| II. DEFINITIONS
Abandonment: Ending of a psychotherapeutic relationship between clinician and client that does not adequately address the client's ongoing treatment needs.
Clinical Termination: The ending of a psychotherapy relationship between a clinician and a client whether formally or unexpectedly.
Deactivation: An administrative process of removing a client's service provider and primary program of service in the electronic health record and other related documents for purposes of billing.
Emergency Psychiatric Episode: A record created in the electronic health record system in which the potential client is a current danger to self or others or immediately unable to provide for or utilize food, shelter, or clothing, and requires psychiatric inpatient hospital or psychiatric health facility services.
Inactive Client: A client who has not had any contact in the last 180 days despite multiple attempts to engage the client by various means, including telephone calls and letters.
Mutual Termination of Services: Clinical termination of mental health services when the client agrees with the termination.
Primary Program of Service: The setting identified by a provider number where the primary practitioner who holds responsibility for the coordination of services to a client is recognized.
Specialty Mental Health Services (SMHS): Services for rehabilitative mental health including, mental health services, medication support services, day treatment intensive, day rehabilitation, crisis intervention, crisis stabilization, adult residential treatment, crisis residential treatment, psychiatric health facility services, psychiatric inpatient hospital, targeted case management, psychiatric services, psychologist services, EPSTD supplemental specialty mental health services, and psychiatric nursing services. These services are interventions designed to provide the maximum reduction of mental disability and restoration or maintenance of functioning consistent with the requirements for learning, development and enhanced self-sufficiency.
Unilateral Termination of Services: Clinical termination of mental health services by clinician with an appropriate clinical justification which may include but are not limited to, inactivity, a pattern of no shows, incarcerations, IMD.
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Administrative Tasks:
Prior to deactivation: - A clinical review shall be required from the primary program of service.
- All documentation shall be completed including all outreach attempts to the client.
The date of deactivation for the primary program service shall be the date that the clinical review was completed whether or not client contact is made for an inactive client.
Inpatient and residential episodes shall be deactivated upon the discharge of a client from the facility.
Emergency psychiatric episodes shall not be deactivated.
Outpatient episodes shall be deactivated upon the death of a client and completion of the Safety Intelligence reporting requirements in accord with DMH Policy 303.05.
Programs with enrollment requirements (e.g., Full Service Partnerships) shall follow established policies and procedures for disenrollment, including obtaining central office approval.
Clinical Determination:
Clinicians shall communicate to clients early in the treatment relationship that services shall be terminated when: - Service providers have no further effective treatment to offer and
- All treatment goals have been realized
- Clinician shall provide appropriate transfer for continuation of treatment when the client no longer meets criteria for specialty mental health however could benefit from a lower level of care
Clinicians shall evaluate and address foundational clinical components of treatment including: - Attainment of clients' recovery goals
- Need for a different treatment program based on level of care
- Appropriate transfer if the clinician is unable to provide on-going care based on unforeseen changes
- Appropriate transfer if the clinician identifies a conflict of interest after treatment begins
If the client requests to terminate services before treatment goals are achieved, the clinical best practice standard of care is to follow up with clients at a later date or ensure linkages to another provider.
In order to avoid abandonment, the clinical termination of services shall be:
- Based on a comprehensive needs assessment, and
- Documented in the clinical record.
Clinicians shall make every effort to engage a client in treatment over the course of service delivery.
When a client has a no show for an appointment, clinicians shall document efforts to engage a client in treatment.
When a period of no shows over 180 days elapses with no responses from multiple attempts to contact a client, clinicians may proceed with an administrative deactivation.
When any client no longer meets criteria for SMHS, clinicians shall complete the appropriate screening using the tool provided by the California Department of Health Care Services Transition of Care Tool for Medi-Cal Mental Health Services and refer to managed care for non-specialty mental health services.
When a client demonstrates a readiness for engagement, services shall resume.
Clinicians shall inform clients of their rights in accordance with DMH Policy 200.04 Beneficiary Problem Resolution.
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