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									Santa Clara Valley Health & Hospital System                               Innovative Partnership
Department of Alcohol & Drug Services Adult Managed Care System           Policy & Procedure Manual
Page 1 of 4                                                               3/1/07
Dual Diagnosis Eligibility Criteria                                       Policy & Procedure 136

POLICY              The Department of Alcohol and Drug Services (DADS) welcomes all individuals
                    with substance abuse related disorders. DADS conducts an assessment of all
                    individuals to determine the appropriate level of care to be provided. The
                    assessment may occasionally identify certain individuals whose needs are better
                    served by other agencies. Individuals who exhibit the following behaviors will be
                    referred to appropriate agencies outside the DADS Managed Care System:

                    1. Currently suicidal, homicidal or gravely disabled – clients should be
                       referred to Emergency Psychiatric Services (EPS) immediately

                    2. Cognitive impairment not due to intoxication and/or withdrawal that makes
                       it impossible to converse or interact with others. (For example, delusions or
                       hallucinations; or severe short term memory problems; or not oriented to
                       person, place, or time; or incoherent.)

                    3. Refusal to take psychiatric medications as prescribed leading to
                       decompensation and behaviors that preclude participation in treatment.

                    4. Unable to give an informed consent for treatment.

                    5. Exhibits current behaviors at the program site which interfere with their
                       ability or the ability of others, to participate in treatment. These include
                       self-mutilation, head banging, poor hygiene (refusal to bathe or shower),
                       and sexual inappropriateness (flashing, public masturbation).

                    6. Unable/unwilling to manage encopresis, enuresis, or incontinence, whether
                       due to behavioral or medical conditions.

                    7. Any medical condition, even if stabilized, which would interfere with, or
                       preclude, a client’s participation in treatment at any level of care. The need
                       for a client to be transported to an Emergency Room (ER) daily is an
                       example of a client whose medical condition would interfere with
                       participation in the residential level of care but not necessarily outpatient.




                                                                                       DdxEligCrit.3-1-07.jw
Santa Clara Valley Health & Hospital System                               Innovative Partnership
Department of Alcohol & Drug Services Adult Managed Care System           Policy & Procedure Manual
Page 2 of 4                                                               3/1/07
Dual Diagnosis Eligibility Criteria                                       Policy & Procedure 136

PROCEDURE

All Providers           Clients who are referred outside DADS Adult Managed Care System due to
                        the behaviors listed above should be given referral names and numbers
                        i.e., shelter numbers for those who are homeless. Consult with your
                        Clinical Supervisor, Program Director, or the Quality Improvement (QI)
                        Division, as needed, when making a decision to refer clients out of the
                        System.

                        If the client has a County Mental Health Service Team, advise the Service
                        Team representative (usually a Case Manager) that the client is ineligible
                        for DADS services at this time and the reason(s) why.

All Staff               If you believe a client or potential client is ineligible for services consult
                        with the DADS Clinical Standards Coordinator (CSC). Following the
                        consultation, fax a completed Ineligible/Unamenable/Suspended Client
                        Report (IUSCR) Form to the CSC. If approved, the CSC will forward the
                        IUSCR form to the QI Division for processing. The QI Division will enter
                        an applicable ALERT in the client’s Unicare record. This will prevent the
                        client from quickly obtaining another referral into the System before
                        resolving the concerns or conditions that led to the ineligible disposition.

                        If the CSC is not available for consultation, contact the QI Coordinator
                        designated by the CSC for back-up. If there is an immediate need to
                        discharge a client for cause from the site during “off hours”, discharge the
                        client and follow the normal protocol (above) the next business day.

                        Ineligible clients who return for services at a later point will be referred
                        back to the same assessor who previously declared them ineligible. If the
                        Assessor is uncertain what to do with the clients, they will refer the cases to
                        the DADS Clinical Standards Coordinator.




                                                                                        DdxEligCrit.3-1-07.jw
Santa Clara Valley Health & Hospital System                              Innovative Partnership
Department of Alcohol & Drug Services Adult Managed Care System          Policy & Procedure Manual
Page 3 of 4                                                              3/1/07
Dual Diagnosis Eligibility Criteria                                      Policy & Procedure 136

Possible Referral Options (see Attachment A for specific contact information)
These are not the only options you may use, but are some of the possible options available. Use
your best judgement and your Clinical Supervisor's guidance to determine the most appropriate
referrals to make, given the situation at hand.

        1.      For clients who are currently suicidal, homicidal or gravely disabled
                    EPS (immediately)
                    Call 911
        2.      For clients with cognitive impairment not due to intoxication and/or withdrawal
                that makes it impossible to converse or interact with others.
                    County Mental Health Call Center
                    Valley Medical Center
                    San Andreas Regional Center
                    Services for Head/Brain Injury
        3.      For clients whose refusal to take psychiatric medications as prescribed leads
                to decompensation and behaviors that preclude participation in treatment.
                    Prescribing physician
                    County Mental Health Service Team Case Manager (if there is one)
                    County Mental Health Call Center
                    Homeless Shelter
                    Family/Friends
        4.      For clients who are unable to give an informed consent for treatment.
                    Public Guardian/Conservator (if applicable)
                    County Mental Health Service Team Case Manager (if there is one)
                    Family/Friends
        5.      For clients who exhibit current behaviors at the program site which interfere
                with their ability, or the ability of others, to participate in treatment.
                    EPS
                    Call 911
                    County Mental Health Call Center
                    County Mental Health Service Team Case Manager (if there is one)
                    Homeless Shelters
                    Family/Friends



                                                                                        DdxEligCrit.3-1-07.jw
Santa Clara Valley Health & Hospital System                                Innovative Partnership
Department of Alcohol & Drug Services Adult Managed Care System            Policy & Procedure Manual
Page 4 of 4                                                                3/1/07
Dual Diagnosis Eligibility Criteria                                        Policy & Procedure 136

Referral Options (contd)

        6.      For clients who are unable/unwilling to manage encopresis, enuresis, or
                incontinence, whether it be behavioral or medical.
                    Primary Care Physician
                    Valley Medical Center
                    Any applicable options previously listed
        7.      Clients who have any medical condition, even if stabilized, which would interfere
                with, or preclude, a client’s participation in treatment at any level of care.
                    Primary Care Physician
                    Valley Medical Center
                    Any applicable options previously listed

        Important additional notes about referring clients out of the System:

        This policy and procedure is applicable during an initial assessment and throughout a
        treatment episode. Clients who have been transferred should not be considered any
        differently than a client who is first entering treatment. For transfers, if a client exhibits
        any of these behaviors at the intake appointment, the referring Provider should be
        consulted to determine whether the behavior is atypical. If it is atypical, the client should
        be admitted and monitored and reassessed for continued appropriateness. If the behavior
        is NOT atypical and has been occurring at the previous Provider site, the appropriate
        referrals should be made.

         If a residential/detox client is referred to EPS/ER at least two times within a week, or an
        outpatient client is referred to EPS/ER two times within a two week period, the provider
        should inform EPS/ER that the client will not be able to return to the program. When the
        client requests services again, a new Level of Care Assessment will be conducted.

        If a client is referred to the County Mental Health Call Center, the Provider should call
        with the client and advocate for the client to be assessed (i.e., tell the Call Center that you
        are not a mental health professional and that the client needs to be assessed by a mental
        health professional).

        If a client is referred out of the System for any of the previously cited reasons, advise the
        client to request services again when and if their condition improves.




                                                                                        DdxEligCrit.3-1-07.jw

								
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