TABLE OF CONTENTS

Care, Treatment, or Services (CTS)

CTS 01.01.01: Identifying and accepting appropriate individuals in need of care, treatment, or service

Revision Date: November 12, 2020 

Written/Revised By: Marie DiDario, DO

Approved By: Thomas Milam, MD

POLICY DESCRIPTION:  

The Iris provider will work with the staff at the on-site facility to ensure individuals seeking care, treatment, or services are treated fall within the scope of the Iris provider’s training and experience and within the on-site facility’s capability and license. The head of the department will review this policy on a biennial basis.

 

PROCEDURES: (See also Iris Telehealth Medication Management & Treatment Policy, Section 9)

  1. The criteria to determine eligibility for care, treatment, or services are identified by the on-site clinical staff, in conjunction with the Iris provider, including an assessment of the appropriateness for a telepsychiatric encounter with the Iris provider. 
  2. Individuals will be screened for eligibility at the point of first contact, whether by phone, in person, or other media. 
  3. Generally, patients seen will have a mental health condition for which specialty care from a psychiatrist or psychiatric nurse practitioner is medically necessary. Standard demographic information and, if applicable, insurance information will be taken. Additional information may be collected from the individual, or his/her legal guardian, to determine eligibility for care, treatment, or services.
  4. The on-site clinical staff, in conjunction with the Iris provider, will try to match the needs of the individual seeking care, treatment, or services with the provider best suited and available to meet the individual’s needed in a timely fashion. 
  5. Once deemed eligible, the individual will be provided with the locations and hours that care, treatment, and services are offered. 
  6. When warranted, the organization provides information about resources available to the individual for the care of his or her dependents.
  7. The populations of individuals accepted or not accepted by the organization needs to be clearly identified to best direct the individual to the appropriate level of care (for example, programs designed to treat adults that do not treat young children)
  8. The procedures for accepting referrals are identified by the on-site staff, with particular attention paid to individuals who may be appropriate to receive care, treatment, or services via a telepsychiatry video encounter.
  9. The Iris provider has the right to decline treating a patient if the care or treatment or services the patient is needing does not fall under the provider’s identified scope of practice (example would be a child and adolescent trained psychiatrist working with a complex geriatric patient. This would not be a good fit for that provider if they do not have the experience to safely treat this type of patient.)

 

 

CTS 01.02.01: Management of Patient Wait Lists

Revision Date: November 12, 2020 

Written/Revised By: Marie DiDario, DO

Approved By: Thomas Milam, MD

 

POLICY DESCRIPTION:  

This written policy outlines how Iris Telehealth providers work in conjunction on-site clinical staff to handle and maintain patient waiting lists. The policy aims to ensure timely and equitable access to all patient services based on clinical need. This policy shall be applicable to Iris providers. The head of the department will review this policy on a biennial basis.

 

PROCEDURES: (See also Iris Telehealth Medication Management and Treatment Policy, Section 10)

  1. Definition of wait time: Between a patient’s first day contacting the clinic or hospital about an appointment and their actual visit (in days).
  2. Management of Demand
    1. The number of referrals received is the initial indication of demand for services. The referral process should be actively managed, and the number of referrals received should form a basis for calculating the level of services to be provided. 
    2. The Iris provider, in conjunction with on-site staff, should be monitoring if the referrals for health care services are clinically appropriate and directed towards the most suitable services
  3. Management of the Queue
    1. A waiting list is a queue of patients waiting for treatment. Every patient waiting in this queue has a valid expectation of treatment within a reasonable period. Waiting lists should be regularly reviewed to ensure they are accurate, and it should be possible at any time to access up-to-date information on any individual patient on the list.
    2. Patients should be called from a waiting list based on scheduled appointment time. Patients with similar clinical priority should be seen predominately in the order of the longest waiting patients first, though some patients with an urgent clinical need may at times take priority
    3. Waiting lists must accurately reflect patients who are actively waiting for an appointment. Regular administrative reviews of the waiting list are intended to identify patients who no longer require an appointment (e.g. deceased or they have had an appointment elsewhere).
    4. Patients should be clearly advised of the action that will be taken if they fail to attend for an appointment and failures to attend should be minimized. All attempts to contact the patient prior to withdrawing the referral must be documented.
  4. Adding and removing patients from waiting lists
    1. Patients should only be placed on a waiting list if:
      1. There is a clear clinical indication that the proposed assessment or treatment is required and will be beneficial. A patient is not to be placed on a waiting list as a holding device until the patient's condition reaches an appropriate stage or the patient reaches a certain age. 
      2. Services are available within the clinic or hospital to provide the planned assessment or treatment. 
      3. There is a valid expectation that the assessment or treatment will be carried out within the agreed waiting time standard. If this is not the case, then the hospital or clinic in partnership with the primary care should make arrangements for the provision of care at an alternative facility or through an alternative and appropriate method of treatment.
    2. Patients should only be removed from a waiting list when:
      1. The patient has been seen or admitted and the planned episode of care has commenced. 
      2. The patient has failed to attend or repeatedly asked for appointments to be rearranged. 
      3. There is another valid reason for removal (e.g., the patient no longer wishes treatment, has moved out of the area, or has received treatment through another provider).
      4. The patient requests to be removed from the outpatient waiting list.
      5. The provider requests that the patient be removed from the outpatient waiting list
      6. Advice has been received that the patient has been, or will be, seen elsewhere for the condition. 
      7. The patient is deceased. 
      8. The patient cannot be contacted. 
      9. The PCP/referrer is unable to contact the patient. 
      10. The patient has been transferred to the waiting list of another hospital or clinic.
      11. The therapist or social worker records patient no longer attending any required therapy appointments in accordance with the conditions set out. 
      12. The patient fails to attend scheduled appointments in accordance with the conditions set out. 
    3. Where patients are removed in the abovementioned circumstances the reason for removal must be recorded in the patient administration system and the removal communicated with the patient and their referrer.
    4. While individual clinic sites may have slight variances to the above referenced waiting list management strategies, the Iris provider will work in accordance with the clinic policies with the sole focus being to promote timely access to the care, treatment, and services that are medically necessary for all eligible patients.

