Psychiatric Residential Treatment Facilities: New Mental Health Treatment for Minnesota’s Youth
Introductions Dave Hartford PRTF Administrator, Cambia Hills – East Bethel, The Hills Youth and Family Services Tammy Bednar Principal, Cambia Hills – East Bethel, Northeast Metro 916 Intermediate School District
What is a Psychiatric Residential Treatment Facility? Centers for Medicare and Medicaid defines PRTF as a separate, stand-alone entity providing a range of comprehensive services to treat the psychiatric condition of residents on an inpatient basis under the direction of a physician: the purpose of the service is to improve the resident’s condition or prevent further regression so that services are no longer needed.
Characteristics of a PRTF Inpatient Facility Serves individuals ages 21 and under A level of care utilized when: Ambulatory care services in the community do not meet the needs of the youth The individual requires 24-hour care with nursing under the direction of a physician Services are reasonably expected to improve the condition or prevent further regression
Why did Minnesota need PRTF’s? Over 300 children sent out of the state every year More intense level of service than Residential Treatment Center Less intensive level of service than inpatient Minnesota Children’s Residential Treatment Centers declared IMD’s (Institutes of Mental Disease)
Residential Treatment Center vs PRTF Residential Treatment Center (RTC) – Rehabilitative Service PRTF – Active Treatment
Legislation that Authorized Minnesota’s PRTF’s Passed in 2015 Authorized 150 beds in up to 6 sites 50 beds by end of 2017 $6.616 million was appropriated for PRTFs and for the contract beds Difference from RTCs Not considered an IMD Payment includes room and board No need for voluntary placement agreement with county Legislative proposals and regulatory changes
NAMI-MN Focus Group and Survey Data NAMI PRTF Family Survey results Identified areas of importance that included physical surroundings, activities, family connections, treatment modalities, staffing, transition planning, and meals
NAMI Survey Recommendations Physical Surroundings – soothing environment, warm colors, natural lighting, open space with flexible seating, comfortable furnishings, and private meeting space for families Activities – provide a variety of physical activities, access to a quality education, different therapy approaches, such as art therapy, music therapy, and pet therapy, ways to help others, yoga, and meditation Family – support groups for family, frequent communication on treatment progress, and a family visiting space
NAMI Survey Recommendations cont. Staffing – well trained and educated, trauma trained and adequate staffing, family peer specialists Transition – create a detailed transition plan that connects youth back to the community with resources for education, appointments and support Food – provide nutritious meals with quality options for those with dietary restrictions. Educate on the importance of fueling the body with the right foods
NAMI Survey Comments Allow connection to friends and unlimited access to families – don’t isolate them from their community Variable or open visiting hours to make it easier to see people Greater connection by phone/text
NAMI Survey Comments cont. Being included in the discharge process from the beginning Include the school district in the discharge planning Checking on client and family after being discharged Ensuring aftercare is set up before discharge
Cambia Hills Stakeholder Summary Do you see a need for a PRTF? 9% 91% Yes No
Cambia Hills Stakeholder Summary A PRTF is needed to serve youth with: *Only those 60% or higher were reported 100% 91% 90% 82% 82% 80% 73% 73% 70% 64% 64% 60% 50% 40% 30% 20% 10% 0% Post Addictions Depression Fetal Alcohol Impulse Anxiety Bipolar Traumatic Syndrome Control Disorders Disorders Stress Disorder Disorder
Cambia Hills Stakeholder Summary How important are the following features in a PRTF 0% 100% 9% 9% 18% 90% 80% 70% 55% 60% 100% 50% 91% 91% 82% 40% 30% 36% 20% 10% 0% Physical Exercise Family Integrated Having Time Community Programming Educational Outdoors Outings Services Very Important Important
Cambia Hills Stakeholder Summary How important are the following treatment modalities: *only those with 60% or higher for very important or important 100% 9% 18% 90% 27% 27% 27% 27% 36% 80% 64% 70% 64% 60% 50% 91% 82% 40% 73% 73% 73% 73% 64% 30% 36% 20% 27% 10% 0% Very Important Important
*Keep ep? Cambia Hills – East Bethel PRTF Floor Plan
Cambia Hills – East Bethel PRTF Aerial View
Cambia Hills – East Bethel PRTF Exterior View
Cambia Hills – East Bethel PRTF Lobby
Cambia Hills – East Bethel PRTF Bedroom
Cambia Hills – East Bethel PRTF Classroom
Cambia Hills – East Bethel PRTF Gym
Regulatory Framework Minnesota Department of Health Medicaid Certified Psychiatric Residential Treatment Facility Licensed Supervised Living Facility Minnesota Department of Human Services Licensed Children’s Residential Treatment Facility (Rules Chapter 2960) PRTF Variance to Rule 2960 Joint Commission or the Council on Accreditation (COA) Certification
Admission Criteria Mental health diagnosis as defined in most recent DSM Clinical evidence that the child is at risk to self or others Functional impairment and a history of difficulty functioning safely in the community, schools, home, or job; inability to adequately care for one’s physical needs; caregivers or family members are unable to fulfill the child’s needs Required to improve the child’s condition or prevent regression Community based services have been exhausted and/or cannot provide the level of care needed
Cambia Hills Target Population Discussion Children ages 7 to 17 Moderate to severe mental disorders Mild neurodevelopment disorders Mild neurocognitive disorders
Service Activities Diagnostic Assessment Therapeutic Recreational Activities Individual Care Plan Development Individual Therapy Medication Management Family Therapy 24-Hour Nursing Service Community Consultations Neuropsychological Testing Health Activities Educational Services Parent Coordination Engagement/Enrichment Discharge and Transition Seclusion/Restraint Capability Planning
Cambia Hills Treatment Approach Provide a safe, supportive, and fun environment Relationships are key – the key vehicle of change Trauma-Informed clinical interventions and organizational framework Education services – integrated and seamless
Cambia Hills Treatment Approach Culturally responsive Families important members of treatment team Comprehensive transition planning Developmentally appropriate
Therapeutic Recreational Activities Animal Husbandry Arts Recreational Sports Therapeutic Gardening Community Outings
Education Services: Intermediate School District 916 Intermediate districts are specialty school districts that provide defined shared student services to a group of K-12 “member” school districts. Minnesota has three intermediate school districts. Combined, the three districts serve more than 18,000 students across 31 member districts. Intermediates offer specialized educational programs and services to member districts that, individually, find it difficult to provide on a smaller scale.
Education Services: Intermediate School District 916 Teaching at Northeast Metro 916
Partners in Education Through the of sharing of resources, talent and ideas, District 916 provides cost-effective, specialized and reliable services to member districts and the Our 1 r 10 M Member D r Distri tricts ts: • Centennial #12 students and families we collectively support. • Columbia Heights #13 • Mahtomedi #832 • Mounds View # 621 How we benefit member districts: North St. Paul-Maplewood- • Oakdale #622 • Innovative and quality educational options not available, or limited, • Roseville #623 in member districts. • South Washington County #833 • High staff retention resulting in consistent and reliable Spring Lake Park #16 • learning environments. • Stillwater Area #834 • Programs created and delivered in partnership with members. • White Bear Lake #624 • Educational options that provide a high return on investment.
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