HomeMy WebLinkAbout20111889.tiff RESOLUTION
RE: APPROVE PROTOCOL AGREEMENT FOR QUALITY CARE OF AT-RISK ADULTS
WITH MENTAL ILLNESS AND AUTHORIZE CHAIR TO SIGN - NORTH RANGE
BEHAVIORAL HEALTH
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with a Protocol Agreement for Quality Care
of At-Risk Adults with Mental Illness between the County of Weld, State of Colorado, by and
through the Board of County Commissioners of Weld County, on behalf of the Department of
Human Services, and North Range Behavioral Health, commencing upon full execution, with
terms and conditions being as stated in said agreement, and
WHEREAS, after review, the Board deems it advisable to approve said agreement, a
copy of which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of
Weld County, Colorado, that the Protocol Agreement for Quality Care of At-Risk Adults with
Mental Illness between the County of Weld, State of Colorado, by and through the Board of
County Commissioners of Weld County, on behalf of the Department of Human Services, and
North Range Behavioral Health be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign said agreement.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 27th day of July, A.D., 2011.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
EXCUSED
Barbara Kirkmeyer, Chair
Weld County Clerk to the Bo IS La J ). c
can P. Co way, Pro-Tem C--9
BY:
Deputy rk to the Bo
" ,
Willia . Garcia
U S/APP V A F M: 1. EXCUSED
David E. Log
nt ttorney -r_ Q
Dougl s Radem cher
Date of signature: g'- //
t,cpyc Q.uU— 145 6
uSu✓ 7 9-/-ii 2011-1889
HR0082
MEMORANDUM
1861 - 2011
DATE: July 25, 2011
W EL DEC O U N T Y TO: Barbara Kirkmeyer, Chair, Board of County Cpmmissioners
FR: Judy A. Griego, Director, Human ices l/JiL
RE: Protocol for Quality Care of At-rick dults with Mental
Illness between the Weld County Department of Human
Services and North Range Behavioral Health
Enclosed for Board approval is a Protocol for Quality Care of At-risk Adults with Mental Illness
between the Department and North Range Behavioral Health. This Protocol was presented at the
Board's March 23, 2011, Work Session.
This Protocol is recommended by the Colorado Department of Human Services. This Protocol is
to ensure a coordinated response during all hours, provide for special requests for assistance
from one agency to another, and arrange for joint service delivery when needed to maximize the
effectiveness of the response.
It is understood that joint service provisions may be used as a means to coordinate the efforts of
the involved agencies, and that each individual agency remains accountable to its own rules,
policies, confidentiality requirements, and statutes
If you have any questions, please give me a call at extension 6510.
2011-1889
Protocol for Quality Care of At-risk Adults with Mental Illness
Between
The Weld County Department of Human Services
and
North Range Behavioral Health
DATE:
PURPOSE
The purpose of this protocol is to provide guidance to adult protection and behavioral health professionals
as they work together to provide collaborative services to at-risk adults with suspected or known
behavioral health needs. The protocol will be used for cross training of behavioral health and adult
protection workers, law enforcement agencies, and professionals who provide services to at-risk adults.
The expectation is that there will be a spirit of cooperation, creativity, and respect among the local
professional agencies involved in assisting at-risk adults with behavioral health issues.
BACKGROUND AND BASIS FOR THE PROTOCOL
The vision of the Colorado Department of Human Services (CDHS) is to be the nation's leader in the
design and delivery of high quality human services that help individuals, families, and communities to be
safe and independent. A significant step toward that end is to issue guidelines endorsed by the requisite
state agencies. This protocol is designed as a template which can be customized at the local level, for
the purpose of assuring maximum local understanding, coordination, and cooperation in the provision of
human services to clients.
The Colorado DBH and Colorado APS recommend that the directors of each county department of social
services and each CMHC develop and implement a protocol agreement between the respective
agencies.
PRINCIPLES OF THE PROTOCOL
This protocol is to ensure a coordinated response during all hours, provide for special requests for
assistance from one agency to another, and arrange for joint service delivery when needed to maximize
the effectiveness of the response. It is understood that joint service provision may be used as a means to
coordinate the efforts of the involved agencies, and that each individual agency remains accountable to
its own rules, policies, confidentiality requirements, and statutes.
LOCAL AGENCY DESCRIPTION
Adult Protective Services (APS) program staff are employees of the Weld County Department of Human
Services, serving Weld County.