 

 

CTS 01.03.01: Plan for Care, Treatment, or Services

Revision Date: November 12, 2020 

Written/Revised By: Marie DiDario, DO

Approved By: Thomas Milam, MD

POLICY DESCRIPTION:  

This written policy outlines how Iris Telehealth providers work in conjunction on-site clinical staff to develop a preliminary plan for care, treatment, or services, when needed. This policy shall be applicable to all Iris providers. The head of the department will review this policy on a biennial basis.

PROCEDURES:

Iris Telehealth providers, in conjunction with on-site clinical staff, may begin preliminary care, treatment, or services deemed medically necessary or appropriate for an individual prior to completing the screening or assessment process for a number of reasons including the needs of, and safety issues related to, the individual served. 

Safety is of great importance, and when there are safety concerns the preliminary care plan may focus on risks such as harm to self or others, elopement, sexual reactiveness, and other immediate safety concerns for patients, clinical staff, and other individuals present

Safety concerns in hospital units and Emergency Departments, as well in the outpatient settings, can arise frequently and need to be addressed immediately, especially if the patient is:

  1. a threat to oneself or others,
  2. at risk of leaving against medical advisement
  3. at increased risk of sexual reactiveness
  4. demonstrates risk of other immediate safety concerns 

In these types of situations, it is expected that the Iris Telehealth provider, working in conjunction with the on-site clinical staff, will begin a preliminary safety check before the initial screening/assessment process has been completed. (Refer to Policy CTS 02.01.01.) The preliminary safety check may include: 

 

  • Asking questions or collect information from other resources (e.g., within the patient’s chart, family, or friends recollection) about the patient’s past emotional and behavioral functioning. 
  • Finding out if the patient has a history of violence or aggression. 
  • Immediate safety assessment if the patient is brought into the clinic or hospital in an agitated state, based on the data collected from this initial assessment, including:
    1. having a patient sitter (i.e. 1:1)
    2. environmental changes such as removing all items that could pose harm to someone if misused. 
    3. Maintaining a calm environment to the extent possible
  • Once the patient is no longer a threat to anyone, nor at risk of eloping, the rest of the required screenings and assessments may be performed. It will be the provider’s responsibility to ensure this follow-up happens in a timely manner.
  • In the event the patient continues to pose a risk of danger to self or others it will be the responsibility of the Iris provider and the on-site staff to collaboratively ensure the patient receives the appropriate level of assessment and be safely transferred to the least restrictive environment consistent with the patient’s level of risk.

 

  •  

 

CTS 02.01.01: Screening for Risk of Imminent Harm

Revision Date: November 12, 2020 

Written/Revised By: Marie DiDario, DO

Approved By: Thomas Milam, MD

POLICY DESCRIPTION:  

The organization has a screening procedure for the early detection of risk of imminent harm to self or others. This policy shall be applicable to Iris providers. The head of the department will review this policy on a biennial basis.

