Oconee

Center

We provide high quality, cost effective behavioral health care services that meet customer expectations.

PROGRAM DESCRIPTION 01/2008

Family Directions is open daily from (8:00- 9:00pm daily) Our mission is to provide timely and competent Mental Health assessment and treatment to children and adolescents age 6-18 that builds the skills needed and links to resources for successful community living that meets the expectations of families and other community agencies involved with the consumer. We truly believe that we can make a difference in the lives of the youths we serve and meet all of their basic needs. We utilize Evidenced -based treatment practices to address co-occurring disorders that will be delivered as clinically indicated with the youth and their families


MISSION:

To provide timely and competent mental health assessment and treatment to children and adolescents that builds the skills needed and links to resources for successful community living that meets the expectations of families and other community agencies involved with the consumer.

BELIEF:

That we can make a difference in the lives of youths we serve.

DEFINITION OF SERVICES:

Community Support Individual services consist of rehabilitative, environmental support and resource coordination considered essential to asses a child and family in gaining access to necessary services and in creating an environment that promotes resiliency and support the emotional and functional growth and development of the child. The service activities include the following:

1. Assistance to the child and responsible family caregivers in the development and coordination of the individual resiliency plan.

2. Planning in a proactive manner to assist the child and family in managing or preventing in-crisis situations.

3. Individualized interventions which will have objectives

* Identification, with the child/youth, of strengths which may aid him or her in achieving resilience, as well as barriers that impede the development of skills necessary for age – appropriate functioning in school, with peers, and with family;

* Support to facilitate enhanced natural and age appropriate supports (including support and assistance with defining what wellness means to the child in order to assist that child/youth with recovery based goal setting and attainment);

* Assistance in the development of interpersonal, community coping and functional skills (including adaption to home, school, and health social environments.

* Encouraging the development and eventual succession of natural supports in school and other social environments;

* Assistance in the acquisition, of skills for the youth to self recognize emotional triggers and to self-manage behaviors related to the child's identified emotional disturbance;

* Assistance with personal development and school performance;

* Assistance in enhancing social and coping skills that ameliorate life stresses resulting from the child's emotional disturbance;

* Service and resource coordination to assist the youth and family in gaining g access to necessary rehabilitative, medical, social and other services and supports;

* Assistance to youth and other supporting natural resources with illness understanding and self management;

* Any necessary monitoring and follow up to determine if the services assessed have adequately met the individuals needs.

* Identification with the youth's family, of risk indicators related to substance related disorders relapse, and strategies to prevent relapse.


An SED consumer is under age 18 and is defined as having an Axis I diagnosis that has persisted or is likely to persist for one year (excludes substance related disorders).

Diagnosis:

A child or adolescent with serious emotional disturbance must have a defined Axis I Mental Disorder from the DSM IV Edition, with the following exceptions and /or conditions:

Axis I- Primary Diagnosis for Psychoactive Substance Use Disorder and V Code are excluded. Organic Mental Disorders are included only if behaviors are a danger to self or others.

Axis II- Any level of Mental Retardation as the primary diagnosis is excluded. Any level of Autistic Disorder under Pervasive Developmental Disorders, diagnosis of Developmental Disorder, or Other Developmental Disorder, or Borderline Intellectual Functioning as the primary or singular diagnosis is excluded.

ADMISSION CRITERIA:

All of the following criteria are necessary for admission:

* Consumer demonstrated symptomatology consistent with DSM IV (Axis I) diagnosis (es) which requires and will respond to therapeutic intervention.

* There is an expectation that the prescribed treatment will show progress toward treatment goals within the specified number or sessions or is needed to maintain current optimum levels of functioning.

* Individual must meet target population criteria:

1. Mental health diagnosis
2. Substance related disorder
3. Co-occurring mental health diagnosis and mental retardation/ developmental disability
4. Co-occurring substance/related disorders and mental retardation/ developmental disabilities

* Individual may need assistance with developing, maintaining, or enhancing social supports or other community coping skills.

* Individual may need assistance with daily living skills including coordination to gain assess to necessary rehabilitative and medical services.

* There are significant symptoms that interfere with the consumer's ability to function in more than one life area. Typical GAF is 31 to 80. CAFAS of 10 to >40.

* The consumer demonstrates a need for ongoing maintenance as evidences by a history of use of highly restrictive services or is judged to be at risk.

* There is an identifiable stressor associated with the alteration of normal level of functioning.

* The mode of treatment is appropriate to the disorder.

* The prescribed treatment follows preferred medical protocols.

