Primary Care / Behavioral Health

PRIMARY CARE / BEHAVIORAL HEALTH

ADULT REFERRAL CRITERIA

PURPOSE: This protocol is intended to set criteria for the referral of Adults and Older Adults from the Primary Care setting to the Behavioral Health setting and vice versa.

I. PC to BH Referral: (check one or more)

These are persons in the primary care setting who have serious mental illness requiring extended specialized behavioral health treatment that is more than can be provided at the primary care site.

[*These persons should have an Initial Risk Assessment (form MRD03) performed by the Behaviorist at Primary Care site.]

 Persons with SMI & moderate to severe chronic impairment in functioning areas (independent living, self-care, vocational skills, social relations)that require specialized BH tx to maintain adequate functioning & prevent decompensation.

 Persons with SMI & at high risk for harm to self or others.

 Persons with severe psychotic disorders or primary disorders with psychotic features who are disorganized and are severely impaired in functioning.

 Persons with severe Axis II personality disorders which severely impairs functioning.

 Persons with complex PTSD which severely impairs functioning.

 Persons with repeated psychiatric hospitalizations or psychiatric emergency room visits in the past year.

 Persons who are high users of multiple emergent/urgent systems of care.

 Other Special Circumstances (describe):

II. BH to PC Referral: Persons may be from1of 2 groups:
1) CBHS clients who have attained the following stability criteria & can be managed in Primary Care setting:
 Mental health stabilityas defined by the following:
-No acute psychiatric symptoms or severe impairments in functioning
-No high suicide/violence risk or safety issues
-No multiple inpatient hospitalizations or multiple PES visits in thepast year
-Compliance with psychiatric medications
-Activities of Daily Living: able to maintain self-care (food, shelter, clothing, personal hygiene, etc.)
 Housing:psychiatric symptoms not impairing ability to obtain or maintain housing.
 Substance abuse harm reduced: has minimal impact on psychiatric symptoms and functioning.
 Entitlements in place: or at least documentation in place for entitlement applications (i.e. SSI if eligible)
 Able to make appointments. PC does not provide outreach or home visits (except w/some Older Adults).
2) Non-SMI persons who can be managed in the Primary Care setting by behaviorist interventions and/or medication. These persons may be new to CBHS or may have received some prior CBHS treatment.
(These are often diagnoses such as Generalized Anxiety, Panic Disorder, Social Phobia, Mild to Moderate Depression, Axis II Personality Disorder, Substance Use Disorder, Adjustment Disorder, Somatoform Disorders, etc.)
[*These persons should have an Initial Risk Assessment (form MRD03) performed by CBHS for referral to PC.]

* Serious Mental Illness (SMI) refers to a mental disorder which is severe in degree and persistent in duration, which may cause behavioral functioning which interferes substantially with the primary activities of daily living, and which may result in an inability to maintain stable adjustment and independent functioning without treatment, support, and rehabilitation (for a long or indefinite period of time). Serious mental disorders include, but are not limited to, schizophrenia, as well as major affective disorders or other severely disabling mental disorders.

As a result of the mental disorder, the person has substantial functional impairments or symptoms, or a psychiatric history demonstrating that without treatment there is an imminent risk of decompensation to having substantial impairments or symptoms.

“Functional impairment” means being substantially impaired as the result of a mental disorder in areas of independent living, social relationships, vocational skills or physical condition. [This form is on reverse side of PCBH Referral form]

Appendix E1-Page 1