 

PROCEDURES: 

There are times in the hospital (Inpatient, Emergency Department, and/or Medical/Surgical floors) settings, and less frequently in our outpatient settings, that a patient is not stable and is:

  1. a threat to oneself or others,
  2. at risk of leaving against medical advisement
  3. at increased risk of sexual reactiveness
  4. demonstrates risk of other immediate safety concerns 

 

In these types of situations, it is expected that an Iris provider will begin a preliminary safety check using the PHQ-9 screening tool prior to the routine screening/assessment process. To do a more focused assessment on the patient’s safety after initial screening, the Iris provider or clinic/unit staff can administer the Columbia-Suicide Severity Rating Scale (CSSRS).The provider should ask questions or collect information from other resources (e.g., within the patient’s chart, or family or friends’ recollection) about the patient’s past emotional and behavioral functioning. The provider should also find out if the patient has a history of violence or aggression. If the patient is brought into the clinic or hospital in an agitated state, based on the data collected from this initial screening, the staff and provider should address the immediate safety of the patient and on-site staff. For the hospital setting, this may include things like having a patient sitter or other environmental changes such as removing all items that could pose harm to someone if misused. 

 

For the outpatient setting, the Iris provider will instruct the on-site staff to use their emergency protocol and have the patient transported to the appropriate hospital. As listed above, the PHQ-9 can be used for depression screening, and the CSSRS for safety and suicide assessment. If, in the event the patient continues to pose a risk, it will be the responsibility of the Iris provider and the on-site staff to ensure the patient is transferred to the appropriate emergency facility. It is the responsibility of the Iris provider to have an emergency plan in place with the on-site staff prior to treating any patients.  

 

Once the patient is no longer a threat to anyone, nor at risk of eloping, the rest of the required screenings and assessments may be performed. 

 

(See PHQ-9 and CSSRS on the next following pages)

 

 

PHQ-9

 

CSSRS

 

CTS 02.01.03: Screenings and Assessments

Revision Date: November 12, 2020 

Written/Revised By: Marie DiDario, DO

Approved By: Thomas Milam, MD

POLICY DESCRIPTION:  

This policy is a written description outlining how Iris Telehealth has a screening and assessment procedure for all patients. This policy shall be applicable to Iris Telehealth providers. The head of the department will review this policy on a biennial basis.

 

PROCEDURES: (See also Iris Telehealth Medication Management and Treatment Guidelines, Section 11)

  1. Iris providers, in conjunction with on-site clinical staff, ensure an appropriate screening and assessment are performed on all new patients each accordance with the policies identified in each clinical setting where Iris Providers see patients. (This may include patients that are not new to the facility but are new to the Iris provider.)  Information, at a minimum, that should be documented by the organization should include:
    1. all relevant behavioral and physical health information pertaining to a patient
    2. all available inpatient and outpatient records from providers that have currently or in the past treated the patient and relate to a patient’s current care, treatment or services
    3. the individual’s perceptions of his or her needs, preferences, and goals for care, treatment, or services 
    4. When indicated and available, the family’s perceptions and preferences for care, treatment, or services
  2. The Iris providers can use the Behavioral Healthcare Instruments Listing for any tools deemed relevant to a patient: https://manual.jointcommission.org/BHCInstruments/WebHome  (Examples of frequently used tools include the PHQ-9, the GAD-7, the Columbia SSRS)
  3. It is the responsibility of the on-site facility to ensure the patient is seen within the time frame dictated by the needs of the patient. If this time frame cannot be met, the on-site facility has the obligation to try and help the patient in an alternative way. 
  4. The Iris provider should follow-up with their administrative contact on-site and/or at Iris if this process is not being followed and well-documented for each patient.

 

 

CTS 02.01.05: Physical Health Screening in non-24 hour settings

Revision Date: November 12, 2020 

Written/Revised By: Marie DiDario, DO

Approved By: Thomas Milam, MD

POLICY DESCRIPTION:  

Iris telehealth, in conjunction with its clinical partners, implements a physical health screening for all patients served in non-24-hour settings to determine the need for a medical history and physical examination. This policy shall be applicable to Iris Telehealth providers. The head of the department will review this policy on a biennial basis.

 

PROCEDURES: (See also Iris Telehealth Medication Management and Treatment Guidelines, Section 12)

