D12-014–Procedure

September 12,2012
TO: / RegionalAdministrators
FieldServicesAdministrators
CaseManagementSupervisors
CaseResourceManagers
VPSSupervisorsandSocialWorkers
FROM: / LindaRolfe,Director,DivisionofDevelopmentalDisabilities
SUBJECT: /
CHILDREN’SLONG-TERMINPATIENTPROGRAMS(CLIP)
Purpose: / Toinformstaffoftheservicedescription,application,payment,andappealprocessforachild/youthapplyingforaccessintoChildren’s Long-term Inpatient Program (CLIP).
Background: / Todate,therehasbeenlittlecommunicationregardingaccesstoCLIPforDDDChildren’sCaseResourceManagers (CRM) andVoluntaryPlacementServices(VPS)Social Workers (SW).
What’snew,changed,orClarified /
  • CLIP isanintensiveinpatientpsychiatrictreatmentavailabletoallWashingtonStateresidents,age5through 17years. Itprovidesindividualizedtreatmentthroughtheuseofevidencedbasedpracticesdesignedtoincreasetheyouth'sskillsandadaptivefunctioningwithafocusonreintegrationtoacommunitysetting. SeetheCLIPwebsiteto learn more:
  • CLIP does not provide an acute inpatient response.
  • AcutepsychiatricinpatienttreatmentisprovidedinacommunityhospitaloracertifiedfreestandingEvaluationandTreatmentfacility(E&Tfacility)whenachildoradolescentisinneedofimmediateinpatientmentalhealthservicesduetotheacuityoftheirmentalillness.
  • Forpubliclyfunded acute hospitalization,amedicalnecessitydeterminationismadebytheRSN/PHPorDesignatedMentalHealthProfessional(DMHP).
  • Forprivatelyfunded acute hospitalization,thefamily'sinsurancecompanymakesthatdetermination.Thelengthofstayinthehospitalisvariable,dependinguponthechild'sneeds.
  • Involuntary Treatment:
  • UnderWashingtonState'sjuvenilementalhealthserviceslaw (Chapter 71.34 RCW)adolescentsage13through 17 yearsmaybecommittedforupto180daysofinvoluntaryinpatientpsychiatrictreatment.Under180dayrestrictivecourtorder,theadolescentbecomeseligibleforadmissiontoaCLIPProgram. Theadolescent'snameisplacedonthestatewidewaitinglistasofthedayofthe180dayrestrictiveITAorder.
  • Adolescents committed for 180 days of involuntary inpatient treatment have been determined to meet medical necessity through the detention and commitment process as defined inRCW 71.34.750.
  • Voluntary Treatment:
  • The CLIP Administration makesdeterminationofmedicalnecessityforvoluntarylong-terminpatientcareregardlessofwhetherthechildhaspublicorprivateinsurance.

ACTION: / EffectiveOctober 1,2012,FieldServicesstaffwillusethefollowinginformationwhenconsideringCLIPtreatmentforchildren/youth:
Step 1:
CRMs and VPS SWs must verify that the following eligibility criteria is met prior to submitting a voluntary CLIP application:
  • Client is age 5 through 17 years and is a legal resident of Washington State.
  • Clienthasbeendiagnosedwithaseverepsychiatricdisorder(seeCLIP website for full description)whichsignificantlyimpactstheirabilitytofunctionsafelyandadaptivelyinacommunitysetting,andrequirestheintensityandrestrictivenessprovidedbyaCLIPProgram.
  • Duetothenatureofthe psychiatricimpairment,the clientpossessesarisktothemselves,othersorisgravelydisabledwhichwarrantscareunderthesupervisionofapsychiatrist, whose treatment needs cannot be met by community based, less restrictive resourcesand would benefit from an extended inpatient course of treatment.
  • Clientsage13yearsofageandoldermustagreetoenteraCLIPProgram. ACLIPProgramdoesnothavetherighttoholdyouthintreatmentagainsttheirwillunlesstheyareadmittedinaccordwithRCW71.34ororderedforshorttermevaluationunderRCW10.77.
Step 2:
The Regional Support Network (RSN)isresponsibleforprovidingtheapplicationandfacilitatingthelocal processofreview. The DDD CRM/SW will assist in obtaining the following information to provide a completed application:
  • PsychosocialHistory: Psychosocialhistoryshouldincludefamily,cultural,andsocialhistory;developmentalandeducationalhistory;currentmedicalinformation;psychiatric,substanceabuseandresidentialtreatmenthistory;legalhistory;andcustodyandcitizenshiphistory(ifapplicable).
  • PsychiatricEvaluation: Anapplicationmustincludeawrittenreportofanevaluationcompletedbyachild/youthpsychiatrist(MD)orARNPwithinthesixmonthspriortoCLIPreview. Thereportmustincludethephysician’sorARNP’sname,dateofassessment,aDSMdiagnosticclassificationonallfiveaxes,amentalstatusexamination,andaComprehensiveAssessmentofthetreatmentneedsoftheapplicant.
  • SupportingDocumentation: Supportingsourcedocumentationoftheapplicant’sneedsisrequired. Supportingdocumentscanincludeschoolrecords,medicalreports,dischargesummariesfromprevioustreatmentfacilities,IQtesting,copiesofrelevantcourtorders,andotherevaluations.
  • AuthorizationtoRelease: Youthovertheageof13andtheirparent/guardianarerequiredbylawtoconsenttoreleaseofinformationaswellasvoluntaryparticipationintheCLIPtreatment. AllconsentformsmustbesignedandsubmittedtotheRSNwiththecompletedapplication.
Step 3:
AftertheCLIP applicationissubmitted, the RSNChildren’sCareCoordinatorwillschedulealocalCLIP review.
  • Ifapprovedlocally,theCLIPApplicationwillbeforwardedtotheCLIPAdministrationforreviewanddetermination.
  • Ifapproved by the CLIP Administration,thechild/youthwillbeassignedforadmissiontoaCLIP Programandtheir namewillbeplacedontheCLIPwaitinglist. Thisassignmentprocesswillbecompletedincollaborationwiththefamily, the RSNtreatmentteam,andtheCLIPcoordinator.
  • If not approved, theCRM/SWand/orfamilymayrequestameetingtodiscusstheappealprocessofalocalreviewdecision.

RelatedREFERENCES: / RCW71.34.750
RCW71.34.020(12)

ATTACHMENT(S): / None
CONTACT(S): / NicholeJensen,DDDProgramManager
360-725-3403

LinPayton,DBHRProgramAdministrator
360-725-1632

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