CMHC program staff are employees of North Range Behavioral Health, a Colorado nonprofit corporation,
providing professional, culturally competent behavioral health services for Weld County. Adult services
provided include but are not limited to:
• Assessments and Intakes
• Brief Outpatient Psychotherapy
• Comprehensive Mental Health Evaluations
• Crisis Intervention
• Medication Therapy
• High Intensity Stabilization and Short-Term Residential Treatment
• Individual and Group Therapy Based on Recovery Model
• Case Management
• Peer-led Support/ Recovery Groups
• Residential Support
• PATH Program
• Full Range of Substance Abuse Treatment
COMMON GROUND
Both the behavioral health and adult protective services systems have common core values:
• Consent to services (§26-3.1-104, C.R.S.)
• Involuntary and/or emergency services (§26-3.1-104, C.R.S.)
• Confidentiality (§26-3.1-102, C.R.S.)
• Self-determination (12 CCR 2509-2)
• Least restrictive intervention and/or environment(§26-3.1-104, C.R.S.)
Communication and collaboration are keys to providing services for the adult and viewed as shared
responsibilities between the CMHC's and APS systems. In order to facilitate treatment and services in a
collaborative manner, CMHC and APS staff members need to make every effort to ensure that the
relevant confidential information can be easily conveyed between respective agencies. This should be
done through the use of a signed consent to services and/or specific release of information form that
allows for the sharing of confidential information.
INFORMATION SHARING AND CONFIDENTIALITY
Information Sharing
The sharing of information between the CMHC and APS will assist each agency in understanding details
about the case that will enable a more efficient approach to improving the safety of the adult and
provision of necessary services.
Confidentiality Guidelines
Statutory guidelines regarding confidentiality for respective programs will be reviewed and clarified as to
their implications when specific information sharing is required. A written release of information will be
obtained from the adult or the adult's guardian when required by mandate or agency policy.
APS: Disclosure of APS program report and case information shall be permitted only when authorized by
law or ordered by the court, as outlined in Section 26-3.1-102(7) and 204(7), C.R.S. APS staff is allowed
to share limited information that is necessary for the purposes of improving the safety and protection of
the victim with those service providers and responsible parties involved in the resolution of the case.
When a question exists regarding confidentiality, APS staff shall consult with their APS supervisor, county
director, county attorney, the state program manager, or designee.
CMHC: No confidential information shall be shared unless a written release of information is executed
and valid for no longer than twelve (12) months. There are no confidentiality exceptions for clients with
HIV/AIDS. However, CMHC staff have a duty to warn and protect, that is, a report must be made when
there is a substantiated threat of violence with: 1) intent to harm self; 2) intent to harm others; or 3) a
threat to national security.
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HIPAA: (Health Insurance Portability and Accountability Act)was not intended to hinder the investigations
of agencies authorized by law to receive reports of abuse, neglect, or domestic violence. Any release of
health information will meet requirements set forth by Section 164.512(c) (1) (i) & (iii) of the HIPAA
Privacy Rule. This section, entitled "Permitted Disclosures," states that a covered entity may disclose
protected health information about an adult that the covered entity reasonably believes to be a victim of
abuse, neglect, or domestic violence to a government authority, including a social services or protective
services agency, authorized by law to receive reports of such abuse, neglect or domestic violence to the
extent the disclosure is required by law, because it is believed that the disclosure is necessary to prevent
serious harm to the adult.
Drug and Alcohol: The confidentiality of drug and alcohol treatment records is protected by federal law,
42 CFR Part 2. Information about drug and/or alcohol treatment may not be released by programs or
counselors without signed consent unless:
• The release is ordered in a court of law by a judge who specifically cites 42 CFR Part 2 in his/her
order and finds that the information contained in the record is of such importance to the case that
the confidentiality considerations are outweighed by the safety benefits of releasing the
information;
• The information is released in order to report suspected child abuse and/or neglect;
• A threat has been made against an adult or individuals; and/or
• The information is medically necessary to treat an adult in a life-threatening emergency.
REFERRAL PROCESS
The following referral process is recommended for each agency. This process will assist each referring
agency to understand the expectations of the receiving agency upon referral of an adult, and will increase
the number of appropriately executed referrals.
Resources to meet the client's needs may need to be parceled out to other community agencies or
services: the local Area Agency on Aging, the Single Entry Point agency, law enforcement, home health,
detoxification units, and so on.
