Presentation:
Mental Health Levels of Care - Amber Willis, PhD, LMFT, Clinical Director, James Mason Centers for Recovery
Presentation slides
. James Mason offers day treatment in Utah and intensive outpatient services, the “middle area” that is so needed for adolescents.
According to IHC, 80% of teens in Utah with mental health issues are not getting what they need.
When, how to refer, and risk criteria.
Inpatient
- Starting at the highest level of care, all sorts of diagnoses, issues, but they often come along with chronic suicidal ideation and emerging personality disorders. Group therapy is very helpful for some members of this population, particularly high functioning autistic kids.
Inpatient is
short term, highly acute care, usually 1 to 2 weeks; safety in the moment; can be pink-slipped (made to go against their will); a lock-down facility. Daily therapy, group therapy, coping skills, breathing skills. Designed to help stabilize for this particular crisis.
Important to know when to send a youth to inpatient; if they aren’t admitted, it can be very traumatic. Parents can advocate, for safety issues.
How to refer:
- Refer to local ER for crisis evaluation
- Call the ER social/crisis worker ahead of time if you think the youth might recant or may not be forthcoming about safety risk
- UNI Mobile Crisis Outreach Team (crisis line: 801-587-3000) can come to your clinic to perform an onsite evaluation
- Youth may go to ER via parental transportation or ambulance
- If parental transportation is used, make sure to have youth sit in back with supportive adult with the child locks on to reduce risk of youth jumping out or grabbing the steering wheel while parent is driving.
Residential -
long-term hospitalization, average 1 - 3 months, a lockdown facility. Lower levels of care have failed; youth is resistant to treatment. Local programs: Life-line Inc. (North SL), Youth Care (Draper), Provo Canyon Behavioral Hospital, New Beginnings (West Jordan), Center for Change (eating disorders), New Haven (girls only), Copper Hills (just started taking local patients).
Risk criteria:
- Chronic suicide/Self-harm risk with low investment in recovery
- Regular use of “hard core” drugs and resistance/refusal to work on recovery
- Multiple recent inpatient stays.
- Not succeeding in PHP/Day Tx.
- Repeated recent running away (multiple days at a time)
- Severe eating disorder needing long-term medical supervision
- Serious conduct/antisocial behaviors
- Chronic psychosis that is not stabilizing
- Not succeeding in lower levels of care
Greg Hawkes can help with referral; there are some eligibility hoops to jump through.
Busy times are Jan - April, also Oct - Nov.
Referral by day treatment program. Parents should contact insurance to identify which providers are in-network. If medically complicated, such as diabetes, requires medical staff,
transgender, may send out of state. Waitlists can be significant. ER is only alternative.
Day Treatment/Partial Hospitalization (PHP) -
All day, go home at night. Working on and recognizing underlying issues and
mitigating factors (diagnoses like PTSD, bipolar, OCD, ADHD, severe depression/anxiety), will include a psych evaluation
. Typically 5-6 weeks. Insurance usually covers 4-5 weeks. (SelectHealth is good.) Local: James Mason CR, UNI’s Teenscope, Wasatch Canyons, Life-line Inc. (substance abuse).
Criteria for day treatment: severe depression, intensive ADHD (video games), dropping grades, failing classes, missing large amounts of school d/t mental health issues, low risk for running.
Referring: be sure to contact program first because there are important nuances to be discussed.
Who’s in network. Parents can do a tour.
Intensive Outpatient Care (IOP) -
Keeps youth in school, not succeeding in outpatient. Usually 3-4 days/week 3-4 hours/day often after school, 5 to 8 weeks duration. Youth show investment in treatment, periods of improved stability, and relative ability to engage successfully/safely in school setting.
Referral process is very similar to Day Treatment. Local IOP programs: James Mason, Wasatch Canyon Adolescent Behavioral Health (Taylorsville), Provo Canyon Behavioral Hospital.
For parents: most providers include family therapy, multi-family groups, parent support groups in residential and intensive outpatient.
Questions
Insurance. If family can first meet their deductible, then it’s often 80/20 or 70/30. Meeting that deductible early in the year can be a life saver for parents; they can get many services from then on.
Insurance companies often require failed lower levels of care. A pattern of insurance not covering Medicaid e
mergency room patients, then escalates until a medical necessity. Need an assessment, from a behavioral health team at the insurance company (SelectHealth), or from day treatment. If providers are not available or easily accessible, single-case agreements for out-of-network are common. Financial agreements available.
For Medicaid, low income population, some options. In-home and family therapy.
- James Mason Centers for Recovery Adolescent treatment program serving youth that struggle with a wide range of mental and behavioral issues. Specializing in comprehensive day treatment (40 hours a week) and intensive outpatient services (10 to 12 hours a week). MHP 24645
- UNI Crisis Line and Mobile Crisis Outreach Team (MCOT) Provides 24-hour phone service staffed by mental health professionals. Specialists provide crisis intervention, suicide prevention, information and referral, emotional support, and assistance to individuals experiencing emotional distress or psychiatric crisis. MHP 22619