Outpatient Services include:

* Assessments

* Crisis Intervention

* Individualized Recovery/Resiliency Planning

* Psychiatric and Nursing Assessments

* Medication-related services

* Brief Intervention

* Intensive Family Intervention

* Skill Training

* Parent/Family Education, Training and Therapy

* Individual Education, Training and Therapy

* Community Support Individual

* Group Education, Training and Therapy

* Referral to Community Resources/Services


EXCLUSIONARY CRITERIA:

Clinical Exclusions

1. Individuals with the following conditions are excluded from admission unless there is clearly documented evidence of a psychiatric condition overlaying the primary diagnosis:

* Mental Retardation

* Autism

* Organic Mental Disorder

* Traumatic Brain Injury

CONCURENT REVIEW CRITERIA

* Severity of illness and resulting impairment continues to require outpatient treatment.

* Treatment planning is individualized, appropriate and specific goals and objectives stated. Discharge goals and
client outcomes are clearly stated.

* The mode, intensity, and frequency of treatment area appropriate and follows prefered practice guidelines.

* When medically necessary, appropriate pharmacological intervention(s) has been prescribed.

* Care is being rendered in a clinically appropriate manner and is focused on the consumer outcomes as described
in the discharge plan.

* Reasonable likelihood of substantial benefit is a result of active intervention.

* Consumer, and when appropriate, family members making progress toward goals and cooperating with plan of
care.


DISCHARGE CRITERIA:

At least one of the following criteria must be met:

* The goals of the consumer's recovery/resiliency plan have been substantially met.

* The consumer, guardian and/ or custodian or non compliant with treatment.

* Consent for treatment is withdrawn.

* Individual/family requests discharge and the individual is not imminently in danger of harm to self or others;

* Transfer to another service is warranted by change in the individual's condition

ESTIMATED LENGTH OF SERVICE:

Depends upon needs and services. The average length of stay is twelve months.


FREQUENCY OF REVIEW:

At least every six months or as the condition changes.

STAFFING PATTERNS:

Office hours are from 8:00 am. - 9:00 pm. Monday through Thursday and 8:00 am. - 5 pm. on Friday and 9:00 am – 1:00 pm every other Saturday.

The following practitioners may provide family community support under the supervision of an MHP:

* Mental health professional

* Substance Abuse Manager Under the documented supervision (organizational charts, supervisory notation, etc.)
of a physician, and MHP, or a SAM. The following staff may also provide Community Support

* Certified Peer Specialist

* Paraprofessional staff The recommended consumer to staff ratio of 30 consumers per staff member and must maintain a maximum ratio of 50 consumers per staff member.

SAFETY AND PROTECTION OF STAFF:

While most of the youths receiving CSI serviceswill present no imminent danger to self or others, there will be those youths who, at times might become involved in high risk situations or behaviors. In these circumstances, it is the policy of Oconee Center that an appropriate assessment of the circumstance is made by a Master's level or licensed staff to determine an appropriate course of action, to include more than one staff member if needed to intervene, involvement of the local law enforcement agency and/or involvement of the local department of children and services staff to intervene in the situation.
At least (2) two staff persons will be assigned to make contact with any youth/family, who is determined to be at significant risk of danger to self or others. Local law enforcement will be contacted where a potential family violence or unlawful situation might exist. Local Department of Family and Children Services will be contacted where leaving the youth in the natural environment jeopardizes the safety of the youth and/or his/her siblings.

CONFIDENTIALITY:


Oconee Center has comprehensive policies regarding privacy and confidentiality. The agency ensures compliance with HIPAA, federal and state laws regarding confidentiality. Because services are provided in various environments such as the youth’s/family’s home, school, jails, homeless shelters, juvenile detention centers, community or street locations, staff have received confidentiality training and are encouraged through on-going supervision to be vigilant in insuring that no privileged or confidential information is directly or indirectly divulged while services are provided in these various environments.

All Oconee Center staff receives training in the protection of consumer’s privacy and confidentiality at employment and at least annually. Intake staff shall ensure that appropriate full and written consent of the youth’s parent/responsible person has been obtained prior to the disclosure of protected health information. As requested, and in respecting the rights of the youth’s/family’s to privacy and confidentiality, staff will allay such concerns surrounding social stigma by minimizing provider/agency identification when meeting with the youth/family in a variety of community settings. The Family Direction staff will take such measures to ensure the removal of the agency’s identification badge and/or decreasing visibility of identification of the agency’s/state logo when driving an agency’s vehicle in these settings.

