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Appendix E

Definition and Terms

 

SAMPLE INDICATOR

 

 

ACCESS

Quick and Convenient Entry into Services

Concern Entry into mental/behavioral health services is quick easy and convenient

 

Access I The average length of time from request for services to the first face-to-face meeting with a behavioral health professional

 

Measure Numerator
The total time between request for services and the first face-to-face contact with a licensed mental health professional for adults (or licensed behavioral health professional for children and adolescents) for new admissions during the reporting year
Denominator
The total number of new admissions

       

The measure is calculated for each of the following categories:
A. for all consumers with emergent situations
B. for all consumers with non-emergent situations
C. for all adults with emergent situations
D. for all children and adolescents with emergent situations
E. for all adults with non-emergent situations
F. for all children and adolescents with non-emergent situations
G. for children and adolescents with a serious emotional disturbance
H. for children and adolescents with other emotionaI disturbances
I. for adults with serious mental illness
J. for adults with other mental illness
K. for adults with dual diagnosis of a mental disorder and substance use disorder
L. for children and adolescents with dual diagnosis of a mental disorder and substance use disorder

        

Definitions

children and adolescents Individuals from birth through 17 years
adults Individuals age 18 or older
new admission Initiation of a new episode of service(s) for an individual who is not currently receiving any service and does not have an open active clinical record with the service provider
serious emotional
disturbance		 Serious Emotional Disturbance shall apply to an individual who is 17 years of age or under and meets the following criteria:

1.  An analysis of a child's functioning should show significant interference with one or more aspects of life, including home, school, daily function and social relationships as measured on the Children's Global Assessment Score (CGAS), Auchenbach or other appropriate measure.


a.


The range for SED is 50 or less on the CGAS that includes serious symptoms of any serious impairments in social, occupational, or school functioning.


b.
Children and youth with SED have multiple service needs which require a multi-disciplinary team evaluation, or are often in/or at-risk of out-of-home placements.


2.  Eligible Diagnosis:


a.
Children and Adolescents included in the target population should have a defined SED which is diagnosable under DSM-IV.


b.
Children with disorders that have a neurobiological basis such as schizophrenia, autism, and other pervasive developmental disorders, bipolar disorder, major depressive disorder, obsessive compulsive disorder, Tourette's Syndrome, Attention Deficit Hyperactivity Disorder, Anxiety and Panic Disorders, and others


c.
Children with disorders that manifest themselves as emotional or behavioral disorders, severe adjustment disorders, major depressive disorders, PTSD, and conduct disorders, and others


d.
Dual or multiple diagnoses are included.  Mental Retardation, Developmental Disability, and Alcohol or Drug Abuse cannot be the only diagnosis.

serious mental illness
For an adult to be designated as having a serious mental illness, the following criteria need to be met:

--an established DSM-IV diagnosis, with the exclusion of the following as principle diagnoses:
 
  • delirium, dementia and other cognitive disorders
  • mental disorders due to a general medical condition
  • disorders usually first diagnosed in infancy, childhood or adolescence
  • substance related disorders
  • other conditions that may be a focus of clinical attention

--persistence of the disorder for a period of time sufficient to meet DSM-IV diagnostic criteria

--the individual experiences significant substantial and persistent impairment in one or more life roles/functions

emergent situation
The individual is in imminent danger of harm to self or others or has a grave disability as a result of a mental/behavioral disorder

grave disability
Inability to provide for one's basic daily needs or care for oneself safely and adequately as age appropriate

licensed mental health professional
Psychiatrist, psychologist, social worker, psychiatric nurse practitioner, marriage and family therapist, or professional clinical counselor (LPCC) and/or provider with specialty certification in mental health counseling from the National Board Of Certified Counselors

licensed behavioral health professional		 In addition to the professionals identified as mental health professionals, licensed drug and/or alcohol abuse counselors
first face-to-face contact
A clinical intervention provided by a mental/behavioral health professional not solely for the purpose of screening, triage or referral which is:
  • at least 30 minutes in length
  • equivalent to one of the following CPT codes:
          *90801
          *90843 or 90844
          *90846
          *90820
request for services
The receipt by phone, postal mail, fax or other electronic transmission of a request for a face-to-face contact with a mental/behavioral health professional or organization
  • the request may be initiated by the consumer, a family member, legal guardian, another health/mental health professional, or law enforcement officer including juvenile probation and parole officer