  1. The on-site healthcare organization’s staff will provide all physical health screenings, as deemed necessary by their clinical staff, as this is outside the primary scope of the Iris Telehealth provider. The Iris Provider will refer to the health screenings performed by the on-site clinical staff, and will recommend any additional information relative to the physical and medical screening be performed by the on-site staff based on the Iris Provider’s mental health assessment of the patient.
  2. Screening format is to be determined on-site clinical staff, but should include, at a minimum:
    1. Data to be collected (i.e. vitals, height & weight, known medical co-morbidities, current medications and allergies, etc.) 
    2. Time frame for completion of the screening (i.e. all new pts appointments, post-hospitalization appts, etc.) 
    3. Screening triggers that indicate the need for a medical history and physical examination (i.e. elevated BMI, strong FH of medical illness, pertinent risk factors related to tobacco, alcohol, or substance use, etc.) 
  3. It is the responsibility of the Iris provider to let the on-site clinical staff know if they do not have access to a physical health screening or if the results of such screening are not in alignment with the request for a medical history and physical examination. 
  4. It is the responsibility of the Iris provider to ensure a medical history and physician screening is completed by onsite clinical staff prior to prescribing any controlled substances. 
  5. In some organizations, there is no on-site medical provider, so the organization would need to gather this information from an external resource such as EMR  (e.g. a primary care provider or family nurse practitioner or recent hospital/ED records).
  6. It is also the responsibility of the Iris provider, in conjunction with on-site clinical staff, to make sure each patient’s most recent physical examination (PE) is within the past calendar year. The Iris provider should request an updated PE and medical history if it is greater than one year old. 
  7. Any additional physical or medical issues that raise concerns by the Iris Telehealth provider will be discussed with on-site clinical staff or patient’s PCP, as available. Any emergency medical concerns will prompt the Iris Telehealth provider to have immediate contact with on-site clinical staff for transfer of patient to PCP or appropriate level of care, including calling 911 if patient is deemed to be in need of emergency medical, or mental health, care.

 

 

CTS 02.01.06: Physical Health Screening in Residential Settings

Revision Date: November 12, 2020 

Written/Revised By: Marie DiDario, DO

Approved By: Thomas Milam, MD

POLICY DESCRIPTION:  

The organization has a physical health screening for all patients served in residential settings. This policy shall be applicable to Iris providers. The head of the department will review this policy on a biennial basis.

PROCEDURES: (See also Iris Telehealth Medication Management and Treatment Guidelines Section 13)

For partner groups that have residential services, the onsite clinical staff would provide the physical health screening as this is outside of the scope of Iris Telehealth providers. 

  1. Iris Telehealth provider will provide mental health treatment services via telehealth video connection to individuals in residential treatment centers when contracted to do so.
  2. The on-site clinical staff will determine whether a medical history and physical examination is necessary for the individual being served, and the Iris Provider, if asked to assist in this determination, will follow written policies and guideline established by that treatment facility, and at a minimum, based on the population served, will include current or past data collected about the individual, the time frame for completion of screening, and screening triggers that indicate the need for a medical history and physical exam. 
  3. The on-site clinical staff will have the organization’s screening process approved by a practitioner qualified by their scope of practice. 
  4. Individuals in need of a physical examination are either examined in the clinical setting or are referred to an outside source to a provider qualified by their scope of practice to perform this examination.
  5. The physical examination will be conducted by the on-site qualified provider within 30 calendar days after admission, or sooner if warranted by the individual’s physical health needs, and in accordance with law and regulation.
  6. When the onsite clinical organization accepts a physical examination completed by a qualified practitioner within the 12 months prior to the individual’s admission, the organization notes any changes to the individual’s physical health condition and documents it in the individual’s clinical/case record. If any changes(s) to the individual’s physical health condition prompts any of the screening process triggers, a new medical history and physical examination is conducted.
  7. If the date of the individual’s most recent physical examination exceeds one year, a medical history and physical examination is performed by a qualified member of the on-site clinical staff

 

 

CTS 02.01.09: Screening for Physical Pain

Revision Date: November 12, 2020 

Written/Revised By: Marie DiDario, DO

Approved By: Thomas Milam, MD

POLICY DESCRIPTION:  

The organization has a physical pain screening for all patients served. This policy shall be applicable to Iris providers. The head of the department will review this policy on a biennial basis.

 

PROCEDURES:

Iris Telehealth providers work with on-site clinicians to provide mental health care. Due to the limited ability to fully assess a patient’s pain via a telehealth video connection, if an Iris provider is assessing a patient who reports being in pain and determines that a physical pain assessment is indicated, the Iris provider will refer them to the appropriate on-site clinician, or appropriate outside qualified clinical organization, for additional treatment. 

Iris providers do not prescribe opiate-based medication to treat physical pain, but if properly waivered and trained according to DEA guidelines, may prescribe buprenorphine containing products solely for the treatment or maintenance of opiate dependence in identified MAT or OBOT programs. All patients in need of treatment for pain, whether pharmacological or non-pharmacological, will be referred to an onsite clinical provider for pain assessment and referral. The Iris provider may need to work in collaboration with other clinicians to assist with a multidisciplinary treatment approach that is patient-centered, especially if additional clinical guidance is sought by the onsite clinical provider in regard to the risks and benefits associated with the strategies, including potential risk of dependency, addiction, and abuse.