SERVICES ACCESS:


Youths/families may access services having been referred through various points of entry in the six (6) counties served by Oconee Center [Baldwin, Hancock, Jasper, Putnam, Washington and Wilkinson]:

* Self/family referral

* Local schools

* Departments of Family Children Services

* Departments of Juvenile Justice/Youth detention centers

* Inpatient Psychiatric Facilities

* Residential/Level of Care Providers

* Statewide Single Point of Access/Referral

* Child and Adolescent Crisis Stabilization Programs

* Homeless shelters * Primary Care Providers/Pediatricians

* Local healthcare agencies/Clinics

* Local Public Health Departments

* Local Core Providers (public/private)

* Other Child Serving Agencies


ASSESSMENT:

Youths who are admitted to the Family Direction's Outpatient program will have a person-centered, integrated biopsychosocial assessment incorporating the following clinical assessments:

* CAFAS

* The biopsychosocial antecedents, influences, and effects of dependence on the consumer, family and significant
others.

* A comprehensive emotional and behavioral assessment after admission process as to needs, problems, disability (ies) and strengths; past and present mental health symptoms and disorder, cognitive deficit and learning deficits; screening for acute safety risks (suicide, violence, inability to care for self, HIV, risky behaviors, and danger of physical or sexual victimization) and past and present victimization and trauma.

* Growth and development-specific to emotional and/or chemical dependent/substance abuse

* A medical history; a physical examination within 24 hours of admission in order to assess the consumer’s physical health status/functioning in relationship to medical needs and dependence and substance abuse.

* Alcohol and drug history, specifically assessing consumer’s history of alcohol and other drug use including nicotine; age of onset; duration, patterns and consequences of use; history of physical problems [psychosomatic] associated with dependence; use of alcohol and other drugs by family members; religious and spiritual orientation; types of previous treatment and responses to the treatment; and any history of abuse [physical, emotional or sexual].

* A nutritional screening

EVIDENCE-BASED PRACTICES/TREATMENT MODALITIES:

Evidence-based treatment practices to address co-occurring disorders will be delivered as clinically indicated with the youth/families to include the followings: Motivational Interviewing/Change Models and Integrated Care are utilized at Oconee Center to:

* Remove barriers to individuals seeking treatment. Frequently, individuals with dual disorders entering the system do not readily admit to substance use and therefore are not formally identified.

* Identify potential dual disorder individuals; assess an individual’s level of readiness for change while engaging him/her in treatment and symptom management until stability or remission can be achieved.

* Elicit the individual’s view of the problem (s) during assessment and to offer factual information from assessment. Risks and consequences of individual choices are utilized to raise awareness, facilitate change through self-efficacy, and keeping options open through development of individual choice.

Illness self-management:

is utilized to assist individuals in self-education, self-management skills, development of their own recovery plan, which encourages individuals to identify experiences which have worked in the past, develop skills to help them stay well, as well as develop skills to build self-esteem as they embark upon recovery. Individualized Crisis plans are developed and implemented in conjunction with an individual youth/family to support advanced directive and self-determination and to assist the youth with remaining in his/her natural environment. The youth/family will be assisted in developing a list of behaviors/tasks that can be completed to stay well and relieve symptoms. Through this process, the youth/family learn ways to enhance recovery by developing a support system, focusing on wellness activities, maintaining a menu of choices, creating sober fun and relaxation activities, journalizing feelings, and utilizing music exercise and relaxation techniques to control troubling symptoms. Crisis plans are put in place to counter individual self-criticism, identification of a clear crisis plan that is individualized, and to support the youth/family’s self-determination.


Advocacy/Empowerment:
The Family Direction's staff will receive training on how to speak or act on behalf of the youth when he/she cannot otherwise advocate for himself. Whenever possible, youths and/or families will be empowered to speak or act independently. As indicated, the IFI staff will be involved in the following advocacy activities in ensuring the basic and psychosocial needs of the youth/family are met: Interacting with police, family, landlords, entitlement programs, personal representation, medical caregivers, neighbors, and employers; Consciously and purposefully serving as a role model/mentor for the youth as well as the general community; Empowering the youth/family through the teaching of self-advocacy skills; promoting self advocacy, independence and empowerment by subscribing to the belief that each youth is the director of his/her own recovery/rehabilitating process by soliciting and incorporating the youth’s preferences and choices in treatment, by developing a systemic belief in the value of self-help and employment, and using naturally occurring community support systems.

Family Psychosocial Education:
Through individual/family training, the Family Direction's staff will enhance the youth/family skills and understanding of their environments through such activities as:

* Education on mental illness/addictive diseases

* Recognition of and management symptoms

* Medication effects/Medication Management

* Relapse Prevention * Illness Self-management

* School Intervention * Safety Planning

* Legal and personal rights and entitlements

* Accessing community resources: Orienting and acclimating the youth to his/her natural environment such as the
neighborhood, public service, critical special services, social, religious and recreational options

* Parenting Skills

* Anger Management

* Budgeting

* Communication Skills

* Assertiveness Skills Training/Empowerment

* Dealing with the social services system, as indicated

* Child Growth and Development

* Supportive Counseling such as problem solving, reality testing and decision-making

* Life skills

Personal Relationship and Support:
The Family Direction's staff will establish a supportive alliance and relationship with the youth that is critical to effective helping by:

* Developing an attitude of positive regard,

* Creating an acceptable attitude,

* Fostering a sense of hope and

* Providing a supportive environment for a trusting relationship.