Referral Process from the CMHC to APS:
The CMHC will refer adults that may need protective services to APS by reporting to the county
department of human services in the county in which the incident occurred. The referral is made because
of the complex issues and is not based upon imminent danger to self or others or grave disability due to
mental illness, but because of complex issues surrounding the person's life. Reports to APS from the
CMHC are appropriate when it is suspected or known that the adult is a victim of mistreatment, requires
but has no caregiver services, and/or is unable to care for him or herself and is at-risk of mistreatment.
The report made to APS should provide as much information as possible, including:
• The concerns that prompted the report;
• Identifying information of the at-risk adult;
• Summary of the allegations;
• Information pertinent to safety issues for the adult and caseworker;
• Overview of the adult's functional capacity.
APS Response and Eligibility Determination
The report will be reviewed to determine whether or not the adult meets the definition of"at-risk" and
whether or not allegations meet the definition of mistreatment or self-neglect. If the adult is determined
eligible and allegations indicate the presence of or potential for mistreatment and/or self-neglect, the
county may determine:
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1. That an APS investigation will not take place because the adult is not an at-risk adult or because
the allegations do not meet the definition of mistreatment or self-neglect, Weld County
Department of Human Services may provide information to the reporter on appropriate service
options for the adult.
2. That an APS investigation is necessary, an APS caseworker will be assigned to investigate. An
investigation involves gathering more information about the at-risk adult and the situation by
calling or visiting the at-risk adult, the person who made the report, and other persons, such as
family, caregivers, or physicians, who might have important information about the at-risk adult
and/or the at-risk adult's situation.
3. That the at-risk adult's health, safety, or welfare is in jeopardy, the APS caseworker will seek the
at-risk adult's consent to services. The APS caseworker will work with the at-risk adult to resolve
the safety concerns, while respecting the rights of the at-risk adult.
Referral Process from APS to CMH'S:
Referrals to CMHC are appropriate when the adult is experiencing one or a combination of the following:
• An imminent danger or threat to self or others, due to a mental illness;
• "Gravely disabled" due to mental illness, as defined by §27-65-101, C.R.S.;
• Experiencing a life crisis with mental illness symptoms; and/or
• In need of and agrees to a mental health assessment for appropriate treatment.
CMHC Response and Eligibility Determination
If the adult is determined ineligible and/or the presenting situation does not warrant formal mental health
intervention and/or treatment, CMHC will:
Notify APS that a determination has been made by CMHC that mental health intervention and/or
treatment will not be provided by CMHC as the individual is not considered to meet any of the following
conditions:
• An imminent danger or threat to self or others;
• "Gravely disabled" due to a mental illness;
• Assessed by CMHC as having symptoms meeting criterion required for a mental illness
diagnosis;
• In need of further mental health evaluation.
An explanation of the reasons for arriving at this determination will be provided to APS.
If the adult is determined eligible for mental health services, the CMHC will proceed as follows:
4
1. If the individual has been determined to be in imminent danger, a threat to self or others, and/or
gravely disabled, a"Professional Person" will place the individual under an emergency 72-hour
hold (§27-65-105, C.R.S.) and ensure the individual is transported to an appropriate hold and
treat facility for assessment. Once an individual is on a 72-hour hold, there is a possibility for
short-term or eventually long-term certification depending on the individual's needs and response
to treatment.
2. Once in a treatment facility, an attempt will be made to encourage the individual to enroll as a
CMHC client and when eligible for voluntary treatment, become engaged in mental health
services designed to meet the identified needs.
3. If the individual is not considered to meet the requirements for a 72-hour hold, an attempt will be
made to engage the individual in mental health services to meet mental health needs. If the
individual is not already a client of the CMHC, an effort will be made to complete enrollment so
the individual can have access to treatment. However, unless the individual is on a 72-hour hold,
the individual's right to determine their own level and type of mental health treatment will be
respected.
If the appropriate release of information is in place, an explanation regarding the outcome of attempted
services will be provided to APS.
GUIDELINES FOR COORDINATED SERVICES
Service coordination between the CMHC and APS will assist each agency in preventing gaps in or
duplication of services and will improve service quality to the adult. When the CMHC and APS are
involved with the same adult, the agencies will seek corresponding written consent in order to share
information and coordinate activities as the adult's presenting condition dictates. Information that is
helpful to share may include:
• Service goals;
• Service plans;
• Anticipated service implementation and ending dates;
• Any significant changes in the adult's condition or situation, such as changes in medical status,
living situation, or loss of benefits; and
• Any activity or decision by either agency that would significantly change the service plan.