 

 

CTS 02.01.11: Screening for Nutritional Status

Revision Date: November 12, 2020 

Written/Revised By: Marie DiDario, DO

Approved By: Thomas Milam, MD

POLICY DESCRIPTION:  

The organization has a nutritional status screening for all patients served. This policy shall be applicable to Iris providers. The head of the department will review this policy on a biennial basis.

PROCEDURES:

It is the responsibility of the on-site healthcare organization to screen all patients for their nutritional status, and to assess the patient, at a minimum, for food allergies, weight gain/loss of 10 pounds or more, decreased appetite or food intake, dental problems, and eating habits or behaviors that may be indicators of an eating disorder, such as bingeing or inducing vomiting, though the Iris provider may be a part of this collaborative assessment as designated by the onsite clinical staff. 

If during the course of mental health treatment an Iris provider determines that a nutritional status assessment is indicated, the Iris provider will gather as much information from the patient as possible about their nutritional status and its possible relationship to a mental health condition so as to refer patient to the appropriate onsite clinician, or outside referral source, for additional care, treatment, or service. This referral will be documented in the patient’s chart and the Iris provider will follow-up with an on-site staff member to refer as appropriate. 

The Iris provider may need to work in collaboration with other clinicians to assist with a multidisciplinary treatment approach that is patient-centered and affords patients in need of nutritional assessments the highest quality of care, service, and treatment.  

 

 

CTS 02.01.13 Screening for Educational Status

Revision Date: November 12, 2020 

Written/Revised By: Marie DiDario, DO

Approved By: Thomas Milam, MD

POLICY DESCRIPTION:  

The organization performs an educational status screening for all relevant patients served. This policy shall be applicable to Iris providers. The head of the department will review this policy on a biennial basis.

PROCEDURES:

It is the responsibility of the on-site healthcare organization to screen all patients on their educational status, though if educational issues arise during the course of the patient’s treatment with an Iris provider, the provider will gather as much information as possible and work with on-site clinical staff to determine if a more in-depth educational status assessment is indicated. 

The Iris provider will help facilitate a referral to an appropriately licensed clinician for additional assessment and treatment. This referral will be documented in the patient’s chart and the Iris provider will follow-up with an on-site staff member to refer as appropriate. 

The Iris provider may need to work in collaboration with other clinicians to assist with a multidisciplinary treatment approach that is patient-centered (example: assessing a child of school-age that is not currently attending school and working with the family or guardian and the on-site organization to refer them to community educational options.)

 

 

Revision Date: November 12, 2020 

Written/Revised By: Marie DiDario, DO

Approved By: Thomas Milam, MD

POLICY DESCRIPTION:  

The organization performs a legal issue(s) screening for all relevant patients served. This policy shall be applicable to Iris providers. The head of the department will review this policy on a biennial basis.

PROCEDURES:

It is the responsibility of the on-site healthcare organization to screen all patients on their legal status. If during the course of treatment with an Iris provider for mental health treatment, it is determined that a more in-depth legal status assessment is indicated, the Iris provider will gather as much information as possible and refer them to the appropriate clinician for additional treatment or appropriate outside referral source.

This referral will be documented in the patient’s chart and the Iris provider will follow-up with an on-site staff member to refer as appropriate. The Iris provider may need to work in collaboration with other clinicians to assist with a multidisciplinary treatment approach that is patient-centered. Information related to this should at least include: 

  • A legal history
  • A preliminary discussion to determine how much the individual’s legal situation will influence his or her progress in care, treatment, or services, and the urgency of the legal situation 
  • The relationship between the presenting conditions and legal involvement

 

 

CTS 02.01.17 Screening for Vocational Status

Revision Date: November 12, 2020 

Written/Revised By: Marie DiDario, DO

Approved By: Thomas Milam, MD

POLICY DESCRIPTION:  

The organization performs a vocation status screening for all relevant patients served. This policy shall be applicable to Iris providers. The head of the department will review this policy on a biennial basis.

PROCEDURES:

It is the responsibility of the on-site healthcare organization to screen all patients on their vocational status. If it is determined in the course of treatment with an Iris provider that a more in-depth vocational status assessment is indicated, the Iris provider will gather as much information as possible and refer the patient to the appropriate clinician, or outside referral source, for additional care, assess, and treatment. This referral will be documented in the patient’s chart and the Iris provider will follow-up with an on-site staff member to refer as appropriate. The Iris provider may need to work in collaboration with other clinicians to assist with a multidisciplinary treatment approach that is patient-centered and affords the patient the best care possible.

