Investigating and Monitoring in PRTFsmaterials.ndrn.org/virtual20/session39/Investigating and...
Transcript of Investigating and Monitoring in PRTFsmaterials.ndrn.org/virtual20/session39/Investigating and...
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Investigatingand Monitoring in
PRTFs
NDRN 2020 Annual ConferenceChristy Johnson, Investigator SupervisorAndrea Fannin, Case Advocate Fellow
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Learning Objectives
Psychiatric Residential Treatment Facility (PRTF) Quick Overview
Alabama’s Childcare System Snapshot
Defining PRTF Initiatives
Alabama PRTF Initiative & Outcome
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Psychiatric Residential Treatment Facility (PRTF) Quick Overview
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What is a PRTF?
• Medicaid funded, separate, stand alone entity serving youth under age 21. 42 USC 1396d(h); 42 CFR 483.352
• A PRTF is NOT a hospital.
• Purpose to improve mental health condition or prevent further regression so intensive services are no longer needed. 42 CFR 441.152(a)(3)
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PRTFs and Medicaid
• Must be accredited by JCACHO, CARF, COA or any other accrediting organization with comparable standards recognized by the State. 42 CFR 441.151(a)(2)(ii)
• Licensing agency must certify that all PRTF contracts meet Medicaid’s Conditions of Participation for Seclusion and Restraint. 42 CFR 483.358(g); 42 CFR 483.358(d)
• Contract programs must submit attestation of compliance with reporting requirements of serious occurrences and the use of restraint and seclusion upon enrollment. 42 CFR 483.374
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Placement in a PRTF
• Individual must be identified by a mental health professional within DSM diagnosis within the range of 290-316 (Per Alabama RFP). Is an optional Medicaid benefit. States can determine which conditions fall under this benefit
• Implementation of a professionally developed and supervised individual plan of care, approved by an independent team as meeting medical necessity for this level of care.
42 CFR 441.150-182
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Ineligibility for PRTF
• Actively homicidal, suicidal or psychosis not controlled with medication or diagnosis in exclusionary category from DMH licensed facilities, (e.g., Autism). (Alabama RFP)
• Displayed major acts of violence or aggression such as rape, arson, and assault with a deadly weapon, murder, and attempted murder within the past (6) months. (Alabama RFP)
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Alabama’s Childcare System Snapshot
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ALABAMA Residential Childcare
Hospitalization
Intensive Psych Under 21 (PRTF)
Moderate Residential
Basic Residential (Group Home)
Therapeutic Foster Home
Foster Home
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Program Type Facilities Group
Homes
Emergency
Shelters
Number by Type 34 30 4
Number of Children 689 131 10
Number Foster Care Children in Child Care Institutions March 2020
https://dhr.alabama.gov/wpcontent/uploads/2020/05/STAT0320.pdf
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Centers for Medicare and Medicaid Services
Department of Human Resources
Department of Mental Health
Department of Public Health
Alabama Medicaid
ADAP (Protection & Advocacy)
Six PRTF Oversight Agencies
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Defining PRTF Initiatives
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Individual Investigations
• Serious occurrence reports
• Individual complaints
Monitoring Efforts
• Abuse, neglect and conditions
• Placement & length of stay (los)
• Education services
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MonitoringScope
Behind-the-Scenes Look
Administrative interview
Facility tour
Information to residents
Individual interviews
Policies, procedures, handbook
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Serious Occurrence Report
• Clearly defined, uniform reporting definitions and process
• Internal data collection and vetting process
• Oversight agency responses
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Identify potential claims
• Right to treatment
• Safety and environment
• Placement/LOS
• Seclusion and restraint use
• Education and FAPE
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Alabama PRTF Initiative & Outcome
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“Happy Farm”Psychiatric Residential Treatment Facility (PRTF)
• Bed capacity: 43• Dorms: 3 female & 1 male• Age range: 12 -18 YO• Co-occurring disorders: approximately 85%• Certification: Alabama Department of Human
Resources• Reimbursement rate: $259.75 per diem• Cameras: 100 + continual feed• Education services: on campus school• Seclusion: Safe Space building and detention center• Restraints: Physical and mechanical
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Monitoring and
29 Investigations
• Restraint and Seclusion Injuries and Misuse
• Physical and Verbal Abuse
• Neglect
• Elopements
• Excessive Seclusion
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GEORGEAge 12
Loves playing Fortnite
Physical Abuse
• Repeatedly dragged across concrete by multiple staff
• Bruises all over body from being bullied and manhandled by staff and residents
• Suffered black eye at the hands of roommate
• Suffered a broken thumb while dragged across floor and into seclusion
Verbal Abuse
• “Cursed at like a dog”
• “Called fat boy”
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ALLISONAge 12
Enjoys dancing
Neglect (Incident #1)
• Taken to seclusion wrapped in blanket and wearing NO clothes.
