N.J. Admin. Code § 10:37-6.104

Current through Register Vol. 56, No. 19, October 7, 2024

Section 10:37-6.104 - Designation of responsibility

(a) County and State psychiatric hospitals shall have a recently negotiated affiliation agreement detailing community/hospital interaction procedures for every county that it serves. Each Chief Executive Officer shall designate one hospital staff person to coordinate all hospital/community interfacing and to be responsible for monitoring the implementation of Unified Services efforts with community agencies.

(b) The Affiliation Agreements shall minimally include the procedures cited below.

1. Admissions: Criteria for hospital admissions:

i. Hospital admission staff shall be made aware of the Division's State Hospital Admission Policy and criteria. Staff should be trained to implement the appropriate screening and referral processes. If the county hospital does not choose to adopt that policy, it should formalize and implement its own criteria.

ii. Hospital admission staff shall gather and analyze Inappropriate Admissions Information on an ongoing basis. Minimally, information shall include (categories may be further delineated by Division):

(1) Number and percentage of appropriate and inappropriate referrals to hospital;

(2) Number and percentage of inappropriate referrals not admitted; and

(3) Key referral sources to hospital of inappropriate admissions.

iii. If an inappropriate admission is made, efforts to exhaust less restrictive community-based alternatives shall be outlined. Discharge shall then be expedited. The hospital, working with BTS, DYFS, and/or the local mental health OPD agency, shall locate a more appropriate community-based living arrangement as quickly as feasible.

2. Community-based screening prior to hospital admission (see N.J.A.C. 10:37-5, Article III):

i. The hospital shall analyze the information cited in N.J.A.C. 10:37-6.104b 1ii above, and determine the extent to which gatekeepers/referral agencies are screening referrals in the community prior to referral to the County or State psychiatric hospital. The hospital shall determine what percentage of admissions are by-passing mental health centers in each Service Area.

ii. Hospital admission staff shall provide feedback to gatekeeper agencies that refer inappropriately. Hospitals and community mental health centers shall coordinate their community C & E efforts to impact on appropriate agencies and to lower the number of inappropriate referrals to the State and county psychiatric hospital(s).

iii. If deficiencies in the community screening process persist, the hospital, Regional Staff of the Division, and the County Mental Health Board shall formally identify the deficiencies and shall work with the community mental health center/clinic in that Service Area to improve community-based screening efforts, gatekeeper response, and Inpatient service utilization patterns.

iv. Referrals of voluntary clients should not be made to a State or County psychiatric hospital if there are vacant beds in a local general hospital Inpatient Program Element. (See N.J.A.C. 10:37-5.8 on "Inpatient Care.")

3. Post admission and pre-discharge:

i. Admission notification procedure:

(1) The hospital shall send an Admission Notification Form to the designated Outpatient agency in each Service Area for every client who voluntarily signs an information release form. Hospital records shall record the numbers and percentage of forms sent, not sent, clients signing information release forms, and clients not signing.

(2) The hospital staff shall encourage clients to sign an information release form and explain possible benefits of the client's involvement in unified services and joint hospital-community discharge planning.

(3) Designated OPD agency records shall minimally include the number received, date client contacted in hospital, level of functioning assessment, and Individual Service Plan (ISP) with specific objectives and time-frames.

ii. Level of Functioning (LOF) Assessment:

(1) The hospital shall complete a Level of Functioning Assessment for every client admitted to the hospital, after crisis stabilization has occurred. The LOF assessments should be utilized as one of the bases for in-hospital program planning and predischarge service procurement.

iii. Individual Service Plan (ISP) (see N.J.A.C. 10:37-6, Article VIII):

(1) An Individual Service Plan (ISP) shall be completed for all clients no later than seven days after the date of admission, in cooperation with the designated OPD agency.

(2) The ISP should be directly related to the LOF assessment.

(3) The ISP shall identify in-hospital as well as post-discharge service needs.

(4) A qualified mental health professional shall be assigned primary service procurement and case management responsibility, during each client's hospitalization, insuring that the ISP is developed, implemented, and modified as client needs change.

(5) The community mental health center liaison, or DYFS when appropriate, shall assume key service procurement responsibility at the point of discharge.

(6) To the maximum extent feasible, the ISP process shall:

(A) Involve an inter-disciplinary team effort;

(B) Be inter-agency, minimally including hospital staff, Bureau of Transitional Services staff, Community Mental Health Center liaison and DYFS staff when appropriate;

(C) Directly involve the client, if possible, in identifying needs, interests, objectives, and time frames;

(D) Produce a comprehensive needs assessment including clinical needs, social, financial, vocational, housing, and educational (for children) needs, as well as identification of natural support resources.

4. Transitional units/residence on hospital grounds:

i. The hospital shall formalize eligibility and referral procedures for identified hospital living units/residences which are transitional in nature, and prepare clients for placement in the community.

ii. Programs shall be tailored to meet the clients' levels of functioning; service plans should reflect this.

iii. The hospital shall regularly reassess the participating clients' Level of Functioning, in order to minimize length of stay.

iv. The hospital shall clearly delineate the differences between transitional units if more than one exist. The relationship between these units/residences and Residential Care (RES) Program Elements in the community should be delineated in County affiliation agreements.

v. The hospital shall insure that program planning involves off-ground community orientation activities.

vi. Programs shall include "Daily Living Education" (See Division Service Dictionary.)

vii. Both the hospital and the designated Service Area community mental health center shall insure a logical continuum from hospital transitional unit(s) to available community-based resources by jointly coordinating program and discharge planning.

5. Discharge:

i. The hospital shall send Discharge Notification Forms for all discharged clients, signing release of information forms, to the Service Area's designated OPD agency.

ii. The hospital discharge summary shall minimally indicate the LOF of the client at the time of discharge, the clinical and other follow-up services needed, the Level of Care required and that of actual placement, and the agency(ies)/individual(s) responsible for placement and service procurement--as stated on the Individual Service Plan. (See N.J.A.C. 10:37-6, Article VIII.)

(1) See Division's Service Dictionary for detailed definition of "Service Procurement."

iii. Every effort shall be made to place clients in their home county. If this is not possible, reasons shall be documented, and the client may be placed in an adjacent county.

(1) If out-of-Service Area placement is necessary, the community agency OPD liaison staff from that receiving Service Area should be involved in the development of the ISP, within three to ten days of a new admission and one month before discharge for a long-term client. Out-of-county and region placements shall not be made unless due to client preference or level of care required. (See N.J.A.C. 10:37-5.29(b)2.)

(2) All alternatives within the client's own Service Area must be exhausted before placement elsewhere, unless the client does not want to return to his/her Service Area. Out-of-Region placements shall not be made.

6. Readmission:

i. The hospital and Service Area community mental health center designated as being responsible for in-hospital liaison and post-discharge service procurement shall, upon readmission, attempt to ascertain why the client's coping mechanisms and/or community support system did not succeed and what should be done during this hospitalization to improve chances for successful community living.

N.J. Admin. Code § 10:37-6.104