 

 

CTS 02.02.01: Collecting Patient Assessment Data

Revision Date: November 12, 2020 

Written/Revised By: Marie DiDario, DO

Approved By: Thomas Milam, MD

POLICY DESCRIPTION:  

The organization collects all relevant data on each patient served. This policy shall be applicable to Iris providers. The head of the department will review this policy on a biennial basis.

 

PROCEDURES:

 

As relevant to care, treatment, or services, during a patient’s initial evaluation and assessment by the onsite clinical staff, and subsequently with the Iris provider, the following data is collected and entered into the patient's chart: 

 

  • Environment and living situation(s) 
  • Leisure and recreational interests 
  • Religion or spiritual orientation 
  • Cultural preferences 
  • Childhood history 
  • Military service history, if applicable
  • Financial issues 
  • Usual social, peer-group, and environmental setting(s) 
  • Language preference and language(s) spoken 
  • Ability to self-care 
  • Family circumstances, including bereavement 
  • Current and past trauma 
  • Community resources accessed by the individual served
  • Current short-term and long-term personal goals

Assessment data collected about the individual's emotional and behavioral functioning include at least the following:

 

  • Emotional and behavioral functioning include at least the following: 
  • History of emotional functioning - History of behavioral functioning 
  • Addictive behaviors as a primary or a co-occurring condition(s), including the use of alcohol, other drugs, gambling, or other addictive behaviors by the individual served and family members 
  • Current emotional functioning 
  • Current behavioral functioning

If the assessment suggests further evaluation for mental status, psychological, psychiatric, intellectual and/or cognitive functioning, the Iris provider will provide these evaluations prior to providing any care, treatment, or services. Any referrals made will be documented in the patient’s chart and the Iris provider will follow-up with an on-site staff member to refer as appropriate, whether that be in-house or at a different organization.

 

Iris providers will invite family members to participate if it is relevant to patient care and if the family members are available. It is a requirement when treating all minors to include the patient’s family or legal guardians in the overarching care, treatment, and services. This does not mean the family needs to be in attendance for all of the appointments and will be left up to the discretion of the Iris provider.

 

 

CTS 02.02.03: Identification and Delivery of Care, Treatment, and Services

Revision Date: November 12, 2020 

Written/Revised By: Marie DiDario, DO

Approved By: Thomas Milam, MD

POLICY DESCRIPTION:  

The organization uses all relevant data on each patient served to design and implement care, treatment, and/or service plans that are uniquely tailored to each patient. This policy shall be applicable to Iris providers. The head of the department will review this policy on a biennial basis.

 

PROCEDURES:

The Iris Telehealth provider, in collaboration with the on-site clinical staff, collects information about the individual’s emotional and behavioral functioning and his or her needs, strengths, preferences, and goals, and uses this information, and any other relevant data on each patient served, to design and implement care, treatment, and/or service plans that are uniquely tailored to each patient.

 

Prior to determining any care, treatment, or services for patients, the Iris provider will collect the appropriate data (refer to CTS 02.02.01) and base their patient plan on this information. Each patient should have care, treatment, and/or services that relate to their needs and are implemented to help the patient reach his/her goals. 

 

It is the responsibility of the Iris provider to use the documentation in the patient’s record as well as the patient history to determine if current services are appropriate for the individual, and if any additional care, treatment, and/or services are warranted. The Iris provider should work with the appropriate on-site personnel to make sure the patient is receiving the care, treatment, and/or services that match the individual’s needs, strengths, preferences, and goals.

 

In conjunction with the above requirements, the Iris provider should utilize the care, treatment, and services guidelines used by the on-site staff as long as they fall into the scope of the provider and all state and federal regulations, and they are in the best interest of the patient. 

 

 

CTS 02.02.05: Identification of Trauma, Abuse, Neglect, or Exploitation

Revision Date: November 12, 2020 

Written/Revised By: Marie DiDario, DO

Approved By: Thomas Milam, MD

POLICY DESCRIPTION:  

This is a written policy defining how Iris Telehealth providers assist in identifying individuals who have been the current or past victims of trauma, abuse, neglect, or exploitation. This policy shall be applicable to Iris providers. The head of the department will review this policy on a biennial basis.