• Allison, NAKED, jump out of vehicle and ran up hill.
• Secluded overnight. NAKED. No mattress
• Not continuously monitoring in seclusion; cut her arm with screw from ceiling.
• Transported back to dorm next day – still NAKED.
Neglect (Incident #2)
• Days later, ingested shampoo and taken to hospital.
Neglect (Incident #3)
• Eloped from campus. Raped while on elopement.
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CANDACEAge 15
Loves to SingWants to work with animals & to be a foster mom
Neglect (Incident #1)
• Three (3) weeks after resident Isabelle ingested soap in a staff bathroom, Candace entered the same unlocked bathroom, found unsecured bleach, and drank bleach.
Neglect (Incident #2)
• Attempted suicide by swallowing a tampon; almost asphyxiated. Sent to hospital.
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Operates Like a Juvenile Detention Facility
• Use of shackles and handcuffs
• Residents forced to wear orange detention jumpsuits
• Routinely use detention building for seclusion
• Facility pressing charges against residents
• Institutional residential units
• Instigators and retaliatory staff
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Restraint and Seclusion
• Purchased straight jacket costume
• Co-mingling DYS/DHR populations
• Excessive seclusion, (i.e. overnight, days and up to a week
• No continuous, in-person, face-to face monitoring
• Handcuffs and shackles
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Behavior Management and Therapeutic Interventions
• Staff lack fundamental understanding of mental health
• Lack of individualized therapy
• Lack of access to therapist
• Lack of transitional programming
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Behavior Management and Therapeutic Interventions (cont.)
• Staff making medical decisions with no license
• Pervasive physical and verbal abuse by staff
• Failure to use least restrictive behavior interventions
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Plan of Action• ADAP met with Happy Farm leadership
• Investigation and Monitoring Team presented a powerful PowerPoint and case examples
• ADAP’s list of met demands:
– Closed intensive program (PRTF)
– Hired expert, agreed upon by both parties, to conduct a program evaluation
– Restructuring program
– Identified baseline metrics for individual child reviews
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Resources
Handouts
• Serious Occurrence Report
• Administrative Questionnaire
• Request for Documents & Data
• Resident Questionnaire
• CMS memo on PRTFs
• CMS Frequently Asked Questions on Restraint and Seclusion
Federal Regulations
• 42 C.F.R. §441.150-184 –Inpatient Psychiatric Services for Individuals Under Age 21 in Psychiatric Facilities or Programs
• 42 C.F.R. §483.350-376 –Condition of Participation for the Use of Restraint or Seclusion in Psychiatric Residential Treatment Facilities Providing Inpatient Psychiatric Services for Individuals Under 21
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Christy JohnsonInvestigator SupervisorAlabama Disabilities Advocacy Program (ADAP) Box 870395Tuscaloosa, AL 35487Office 205-348-7196 | Cell [email protected]
Andrea FanninCase Advocate FellowAlabama Disabilities Advocacy Program (ADAP) Box 870395Tuscaloosa, AL 35487Phone 205-348-0122 | Cell [email protected]