director. If there is a disagreement regarding the discharge and a resolution cannot be reached by the Medical Directors, COPE will follow the DBHS/CPSA “Practice Improvement Protocol 17, Arizona State Hospital: Effective Utilization and Collaboration” procedures.
UM will:
1. Complete a CON/RCON for individuals between the ages of 18-22 monthly and all XIX and XXI clients.
2. Provide continuous IBNR entries until discharge for individuals 65+, but no RCON.
Discharge Procedure:
CM staff will:
1. Attend the scheduled ASH discharge ART meeting. This meeting should be scheduled by COPE the day the client is placed on the ASH Discharge Ready List.
a) Determine the client’s discharge date, in writing. If the client is between the ages of 18-22, the discharge date should not be exceed one week with a secure placement. The discharge date cannot exceed 30 days from the date of placement on the ASH Discharge Ready List regardless of age.
b) Complete a detailed Final Comprehensive Service Provider Discharge Plan describing placement; follow up appointments, and a description of all groups/ services in place to support the individual in the community. Provide a yellow copy to ASH, a copy to MIS, a copy to UM, and original to client’s COPE medical record.
c) Create a COPE service plan describing services provided upon discharge from ASH. The service plan should include the goals developed from the Comprehensive Service Provider Discharge Plan form.
d) Document the ART meeting by completion of a DAP note.
e) Complete CPSA PL Form 3.8.2, Recommended Crisis Plan Form and Content.
References:
CPSA Provider Manual Section 3.14
CPSA Provider Manual Section 10.7
CPSA Provider Manual Section 10.22
Revised 11.18.10
COPE Website: ASH level-I protocol 11.18.10 Page 1 of 2