Table of Contents
Overview & Purpose 1
Definitions 1
Crisis During Normal Business Hours 4
Crisis Services 5
The NurseWise Crisis Line 5
Crisis Mobile Teams 5
Response in the Community- 5
Services available to private psychiatrists (in office)/persons at a local psychiatrist’s office- 5
Crisis Mobile Team Response on the Reservations- 5
Involuntary Persons in Need of Mental Health Treatment 5
A person in the ER 6
A person in the community 7
A person at an outpatient clinic during office hours 8
When law enforcement are involved (ARS 36-525(B)) 9
A person who is detained at the La Paz County Jail and involuntary for treatment- 9
An involuntary person on the Colorado River Indian Tribe (CRIT) Reservation 9
Non-Emergency Requests for Involuntary Evaluation (PAD or GD) 10
Voluntary Crisis Services for incarcerated persons 10
At the La Paz County Jail 10
At the Colorado River Indian Community Detention Center 10
Revocation of the Outpatient Treatment of an Existing COT (RCOT) (ARS.36-540.01 I) 10
During Regular Business Hours 10
T19, Non-Medicare members who will be admitted to HHW-SAF: 11
Medicare members and medically compromised persons who will not be admitted to HHW-SAF 11
After Hours 12
Direct Admission to a Level One (Acute or Sub-Acute) Psychiatric Inpatient facility 13
By outpatient providers (voluntary only) 13
By crisis mobile teams (voluntary only) 13
Title 36 Transports to HHW by Law Enforcement 13
Basic Transport 13
Medically compromised clients 14
Coordination of Care 14
Coordination with the ER on Enrolled Persons 14
Coordination with the ER on NON-enrolled persons 14
Coordination with LPRMC and Parker Indian Medical Center on medically admitted patients enrolled with an outpatient service provider 14
Meeting Attendance 15
Quarterly La Paz County Mental Health Crisis System Meetings 15
Regular Crisis Team Meetings 15
Problem Resolution Process 15
NAZCARE…………………………………………………………………………..………………………….16
Drug and or Alcohol Use – Services Available 16
Crossroads Mission 16
Yuma SAF (HHW Sub-Acute Facility) 17
Crisis Transportation for Voluntary Title 19 & 21 persons in need of a higher level of care 17
Signature Pages 18
Involved parties:
Buckskin Fire/EMS
CIA Crisis Mobile Team (CMT)
Cenpatico Integrated Care
Crossroads Mission
Colorado River Indian Tribe Police
Community Intervention Associates (CIA)
Ehrenberg EMS/Fire
La Paz County Attorney’s Office
La Paz Regional Hospital (LPRH)
La Paz County Sheriff’s Office (LPCSO)
La Paz County Jail
Mountain Health and Wellness (HHW)
NurseWise (NW)
Outpatient Treatment Providers (ACTS & CIA)
Parker Indian Medical Center
Parker Police Department
Parker Fire Department
Quartzsite Police Department
Quartzsite Fire Department
Salome EMS/Fire
12-3-12; Revised 7/31/2015 1 | Page
Overview & Purpose
The Protocols are guidelines that describe how we will all work together to ensure that behavioral health services are delivered in La Paz County. The Purpose is to enhance the network and response capability to address behavioral health crisis in La Paz County through ongoing communication and collaborative agreements between community stakeholders and behavioral health provider agencies developing an environment where there is no wrong door.
Cenpatico Behavioral Health of Arizona, LLC and Cenpatico of Arizona, Inc. dba Cenpatico Integrated Care (herein referred to as Cenpatico) and their contracted providers and identified La Paz County Community Stakeholders agree to coordinate activities to facilitate the implementation of crisis services in La Paz County. The elements of the Crisis System (including referral, assessment and service implementation processes) and the roles and responsibilities of each agency are outlined below.
Cenpatico and their contracted providers and identified La Paz County Community Stakeholders agree to work in partnership on behalf of persons experiencing a behavioral health crisis to ensure they receive the appropriate services and level of care that promote resiliency and protect the community.
