The mental health reform legislation requires that certain core service functions be available in all North Carolina communities. These include screening, assessment and referral, emergency services, service coordination, consultation, and prevention and education. The expectation is that these services will be organized, managed, and delivered uniformly across North Carolina. Some of these functions are those that were discussed in the Uniform Portal section above. Definitions of these functions are:

• Referral is providing information about available providers, generic resources, and community capacity that may best meet the needs of the individual.

• Screening is a brief standardized appraisal of an individual who is not a client of the "system" in order to determine the nature of the individual’s problem and his need for service. The "triage" must include both financial and clinical information to determine the next steps.

• Assessment is a follow up step to screening. It is a clinical procedure for determining the level of clinical eligibility. It may include an assessment of the nature and extent of the individual’s problem through a systematic appraisal of any combination of mental, psychological, physical, behavioral, functions, social, economic, and intellectual resources, for the purpose of diagnosis and determination of the disability of the individual, level of eligibility.

Assessments will only occur as authorized and are not automatic. Existing assessment information will be utilized to the extent possible and "starting over" is not recommended. The outcome of the assessment protocol(s) will be standardized in order to assure consistency in the state. Protocols should be specific to the age/disabilities and for those with co-occurring diagnosis.

The combination of screening, assessment and referral is limited to 6 visits.

• Emergency Services benefit includes all crisis services outlined in the Division’s existing Crisis Services Policy, including both crisis response and crisis stabilization services. The full continuum of 24/7 services is available, e.g. phone response, face-to-face intervention, crisis respite, facility-based crisis services, mobile crisis services. Crisis stabilization services include follow-up visits, if needed by the client, until crisis resolution or full transfer to another clinical service. These services may be shared, and unless noted, will not be in every county.

• Consultation is a macro [system level] service provided to other agencies, groups or organizations to promote planning and development of MH/DD/SA services or to individual practitioners. The service is designed to assist in the development of insights, skills of organizations or individual practitioners thus increasing the quality of care available in the community.

• Education means a macro service which is designed to inform and teach various groups: including clients, families, schools, businesses, churches, industries, civic, and other community groups about the nature of MH/DD/SA disabilities and services in the state and community.

• Prevention means a universal service that is designed to inform and teach individuals, various groups, or the population at large about the insights and skills related to healthy living and possible avoidance of MH/DD/SA issues. This service includes activities designed to promote self-esteem and positive decision making of the recipients. Examples include speeches on stress management, fun/activity fairs for children.

This service is different from targeted prevention. Targeted prevention may provide universal prevention strategies but the strategies are "targeted" for high risk groups and as identified for targeted populations.

• Service Coordination benefit is a separate and distinct care coordination administrative function. It ensures that clients know about and are linked with the services that are available in the community, manages relationships with providers in the community, and includes capacity-building within the community when additional service capacity is needed (including peer support community resources).

The reform legislation makes a philosophical shift from the belief that everyone should be served by the public system to the recognition that there are not enough resources to serve everyone and the state must target resources to populations of people. The state plan identifies those populations of people that should be targeted. Within the targeted groups are special populations or "priority" populations. Below are the definitions of the targeted and priority populations and targeted populations for the state hospitals.

• Persons with Severe and Persistent Mental Illness: Persons 18 years or older who as a result of a mental illness exhibit functioning which is so impaired as to interfere substantially with their capacity to remain in the community. In these persons with mental disability limits their functional capacities for activities of daily living such as interpersonal relations, homemaking, self-care, employment, and recreation. The following diagnoses are included under the rubric of severe and persistent mental illness: schizophrenia, bipolar disorder, major depression, schizoaffective disorder, schizophreniform disorders, psychotic disorder Not Otherwise Specified (NOS). Initial Global Assessment of Functioning scores for these persons will usually be 40 or lower.

• Persons with Serious Mental Illness: Persons 18 years or older who have a diagnosable mental, behavioral, or emotional disorder which substantially interferes with one or more major life activities. Initial Global Assessment of Functioning scores for these persons will usually be 50 or lower.

Within these target populations, the priority populations are:

1. Persons with Multiple Diagnoses: Persons 18 or older with a severe and persistent mental illness and a diagnosis of substance abuse and /or mental retardation or serious health complication.
2. Homeless Mentally Ill: Persons 18 or older with a serious long term mental illness or a serious long term mental illness and substance abuse diagnosis who lack fixed, regular, adequate nighttime residence.
3. Mentally Ill Adults in the Criminal Justice System: Persons 18 or older with serious mental illness who are released from the Division of Prisons, or are in local jails, or on probation.
4. Elderly Persons: Persons age 65 and over with a serious mental illness, including dementia.
5. Deaf Mentally Ill Persons: Persons 18 or older with a diagnosable mental, behavioral, or emotional disorder who need specialized services provided by staff who have ASL skills and knowledge of deaf culture.

