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DSL MEMO SERIES 2002-06

June 12, 2002

STATE OF WISCONSIN
Department of Health and Family Services
Division of Supportive Living

To:
Area Administrators/Assistant Area Administrators
Community Support Program Directors/Coordinators
Consumer Organizations
County Departments of Community Program Directors
County Departments of Human Services Directors
Mental Health Coordinators
Tribal Chairpersons/Human Services Facilitators
Mental Health Council
Blue Ribbon Commission Implementation Advisory Committee
Wisconsin Coalition for Advocacy
Wisconsin Counties Human Service Association
Wisconsin NAMI and Local Affiliates

From:
Sinikka McCabe, Administrator

Re: CSP Discharge Criteria

The purpose of this memo is to clarify the current discharge criteria for Community Support Programs (CSP). It is the position of the Bureau of Community Mental Health to support individual recovery and client choice. It is also the Bureau’s position to assure continuity of care and access to treatment and support services appropriate to the needs and wishes of consumers. The Bureau is in the process of identifying ways that the mental health system can enhance these outcomes. First, it is important that there is information available to our partners on what the current statutes and regulations require. This information memorandum outlines the current requirements for the Community Support Program client discharge criteria. Secondly, the Community Support Program standards will be revised and during that process the discharge criteria will be re-evaluated.

Community Support Programs were developed to provide a range of coordinated and comprehensive treatment, rehabilitation and support services via a specified program with highly trained staff. The design of the program is to provide services to individuals meeting the admission criteria as long as services are necessary and desired. Individuals admitted to Community Support Programs have serious and persistent mental illnesses that significantly impact their lives and present barriers to personal accomplishments in the areas of work, social relationships, and independent living. These individuals typically need more than is provided in case management or outpatient treatment services. Due to the severity and persistence of these illnesses, Community Support Programs were intended to provide individuals with continuity of care and long term access to treatment services.

HSS 63.10(2)(b)5. requires that criteria for termination of treatment, rehabilitation and support services be described on the individualized treatment plan. Optimally these criteria should be individualized and specific to the individual consumer. There has been some confusion around these criteria and programs have referred to specific criteria required by state surveyors and consultants. There is no such state criterion. The Community Support Programs establish the discharge criteria. A number of CSPs have adopted the same discharge criteria for all consumers in the program. Other CSPs have moved toward individual criteria developed in partnership and collaboration with individual consumers.

There are a number of reasons that discharge from a CSP would occur. Each program determines the possible reasons for discharge in their discharge policy. Some situations that have resulted in discharge are:

• meeting individual discharge criteria on the treatment plan;
• the individual client no longer meets the admission criteria;
• long term nursing home placement related to physical medical needs;
• client moves out of the county with no intention of return;
• client chooses to receive alternative services;
• long term incarceration;

• client refuses CSP services in spite of identified outreach attempts to engage the consumer; and

• death.

CSPs are required to have policies that define the discharge process and procedures to be followed in the above circumstances and define the transition and aftercare planning. HSS 63.12(2) and (3) require coordination of treatment and referrals. The CSP has responsibility for coordination of treatment while an individual is part of the CSP. The program also has the responsibility for coordination of linkages and referrals to ensure follow-up of consumers referred to other treatment and service providers. In the case of discharge, this is accomplished through direct communication with providers who will provide services after discharge from the CSP. This coordination helps smooth the transition from one provider to another and assures continuity of care. Planning must include attention to clinical treatment needs as well as practical needs that have been addressed during the course of CSP involvement (housing, parenting, health care, employment and activities of daily living). The comprehensiveness of this transition planning offers assurance that consumers do not experience lapses in services or untoward outcomes as a result of discharge from a CSP.

It is required that a discharge summary be written within one week after termination of treatment or services.

Discharges do occur from CSPs. The 2000 CSP Monitoring Report indicates that 322 individuals were discharged from certified CSPs. The breakdown of the total is that 73 individuals met the discharge criteria, 97 individuals moved out of the county, 64 deaths occurred, 25 individuals were discharged due to medical reasons and nursing home placement, 10 individuals were incarcerated, 30 individuals refused CSP or selected other services, and 23 were discharged for other reasons specified in program policies.

REGIONAL OFFICE CONTACT: Area Administrator

cc:
BQA Certification Staff
Sue Schroeder
Joyce Allen

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