These guidelines will be active from date of signature until modified by the involved parties. These guidelines do not create or delegate obligations or financial responsibilities. These guidelines are not a legal and binding contract or Memorandum of Understanding. These guidelines should never override the obligation to provide the most clinically appropriate intervention based on each individual situation nor should they override law or professional responsibility to members. Agencies are encouraged to have adequate clinical supervision and guidance to support such actions.
Goals of the Crisis System
To ensure persons receive the appropriate services and level of care, stabilize persons in the community whenever possible, support individuals in their recovery, promote resiliency and protect the community.
Definitions
Active Episode of Care: -A member is in an active episode of care if he or she is enrolled with an AHCCCS plan is assigned to Cenpatico Integrated Care, AND the member has been opened for and receiving services with a Cenpatico Integrated Care provider.
Admitting Officer –Per ARS 36-501.1 Admitting officer is a psychiatrist or other physician or psychiatric and mental health nurse practitioner with experience in performing psychiatric examinations who has been designated as an admitting officer of the evaluation agency by the person in charge of the evaluation agency.
Application for Emergency Admission for Evaluation-Paperwork completed to initiate an emergency evaluation of a person who, based on probable cause, is believed to be, a danger to self or others and that during the time necessary to complete the prepetition screening procedures the person is likely without immediate hospitalization to suffer serious physical harm or serious illness or to inflict serious physical harm on another person.
Application for Involuntary Evaluation -Paperwork completed to initiate a request for an evaluation of a person who is alleged to be Persistently or Acutely Disabled (PAD) and/or Gravely Disabled (GD) and may also be alleged to be Danger to Self (DTS) and/or Danger to Others (DTO). This process of requesting an involuntary evaluation is for situations that do not represent eminent danger and are considered non-emergency requests for an evaluation.
Amendment of the outpatient portion of a court order- The process outlined in ARS 36-540 (E) 5. in which the medical director of the mental health treatment agency can order a person court ordered to outpatient treatment back into inpatient treatment.
Authorization for Apprehension and Transport (Form A-9.1) - Pursuant to A.R.S. §§ 36-524(E) and 36-525 which allows a peace officer to transport a person to a screening or evaluation agency.
Behavioral Health Inpatient Facility- A facility licensed per 9 A.A.C. 20 and includes a psychiatric acute hospital (including a psychiatric unit in a general hospital), a residential treatment center for persons under the age of 21, or a sub-acute facility. For the purposes of these protocols, a Behavioral Health Inpatient Facility does not include residential treatment.
Business Hours-Monday through Friday from 8am to 5pm.
Crisis - An acute, unanticipated, or potentially dangerous behavioral health condition, episode or behavior.
Crisis Intervention Services (Mobile, Community Based)- Crisis intervention services provided by a mobile team or individual who travels to the place where the person is experiencing the crisis (e.g., person’s place of residence, emergency room, jail, community setting) to:
· Stabilize acute psychiatric or behavioral symptoms;
· Evaluate treatment needs; and
· Develop plans to meet the needs of the persons served.
Depending on the situation, the person may be transported to a more appropriate facility for further care (e.g., a crisis services center).
Crisis Intervention Services (Telephone) - Crisis intervention (telephone) services provided by qualified service providers within the scope of their practice to triage, refer and provide telephone-based support to persons in crisis. This is often the first place of access to the behavioral health system. This service may also include a follow-up call to ensure the person is stabilized
Danger to Self (DTS)-(a) Behavior which, as a result of a mental disorder, constitutes a danger of inflicting serious physical harm upon oneself, including attempted suicide or the serious threat thereof, if the threat is such that, when considered in the light of its context and in light of the individual's previous acts, it is substantially supportive of an expectation that the threat will be carried out.
(b) Behavior which, as a result of a mental disorder, will, without hospitalization, results in serious physical harm or serious illness to the person, except that this definition shall not include behavior that establishes only the condition of gravely disabled.
Danger to Others (DTO)-The judgment of a person who has a mental disorder is so impaired that he is unable to understand his need for treatment and as a result of his mental disorder his continued behavior can reasonably be expected, on the basis of competent medical opinion, to result in serious physical harm to others.
Evaluation Agency- Per ARS 36-501 (13) “a health care agency that is licensed by the department and that has been approved pursuant to this title, providing those services required of such agency by this chapter.” There are several evaluation agencies located in Tucson including Palo Verde, Sonora and University of Arizona Medical Center-South Campus (UAMC-South). The preferred Evaluation Agency is Canyon Vista Medical Center in Sierra Vista.