Social Support:
The Family Direction's staff will assess the extent of the youth’s personal support system and assist in the establishment or expansion of a personal network by:

* Identifying the extent, capacity and effectiveness of existing personal support systems through interviews and contact with the youth/family and significant others;

* Fostering family unification or reunification services and

* Linking the youth/family with appropriate persons, support groups or agencies, or developing support groups in lieu of inadequate supportive family relationships.

Family-Based Interventions:
The Family Direction's staff will utilize such models as parent management training, multidimensional family therapy or structural strategic family therapy. These therapies are based upon family systems and teach parents behavioral principles and better monitoring skills to increase pro-social behaviors of the youth, decrease substance use, improve family functions and maintain treatment.

Cognitive Behavior Therapy:
The Family Direction's staff utilizes this therapeutic approach to address the underlying beliefs and thinking of the youth/family in effort to change behaviors. Staff works with the youth/family on understanding the influences of the ABCs of this model: A=antecedents B=behavior C=consequences and the correlation to the Stages of Change.


SERVICE COORDINATION/LINKING:

The Family Direction's staff will engage the youth/family in needed services by linking them with available community resources.

This linking function will include:

* Making referrals and/or appointments with various agencies and insuring the youth receive what he/she needs.

* Assisting the youth/family with accessing natural and community resources, family, church, civic groups and recreational opportunities.

* Facilitating communication among involved caregivers or providers internally and within the community.

* Accompanying youths to needed services and resources.

* Accessing and ensuring services for the youth/family’s basic needs (including transportation, housing, food,
clothing, utilities, entitlement/benefit assistance and/or medical care).

TRANSITIONAL PLANNING:

It is the policy of Oconee Center to assure the timely and orderly planning of reduction in services. In concert with the continuity of care, this process will start early in the assessment process and proceed throughout the course of treatment until final discharge is facilitated. The transitional plan shall be designed to move the youth/family to the least restrictive level of care as soon as clinically indicated.

Additional Service Criteria:

A. Required Components

* Community Support services must include a variety of interventions in order to assist the consumer in developing:

* Symptom self monitoring and self-management of symptoms
* Strategies and supportive interventions for avoiding out-of-home placement for children and building stronger family support skills and knowledge of the child or youth's strengths and limitations
* Relapse prevention strategies and plans

* Family Direction Services focus on building and maintaining a therapeutic relationship with the child and facilitating treatment and resiliency goals.

* The organization must have policies and procedures for protecting the safety of staff that engage in these community based service delivery activities.

* Individuals receiving C & A outpatient services must be seen face-to-face a minimum of once every 30 days.

Children/youth and families must also receive a telephone check in call once a month unless there have been 2 or more face-to-face contacts within the community. The child/adolescent consumer of service must clearly remain the target of service. Provider can only bill for up to three unsuccessful attempts to provide face to face contact outside of the agency during the authorized time frame.

* At lease 60% of community support services must be delivered face-to face with the identified children receiving this service, and at least 80% of all face-to-face services must be delivered in non-clinic settings over the authorization period. The Community Support-Individual provider, through documentation, must demonstrate that a significant effort has been made to make a face-to-face contact with the child/adolescent outside the agency;however,when multiple attempts made to contact youth have failed and have been documented, Community Support-Individual may still be billed.

* When Community Support- Individual supports children/youth participating in medication management as a primary focus of service, the following allowances apply:

1. These children/youth are not counted in the off site service requirement or the consumer-to-staff ratio.

2. These children/youth are not counted in the monthly face-to-face contact is required every 3 months and monthly calls are an billable allowed billable service.

* Any diagnosis given to an individual must come from persons identified in O.C.G.A Practice Acts as qualified to provide a diagnosis. These practitioners include a licensed psychologist, a physician or a PA or APRN (NP and CNS-PMH) working in conjunction with a physician with an approved job description or protocol.

Expected Outcomes:

Of Children and adolescents served with total CAFAS scores of 60 or above at intake, at least 50% shall show an improvement in functioning, as indicated by a decrease of at least 10 points on the total CAFAS score from intake to the last available follow-up.

Of children and adolescents served with previous CAFAS Substance Use sub scale scores indicating moderate to severe impairment, at least 60% shall show an improvement in substance use, as indicated by a decrease of at least 10 points in the current sub scale score.

Of children and adolescents served with previous CAFAS Community sub scale scores indicating severe impairment, at least 60% shall show an improvement in delinquent behavior/legal status, as indicated by a decrease of at least 10 points in the current sub scale score.