In addition, the agencies will clarify on an as needed basis:
• The roles of each agency in ongoing service provision;
• The roles of each agency in emergency situations, such as emergency need for mental health,
detoxification, or medical intervention;
• The agency that will act as primary case manager, to be determined on a case-by-case basis;
and
• In instances where the at-risk adult is deemed not legally competent to make their own decisions,
the process for identifying an individual to act as guardian.
High-risk Cases Involving Adults Receiving Mental Health and/or APS services:
Mutually served cases identified as high risk by APS or the CMHC receiving the emergency services will
be treated in a coordinated manner.
• The agency (CMHC or APS) that first identifies a high-risk situation for an adult receiving Mental
Health and/or Adult Protective services will immediately contact the other agency.
• Some situations call for immediate action. When an agency identifies a high-risk situation, the
agency will take immediate action to ensure the safety of the adult and of the public.
5
• Further, the agency has the responsibility to notify the collaborating agencies of the action taken
no later than the end of the next business day.
• Supervisors from the CMHC and APS will work together to devise an immediate response to
resolve the crisis using the resources available to both agencies. Specific services and distinct
agency roles will be developed and clarified locally.
• Emergency joint case conferences may be called by either agency to devise contingency and
longer term plans to address the high-risk situation.
• When feasible,joint home visits to the adult by APS and the CMHC staff will be made to assess
and resolve the high-risk situation.
High-risk Cases Involving APS Adults Living in the Community and Not Receiving CMHC
Services:
• The supervisor of the agency that identifies the high-risk situation for an adult not receiving
CMHC services will notify the supervisor of the other agency as soon as possible if it is believed
that agency collaboration is necessary.
• The high-risk factors in the adult's situation and the need for priority attention will be explained.
• Emergency procedures such as defined by the 27-65-101 C.R.S., may or may not be enacted to
resolve the crisis.
Involuntary and Emergency Commitment Process for Alcohol and/or Drug Abuse:
Please be aware that all admissions to a detoxification center may be voluntary or involuntary. For adults
that abuse alcohol or other drugs and refuse to seek treatment, APS should contact the local
detoxification program for information regarding the emergency commitment process. Adults that are
under the influence of alcohol and/or other drugs and present as a danger to self or others, are eligible for
an emergency commitment and subsequent confinement at the detoxification program for up to five (5)
days.
This procedure can be applied to individuals who are incapacitated as a result of abusing alcohol or other
drugs. If APS is interested in pursuing an alcohol or drug involuntary commitment, DBH's involuntary
commitment coordinator must be notified after the emergency commitment has been authorized by the
local detoxification program. An informational contact can be made prior to the implementation of the
emergency commitment.
The emergency commitment should be used to intervene with an adult's use of alcohol and/or drugs.
While the adult is in a detoxification program, staff will attempt to motivate the adult into treatment on a
voluntary basis. If the adult is not receptive to voluntary treatment, a discussion can be initiated with the
APS caseworker, family, other interested party and DBH as to whether an involuntary commitment would
be appropriate.
An involuntary commitment can be pursued if it can be proven in court that an adult is clearly an alcoholic
(drug abuser), danger to self or others and/or is incapacitated as a result of drinking alcohol (abusing
drugs other than alcohol), and refuses voluntary treatment. Additionally, DBH must be able to prove to
the court that it has appropriate treatment that is likely to be beneficial to the adult.
CONFLICT RESOLUTION
APS and the respective CMHC retain responsibility for making eligibility decisions regarding respective
programs and services, and for determining the type, duration, and scope of services it will provide to
6
eligible adults. In order to promote coordination and collaboration each entity shall attempt to resolve any
conflicts in accordance with the process described below.
• In cases of disagreement between APS and CMHC staff about an adult's eligibility for services or
the appropriateness of a service offered by the CMHC, every effort will be made to resolve the
conflict at the practitioner level.
• If resolution cannot be achieved at the practitioner level, supervisory staff in each
Agency will confer to reach an acceptable resolution.
• If a county department of human services has an established Adult Protection (AP) team, and if
approved by the supervisors of respective agencies, the case situation may be presented to the
AP team for recommendations.
• If a dispute cannot be resolved at the supervisory level or APS team level, the dispute will be
referred to the administrative level at each agency for resolution.