 

PROCEDURES:

 (See also: Iris Telehealth Medication Management and Treatment Policy, Section 14)

  1. Iris Telehealth providers work in conjunction with onsite clinical staff to identify individuals who may have experienced trauma, abuse, neglect, or exploitation. This is an important ongoing identification process that applies to all individuals seeking care, treatment, or service.
  2. During the course of assessment or treatment, the Iris provider will identify patients that may have a history of any of the above in their initial and follow-up appointments.
  3. If the on-site organization cannot appropriately treat the patient for their trauma, abuse, neglect, and/or exploitation, they will refer the patient to the appropriate external resource.
  4. Regarding the reporting of victims or perpetrators of trauma, abuse, neglect, or exploitation, the Iris provider must ensure that the appropriate authorities have been contacted and this step is noted in the patient’s chart. The leaders of the on-site organizations must be made aware of any reports to external authorities by the Iris provider or on-site staff clinical or administrative staff. Whoever reports this contact to an external authority or to the on-site leadership must be the person to document in the patient’s chart that this step is complete. 
  5. The on-site organization will maintain a list of private and public community agencies that provide or arrange for assessment and care of individuals who may have experienced abuse, neglect, or exploitation.
  6. It is important for all Iris providers to remain educated about the diagnosis, assessment, and treatment of individuals who have experienced trauma, abuse, neglect, or exploitation. The following links to resources are among those many Iris providers find educational and clinically relevant:

 

  1. https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_Psychiatry_Guide/787122/all/Abuse_and_Neglect
  2. https://www.helpguide.org/articles/abuse/elder-abuse-and-neglect.htm
  3. https://ncea.acl.gov/resources/state.html

 

 

CTS 02.02.07: Patient Reassessment

Revision Date: November 12, 2020 

Written/Revised By: Marie DiDario, DO

Approved By: Thomas Milam, MD

POLICY DESCRIPTION:  

All patients will be reassessed as needed. These reassessments will be unique to each individual and based on the history and presenting information, needs, and goals. This policy shall be applicable to Iris providers. The head of the department will review this policy on a biennial basis.

 

PROCEDURES:

Each reassessment will be tailored toward the unique needs of each individual. The organization reassesses each individual served, as needed.

  1. Reassessment intensity and scope varies and may be based on the following:
  • the individual’s level of functioning
  • setting
  • the individual’s preferences for care, treatment, or services
  • the individual’s response to care, treatment, or services provided.

 

  1. Reassessments may be done for any of the following reasons (or other reasons not listed that are deemed pertinent to the individual’s care:
  • to evaluate the individual’s response to care, treatment, or services 
  • to respond to a significant change in the individual’s status and/or diagnosis or condition 
  • to satisfy legal or regulatory requirements 
  • to meet time intervals specified by the organization 
  • to meet time intervals determined by the course of the individual’s care, treatment, or services
  1. Things that should take place with reassessment appointments:
  • Assess clinical status
  • Review and confirm each medication and allergy
  • Review follow-up appointments/follow-up intervals
  • Assess for barriers, problem-solve, review what to do if problem arises
  • Review any needed follow-up actions
  • Assess client risk, adjust intensity and time frame accordingly
  • Address concrete needs, especially those that will pose barriers to accessing medication and aftercare services
  • Actively follow up on non-adherence (e.g. reschedule missed appointments)
  • Identify and flag clients referred from inpatient
  • Develop strategies for crisis management (if applicable)

 

  1. Other categories to consider may include the following, depending on the individual’s need for care, treatment or services: 
  • Wellbeing
  • Cognition/Emotion
  • Behavior
  • Physical Health
  • Interpersonal
  • Society
  • Services

Refer to the following for details: https://www.atsu.edu/research/pdfs/Mental_Hlth_Outcomes.pdf 

 

  1. Once the appropriate interventions have been implemented, further evaluation and modification of those interventions take place on an ongoing basis to further define:
    • New or revised goals, objectives, and interventions 
    • Discharge or transfer planning (if applicable) 
    • Follow-up care

 

 

CTS 02.03.01: Family or Guardian Coordination for Children or Youth Patients

Revision Date: November 12, 2020 

Written/Revised By: Marie DiDario, DO

Approved By: Thomas Milam, MD

Policy Description:  

The family or guardian should be involved in the assessment of any child or youth receiving a behavioral health assessment. This policy shall be applicable to Iris providers. The head of the department will review this policy on a biennial basis.

 

PROCEDURES:

The Iris provider should involve every child or youth’s parent or guardian in the assessment process. The Iris provider will speak with the family member or guardian to assess their expectations and involvement in the evaluation and care, treatment, or services of each child and document in the patient’s chart. The requirements of the family or legal guardian should be carefully explained and documented in the patient’s chart. Family involvement gives the child the support they need. Patient- and family-centered treatment planning is a collaborative process where care recipients participate in the development of treatment goals and services provided, to the greatest extent possible. This type of planning should be strength-based and focuses on individual capacities, preferences, and goals. Individuals and families are core participants in the development of the plans and goals of treatment.

 

Providers should be trained on the key principles of person- and family-centered care, shared decision-making, and fostering individual self-direction in treatment planning. Training should cover awareness and sensitivity on issues of race, ethnicity, age, sexual orientation, and gender identity. Person-centered and family-centered care includes care which recognizes the particular cultural and other needs of the individual, including but not limited to risk/safety assessment and crisis planning. The patient’s provider should specify the scope of family involvement they will require based upon the needs of the population served.