Gravely Disabled (GD)- A condition evidenced by behavior in which a person, as a result of a mental disorder, is likely to come to serious physical harm or serious illness because he/she is unable to provide for his/her basic physical needs.
Guardian- A guardian is a person who has the legal authority to make personal decisions for the ward relating to living arrangements, education, social activities, and authorization or withholding of medical or other professional care, treatment, or advice. The guardian must always make decisions that are in the best interests of the ward. The guardian must always make sure that the ward is living in the least restrictive environment in which the ward can remain safe. Under §14-5312.01 (a) a guardian is able to consent to medical treatment outside a level one behavioral health facility. A mental health guardian is given under §14-5312.01 (b) for placement in a level one behavioral health facility. It is based on evidence produced from a licensed mental health expert that the ward is in need of such hospitalization due to a mental disorder as listed in §36-501. It is renewed every year with an affidavit from a mental health expert stating that it is likely that the ward will need to be placed in a level one behavioral facility.
Intake and Coordination Care Agency (ICCA) - (Also referred to as Outpatient Treatment Agencies or Provider Agencies). ICCAs are contracted provider type requiring full execution of Intake Provider functions and requirements. ICCAs must accept all requests for services for eligible populations and are required to manage members’ care by performing the following roles: intake, assessment, service planning, clinical oversight of all services, service tracking and data reporting, enrollment and demographic submissions, education, engagement activities, psychiatric services and ensure adequate treatment service availability to all enrolled members.
ICCAs are further divided into High Needs Care Management Centers (HNCM) and Low to Moderate Needs Treatment (LNMT) Centers. ICCAs are required to screen members and refer them to either an (HNCM) or an (LMNT) Center. In La Paz County, ACTS and CIA are ICCAs.
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Natural supports- Refers collectively to support commonly identified as:
a. "Informal Support " (support provided by those individuals who know or are related to the individual/family, but do not provide a paid service, such as a grandparent or neighbor who is connected to the individual/family) and
b. "Community Support" (those supports that are part of the individuals/family's community, such as faith community, neighborhood or community organizations).
Persistently and Acutely Disabled (PAD)-A severe mental disorder that meets all the following criteria:
(a) If not treated has a substantial probability of causing the person to suffer or continue to suffer severe and abnormal mental, emotional or physical harm that significantly impairs judgment, reason, behavior or capacity to recognize reality.
(b) Substantially impairs the person's capacity to make an informed decision regarding treatment and this impairment causes the person to be incapable of understanding and expressing an understanding of the advantages and disadvantages of accepting treatment and understanding and expressing an understanding of the alternatives to the particular treatment offered after the advantages, disadvantages and alternatives are explained to that person.
Petition for court ordered EvaluationThe prescribed form used to request a petition for court-ordered evaluation. This form must be reviewed and signed by the Medical Director.
Revocation of the outpatient treatment portion of a court order -The process outlined in ARS 36-540-01. Section I in which the medical director of the mental health treatment agency can order a person court ordered to outpatient treatment back into inpatient treatment.
Serious Mental Illness (SMI) - A condition of persons who are eighteen years of age or older and who, as a result of a mental disorder as defined in A.R.S. 36-501, exhibit emotional or behavioral functioning which is so impaired as to interfere substantially with their capacity to remain in the community without supportive treatment or services of a long -term or indefinite duration. In these persons mental disability is severe and persistent, resulting in a long-term limitation of their functional capacities for primary activities of daily living such as interpersonal relationships, homemaking, self-care, employment and recreation.
Title 36 - Arizona’s state law for involuntary mental health commitment. The law is located in the Arizona Revised Statutes, Title 36 (Public Health and Safety) Chapter Five (Mental Health Services).
Title 36 pre-petition screening-The review of an application (MH 100 or MH 104) application requesting court-ordered evaluation, including an investigation of facts alleged in such application, an interview with each applicant, and an interview, if possible, with the proposed patient. The purpose of the interview with the proposed patient is to assess the problem, explain the application and, when indicated, attempt to persuade the proposed patient to receive, on a voluntary basis, evaluation or other services.