REVIEW
APS and the CMHC will review the terms of this protocol at least biennially from the day the agreement is
enacted. APS and the CMHC may seek the consultation of respective state programs in the development
or revision of protocols.
SIGNED BY:
Weld County Department of Human Services (WCDHS)
J i . /c2poiL
J ,.y Griegq, Director ate
NORTH RANGE BEHAVIORAL HEALTH (CMHC)
• 7 /vr /I
Larry D. Pottorff xecutive Director D e
BOARD OF COUNTY COMMISSIONERS
COLORADO
WELD COUNTY,
ATTEST: ,Iq Silda ---• G ) C
Sean P. Conway Chair Pro4m
Weld Count Clerk to the .a ' rye
,�y � �i JUL 2 72011
BY:
Deputy Cle to the
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GLOSSARY
Abuse: The infliction of physical pain or injury, as demonstrated by, but not limited to, substantial or
multiple skin bruising, bleeding, malnutrition, dehydration, burns, bone fractures, poisoning, subdural
hematoma, soft tissue swelling, or suffocation; where unreasonable confinement or restraint is imposed;
or where there is subjection to nonconsensual sexual conduct or contact classified as a crime under the
"Colorado Criminal Code", title 18, C.R.S.;
At Risk Adult: Person's 18 years or older who are subjected to abuse/neglect or exploitation because
they are unable to obtain services necessary for their health, safety or welfare or lack sufficient
understanding or capacity to make or communicate responsible decisions.
Caretaker Neglect: See Neglect.
Emergency Mental Health Services: Emergency Mental Health Services shall be provided when an
adult or someone authorized to act on behalf of the adult contacts the organization designated to be a
point of access, such as emergency departments or community mental health centers, information
received during the call will be used to triage (assess)the situation to determine an appropriate response.
If the adult requires face-to-face contact because they have an emergency as defined by the prudent
layperson standard included in the federal regulations for managed care, the adult must be seen within
one hour(two hours in rural/frontier areas). The adult could be a current adult in treatment or new to the
CMHC. The provider must be qualified to provide emergency mental health services. Definitions of grave
disability, imminent dangerousness and/or harm to self/others are (27-65-105 M-1 Emergency Treatment
and Evaluation).
Exploitation: The illegal or improper use of an at-risk adult for another adult's advantage, such as
forcing the adult to panhandle.
Financial Exploitation: The illegal or improper use of an at-risk adult's financial resources for another
adult's profit or advantage.
Guardian: An adult at least twenty-one years of age, resident or non-resident, who has been appointed
by the court to make decisions for an adult found to lack decision-making capacity. The court may grant
the guardian authority to make all decisions for the adult(ward)or may grant a limited guardianship that
limits the duties, powers, and/or duration of the guardianship. APS and Mental Health Centers are not
required to take guardianship of any clients receiving the respective services.
An emergency guardian may be appointed without notice only if the court finds from testimony that the
adult will be substantially harmed if appointment of a guardian is delayed. The emergency guardian's
authority may not exceed sixty days and the guardian may exercise only the powers specified in the court
order. Appointment of an emergency guardian is not a determination of the adult's incapacity. An
emergency guardian or the powers granted may be removed or modified by the court at any time.
If the court finds that a guardian is not effectively performing the guardian's duties and that the welfare of
the ward requires immediate action, it may appoint a temporary substitute guardian for the ward for a
specified period not exceeding six months.
Gravely Disabled: A condition in which an adult, as a result of mental illness, is in danger of serious
physical harm due to his inability or failure to provide himself the essential human needs of food, clothing,
shelter, and medical care,
OR
Lacks judgment in the management of his resources and in the conduct of his social relations to the
extent that his health or safety is significantly endangered and lacks the capacity to understand that this is
SO.
OR
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An adult who, because of care provided by a family member or by an adult with a similar relationship to
the adult, is not in danger of serious physical harm or is not significantly endangered may be deemed
"gravely disabled" if there is notice given that the support given by the family member or other adult who
has a similar relationship to the adult is to be terminated and the mentally ill adult is diagnosed by a
professional as suffering from any one of the following: chronic schizophrenia; a chronic major affective
disorder; a chronic delusional disorder; or other chronic mental disorder with psychotic features
AND
Has been certified pursuant to this article for treatment of such disorder or has been admitted as an
inpatient to a treatment facility for treatment of such disorder at least twice during the last thirty-six months
with a period of at least thirty days between certifications or admissions AND is exhibiting a deteriorating
symptomatic course leading toward danger to self or toward others and is not receiving treatment that is
essential for his health or safety. (Section 27-65-102, C.R.S.)