 

In order to keep track of the family or guardian’s involvement, the Iris provider and the family should determine the best way to facilitate ongoing communication. The family member or guardian should do their best to attend every follow-up appointment. The Iris provider should also be collecting data on how the patient is doing from the on-site staff (e.g. – a therapist or social worker), from the patient, and from the family. All of this information should be collected and used to determine if/when follow-up care, treatment, or services are needed. This data can also be useful in determining if any referral sources are needed for the child or youth patient. 

 

Sample questions for parents: 

  1. What are the emotional and behavioral problems that your child experiences at school?
  2. What are your concerns for your child related to their behavior or emotions? 
  3. What types of services are provided and/or offered at school for your child? 
  4. Who provides the services? 
  5. Are there additional services that need to be provided at school for your child that are not currently available? 
  6. Do you have difficulty obtaining mental health services for your child at school? In the community? If yes, what are the reasons that you cannot obtain services?
  7.  Is funding a concern for you?

 

 

CTS 02.03.03: Assessing the Needs of a Child or Youth

Revision Date: November 12, 2020 

Written/Revised By: Marie DiDario, DO

Approved By: Thomas Milam, MD

Policy Description:  

All children or youth should be assessed for mental health concerns. This policy shall be applicable to Iris providers. The head of the department will review this policy on a biennial basis.

 

PROCEDURES:

Anytime a child or youth is seen by an Iris provider, the Iris provider must make sure the initial assessment has at minimum the following items:

  • Legal custody status, including the clear identification of the legal guardian(s) 
  • The use of a developmental perspective in evaluating all aspects of functioning, including the child’s or youth’s physical, emotional, cognitive, educational, nutritional, and social development
  • Assessment of normative development as related to chronological age
  • The child's or youth's leisure and recreational interests 
  • The family history and current living situation
  • The family dynamics and their impact on the child’s or youth’s current needs
  • Family factors that should be considered in discharge planning

 

All parts of the assessment should be documented in the patient’s chart. Screening tools can also be used for these assessments if they are not already found in the on-site EMR template. Although the Iris provider is not able to perform a full physical health examination, the patient should have one of these assessments already on file. If they do not, the Iris provider needs to refer them to a provider who can do the physical health examination and ensure the results are documented in the patient’s chart. This exam should include, but is not limited to, the following:

  • Motor development and functioning
  • Sensorimotor functioning 
  • Speech, hearing, and language functioning 
  • Visual functioning 
  • Immunization status   
  • Oral health and oral hygiene

 

Below are sample screening tools used to assess early childhood mental health: https://dmh.mo.gov/healthykids/providers/screening-tools.html

https://humanservices.ucdavis.edu/sites/default/files/104056-MentalHealthLR.pdf 

 

 

CTS 02.03.07: Assessment of Addictive Behaviors

Revision Date: November 12, 2020 

Written/Revised By: Marie DiDario, DO

Approved By: Thomas Milam, MD

POLICY DESCRIPTION:  

This policy is a written description of what the minimum standard is for doing an assessment on a patient with an addiction. This policy shall be applicable to Iris providers. The head of the department will review this policy on a biennial basis.

 

PROCEDURES:

The purpose of obtaining a thorough assessment of addictive behaviors is to identify individuals’ unique characteristics and contexts that place them at risk for relapse. For those patients with an addiction, whether it be a primary diagnosis or a co-occurring one, the Iris provider should obtain a full history on their addictive behaviors. At a minimum, they should be collecting and documenting data on: 

  • The patient’s history of alcohol use, drug use, nicotine use, and other addictive behaviors. 
  • The age of onset, duration, and patterns of use (e.g. continuous, episodic, binge)

If the Iris provider is providing care, treatment, or services to a patient with an addiction, they must obtain, at a minimum, the following data and document it in the patient’s chart:

  • The individual's history of mental, emotional, behavioral, legal, and social consequences of dependence or addiction 
  • The consequences of dependence or addiction (for example, legal problems, divorce, loss of family members or friends, job-related incidents, financial difficulties, blackouts, memory impairment) 
  • The individual's history of physical problems associated with substance abuse, dependence, and other addictive behaviors 
  • The history of the use of alcohol and other drugs, and other addictive behaviors by the individual's family 
  • The individual's perception of the role of spirituality or religion in his or her life

For organizations providing care, treatment, or services to individuals with addictions, the assessments of the individual served should contain information about the following: 

  • Previous care, treatment, or services 
  • The individual's response to previous care, treatment, or services 
  • The individual's relapse history