The state hospitals will provide inpatient care to adults and children with severe mental illness and severe emotional disorders who cannot be appropriately treated in local communities

Primary populations to be served:

• Adults and older adults with psychiatric illness including schizophrenia spectrum, bipolar disorder, major depression, and personality disorder requiring acute inpatient treatment to stabilize and return to community
• Adults with psychiatric illness including schizophrenia spectrum, bipolar disorder, major depression, and personality disorder requiring long-term inpatient treatment to rehabilitate and prevent rapid relapse and readmission
• Children with severe emotional disorders requiring acute inpatient treatment to stabilize and return to lower level of care
• Adults and older adults with psychiatric illness and substance abuse requiring acute and/or longer-term inpatient treatment to stabilize and prevent rapid relapse and readmission
• Forensic patients, including HB95 (incapable of proceeding), NGRI (not guilty by reason of insanity), and other detained for legal reasons
• Research protocol patients
• Deaf and hard of hearing people requiring acute or long-term inpatient psychiatric services

Will provide intermediate and skilled nursing care for patients referred from the State hospitals. Sufficient bed-space and intensity of psychiatric services are unavailable in the community to address the needs of this population.

1. Primary populations to be served
1. Consumers with severe mental illness requiring Intensive Care Facility level care
2. Consumers with severe mental illness requiring Skilled Nursing Facility level care
2. Specialty population to be served
1. Consumers with mid-stage Alzheimer’s disease requiring nursing care

• Children with severe functional difficulties in home, childcare, school or community activities that lead to a CAFAS score of at least 90, or a CAFAS score 60 with at least one domain having a score of 30;
• Presence of an extreme level of psychosocial risk as measured by the presence of 4 or more psychosocial risk factors and 10 or fewer psychosocial protective factors on the AOI Part I (Resilience Assessment);

• Children and youth who fall into this Target Population are those from whom supports and interventions routinely provided through human service agencies are not working, those who need the highest level of support and treatment in order to regain the ability to function successfully;

AND

• Are identified as sexually aggressive; and/or
• Deaf; and/or
• Dually or multiply diagnosed.

AND

• Utilizing or having utilized acute mental health crisis intervention in the past year or intensive wraparound services in order to maintain community placement;
• Having had 3 or more state hospitalizations in the past year or at least 1 hospitalization of 60 continuous days;
• Having had DSS substantiated abuse, neglect or dependency in the past year;
• Having experienced school (or child care) failures, suspension or expulsion
• Having been convicted of a felony or 2 or more serious misdemeanors in juvenile/adult court or being currently placed in a youth advocacy program (training school), prison, juvenile detention center, or jail - any within the past year;

AND

AND

• Support network is not accessible to the child and family
• Support network is overwhelmed by current needs of the child and family
• Available supports are not sufficiently resourced to address current needs, e.g., safety

 

• Children with moderate functional difficulties in home, childcare, school or community activities that lead to a CAFAS score of at least 60, or a CAFAS score 40 with at least one domain having a score of 20;
• Presence of a moderate level of psychosocial risk as measured by the presence of 2 or more psychosocial risk factors and 6 or fewer psychosocial protective factors on the AOI Part I (Resilience Assessment);

AND

AND

• Crisis intervention (an individual or family crisis), behaviors may include those that impact the safety/well-being of self and/or of others, e.g., assaults, withdrawal/depression, suicide threats/attempt
• Wraparound services, behaviors may include those that impact the safety/well-being of self and/or of others, e.g., assaults, withdrawal/depression, suicide threats/attempt)
• Abuse, neglect, or dependency; foster care or adoption
• School failure, suspension, expulsion, Special Education services
• Adjudication in juvenile court; conviction of at least a significant misdemeanor; diversion from court involvement; charged (but not necessarily adjudicated) with a criminal activity; on probation

AND

AND

• Support network is not accessible to the child and family
• Support network is overwhelmed by current needs of the child and family
• Available supports are not sufficiently resourced to address current needs, e.g., safety

• Children with functional difficulties in home, childcare, school or community activities that lead to a score of at least 30 on the CAFAS

• Children who have not proven resilient enough to combat their level of psychosocial risk, as measured by the presence of 1 or more psychosocial risk factors and 4 or fewer psychosocial protective factors on the AOI Part I (Resilience Assessment);

AND

AND

AND

4.  Children in need of and/or receiving enhanced informal supports.