High Risk: "High risk" refers to a situation in which there is imminent risk to the adult's health or safety,
or public safety is in immediate jeopardy. The primary focus in high-risk cases will be the resolution of the
immediate or pending crisis.
Incapacitated Adult: An adult, other than a minor, who is unable to effectively receive and/or evaluate
information or make or communicate decisions to such an extent that the adult lacks the ability to satisfy
essential requirements for physical health, safety, or self-care, even with appropriate and reasonably
available technological assistance. (Section 15-14-102, C.R.S.) A licensed physician or psychologist
determines the adult is incapacitated and a court must declare the adult to lack decision-making capacity.
Medical Clearance: A procedure performed by medical personnel to determine that the patient does not
have an ongoing medical emergency or acute medical conditions requiring inpatient hospital care.
Mental Health Hold: A 72-hour involuntary period of commitment for the assessment and acute
treatment of symptoms related to mental illness. A hold can be written by various professionals, including
law enforcement, registered nurse, licensed clinical social worker(LCSW), licensed professional
counselor(LPC), licensed psychologist, and any licensed physician.
Mistreatment: For purposes of this protocol, includes physical, self, and sexual abuse, self and
caretaker neglect, and financial and other exploitation.
Neglect: "Caretaker neglect" occurs when adequate food, clothing, shelter, psychological care, physical
care, medical care, or supervision is not secured for the at-risk adult or is not provided by a caretaker in a
timely manner and with the degree of care that a reasonable adult in the same situation would exercise;
except that the withholding of artificial nourishment in accordance with the "Colorado Medical Treatment
Decision Act", article 18 of title 15, C.R.S., shall not be considered as abuse.
Organic Mental Disorder: The term "organic mental disorder" has been replaced by the term "mental
disorder due to general medical condition." The term distinguishes this condition from (primary) "mental
disorders." A"mental disorder" is defined as a clinically significant behavioral or psychological syndrome
or pattern that is associated with distress or disability or with a significantly increased risk of suffering
death, pain, disability, or an important loss of freedom.
Reasonable Distance: In a rural area, a reasonable distance to travel for urgent services is one that
would be comparable with the distance that area residents have to travel for other urgent health care and
human services. If someone lives in an area where they must travel 50 miles to urgent health care and
human services, then this is a reasonable distance to have to travel for urgent mental health services. If
other urgent health care and human social services are available within 20 miles, then 50 miles would not
be a reasonable distance to travel for urgent mental health services.
Routine Mental Health Services: Routine services shall be provided to consumers when ongoing
mental health treatment is requested in a non-emergency situation and:
•
The adult agrees to treatment;
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• There is no suicidal ideation, plan, or recent gestures. History of past attempts should be
considered;
• The prospective adult indicates no hallucinations or delusions that are interfering in his or
her ability to function, and appears to be oriented to time, person and place; and
• The adult is able to care for self(and others in his/her charge) in a reasonable, adaptive
manner.
Self- Neglect: An act or failure to act whereby an at-risk adult substantially endangers his/her own
health, safety, welfare, or life by not seeking or obtaining services necessary to meet his/her essential
human needs. Choice of lifestyle or living arrangements shall not, by itself, be evidence of self-neglect.
Urgent Mental Health Services: Urgent services shall be provided to an adult who is experiencing a life
crisis, or when there is an indication of a deteriorating course of symptoms that is not deemed an
emergency, as evidenced by one or more of the following:
• The adult is in need of a prescription and has run out of medication that is necessary to
stabilize a mental health disorder;
• The adult is exhibiting mild/moderate symptoms of a deteriorating course;
• The adult's mental illness is exacerbated thereby affecting his/her ability to perform
activities of daily living;
• The adult presents without a support system; and/or
• An assessment indicates that an intervention scheduled the same day or the next day
meets the needs of the adult.
If the adult appears to lack decision-making capacity, due to a psychological or medical condition, limited
services may be provided to assure the adult's immediate safety.
APS may seek professional assistance to establish the adult's decision-making capacity in order to better
protect the safety of the adult. This may require professional medical and court involvement. A
Community Mental Health Center may have services to meet this need; therefore, APS staff are
encouraged to call their local mental health center to ensure an appropriate referral can be made.
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