MH/AODA Functional Screener Instructions
Glossary of Acronyms (PDF, 27 KB)
Module #7: Diagnoses
There are two diagnoses tables on the MH/AODA FS. The first is for mental illness and substance-related diagnoses, and the second is to indicate other general medical diagnoses. Psychiatric diagnoses are needed for eligibility for MH programs. "Other" or "general" medical diagnoses do not affect eligibility for MH/AODA programs. The "other" diagnoses are included on the MH/AODA FS to improve, at all levels from practitioners' awareness to county and state systems, the well-being and access to quality health care for people with mental illness and/or substance use problems.
The MH/AODA FS reflects current state and federal policies on eligibility for Medicaid-funded MH and AODA programs. As those policies evolve (e.g., with the new CCS program), the functional screen and instructions will be revised as needed.
Screeners can obtain diagnoses from any of the following:
Diagnoses obtained in these ways are "verified" diagnoses. In many cases, screeners will need to obtain a signed release of information in order to verify diagnoses. Sometimes you or another helper will need to persuade the consumer and assist them to see a qualified diagnostician to obtain the diagnoses required for entry into MH or AODA treatment programs.
Not every diagnosis is considered sufficient grounds for eligibility for MH/AODA programs. The DSM-IV includes some diagnoses that should not count toward eligibility for MH/AODA programs. Examples include mental retardation, learning disorder, ADHD (attention deficit/hyperactivity disorder), or dementia.
If you encounter someone with a diagnosis not on this table whom you think should be eligible for MH/AODA programs, please contact your Screen Leader immediately, who will contact designated state staff.
The same individual may be given different diagnoses by different psychiatrists at different times. Below are some guidelines to follow. These apply to psychiatric diagnoses made by psychiatrists or licensed psychologists only; diagnoses made by general MDs or others are not included in the MH/AODA Diagnoses table.
Check a Diagnosis on the MH/AODA Diagnosis Table When:
Do NOT Check a Diagnosis on the MH/AODA Diagnosis Table When:
If after review of medical records and contact with health care providers it is determined that a consumer has no diagnosis, the screener should choose the "No Diagnoses" box.
If an applicant refuses to see a health care professional and does not have any medical records that confirm a diagnosis, enter this information in the "Notes" field on the functional screen.
You will continue to carry out your normal professional responsibilities to help Mr. Smith get whatever assistance he needs. If he is in immediate danger, you might seek emergency detention for him. If not, you may continue to visit him and establish a relationship with him, such that eventually you can coax him into being seen by a psychiatrist or psychologist. You can then re-do a MH/AODA FS for him, and he might then be eligible for MH/AODA programs. This process is not unlike what counties have always done in Wisconsin.
The Global Assessment of Functioning is for reporting the clinicians judgment of the consumer's overall level of functioning. The GAF scale is to be rated with respect only to psychological, social, and occupational functioning. Do not include impairment in functioning due to physical or environmental limitations. In most instances, ratings on the GAF scale should be for the current period (i.e. the level of functioning at the time of the evaluation) because ratings of current functioning will generally reflect the need for treatment or care. If you are obtaining this information from a previous evaluation, please note the date of that evaluation in the Notes Section on the MH/AODA Diagnosis page of the screen.
The GAF does not have to be provided by a psychologist or psychiatrist because this does not affect eligibility for MH or AODA programs. This information should be provided by a qualified clinician who is familiar with using this measure, for example a Licensed Social Worker or a Licensed Professional Counselor.
The "Other Diagnoses" table does not affect eligibility for MH or AODA programs. It is here to improve, at all levels from practitioners' awareness to county and state systems, the health and access to quality health care for people with mental illness and/or substance use problems. Research shows that the most effective services fully integrate healthcare with mental health and AODA treatment. Functional screen data will help counties and the state move toward more integrated and effective services for all.
Unlike the "Mental Health and AODA Diagnoses" table, the "Other Diagnoses" table is not meant to be all-inclusive; only some of the more common diagnoses are here. For convenience, the diagnoses are grouped by major categories (e.g., Pulmonary, Cardiovascular, Neurological).
If the applicant has no "other" diagnoses, check the "No Diagnoses" box.
Check all that apply, meaning all that are still applicable to the individual. Screeners are not expected to make clinical decisions about whether or not a previous condition still affects an applicant. When you are not sure, go ahead and check the diagnosis in the table. Still, some diagnoses are clearly only in the past and no longer applicable. A few examples include:
Again, when in doubt, check the diagnosis on the "Other Diagnoses" table.
Screeners should NOT interpret the applicant's complaints or symptoms. Instead, only check if you have a "verified diagnosis."
Medical information on a physical diagnosis only is "verified" if it is:
There are different requirements for a MH/AODA diagnosis, refer to the previous set of instructions for the complete description of a verifiable MH/AODA diagnosis.