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11/5/12 1
Welcome to theCalifornia Department of
Social Services’In-Home Supportive Services
Training Academy
Overview
Assessing Severe Disabilities
Working with Consumers with Mental Illness
Protective Supervision
Paramedical Services Paramedical Services
Activity – Resources
Adults
Mental Health
Disability
Health
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11/5/12 2
Assessing the Needs of People with Severe Disabilities
Asking the hard questions (digging for the actual need)
Screening for other issues
Assessing need for alternative resources Assessing need for alternative resources
Exercise: Complex Medical
Within your group, read and discuss the scenario and questions.
Report the group’s responses to the questions.
Include further actions / needs for referral in your response.
Working with the Consumer with Mental IllnessIllness
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11/5/12 3
Important Concepts
Mental illness can have a significant impact on functional ability.
People with mental illness have a range of symptoms.The person with mental illness is not in control The person with mental illness is not in control of their symptoms.
Functional ability can change significantly and frequently for some consumers with mental illness.
Stigma of Mental Illness
Behaviors are controllable.
The person can overcome illness if had enough will power.
Mental illness reflects the person’s character pand intelligence.
Schizophrenia
Affects around 1 percent of the American population.
“Positive” and “negative” symptoms:
Positive symptoms: active symptoms,Positive symptoms: active symptoms, including delusions, hallucinations, disorganized thinking, and disorganized behavior.
Negative symptoms: loss in functioning, including withdrawal or lack of motivation, inability to feel pleasure, lack of verbal speech, or flat affect.
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SchizophreniaIHSS Functional Limitations
Concentration or sleep deterioration
Delusions or hallucinations
Total lack of motivation due to “negative” symptomssymptoms
SchizophreniaTechniques for Interactions
Use short, simple phrases when asking questions or giving information.
Use a calm and unhurried tone of voice.
Never shout or try to argue with theNever shout or try to argue with the consumer.
Give the consumer some physical space.
Try to avoid too much direct eye contact.
If the consumer is tangential, politely interrupt by recapping what he/she said, and then move on to your questioning.
SchizophreniaTechniques for Interactions
Never be judgmental or put blame on the consumer for their condition.
Do not try and convince the consumer their delusions or hallucinations are fake.
Eliminate unnecessary noises.
End interview if consumer is not able to cooperate.
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11/5/12 5
Bipolar Disorder (manic-depression)
Unusual shifts in a person’s mood, energy, and ability to function.
Different from the normal ups and downs that everyone goes through; the symptoms of bipolar disorder are severe.
“Higher highs and lower lows”
Bipolar DisorderIHSS Functional Limitations
Mania Severe mania may not feel the need to keep
themselves well groomed or his/her apartment clean p
Risk with physical impairments – taking risks with mania
Not taking medications
Need for sleep or for eating regularly may become less
Bipolar Disorder IHSS Functional Limitations
Depression Problems with toileting, dressing, grooming,
preparing food, and taking medication
Handling finances, shopping, or cleaning Handling finances, shopping, or cleaning one’s house can be extremely daunting tasks
Suicidal behaviors may be more for those with a bipolar disorder than for consumers with general depression.
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11/5/12 6
Bipolar Disorder Techniques for Interaction
Mania Don’t try to calm down
Avoid intense conversations if in manic statestate
Do not debate or argue
Try and gently steer the conversation to your interview goals
May say hurtful or mean things - Do not become offended or act defensive
Speak calmly and at a low level
Personality Disorders
People with personality disorders have traits that cause them to feel and behave in socially distressing ways, which often limit their ability to function in relationshipslimit their ability to function in relationships and in social situations.
Personality Disorders
Cluster A includes personality disorders marked by odd, eccentric behavior, including paranoid, schizoid and schizotypal personality disorders.
Cluster B personality disorders are those defined by dramatic, emotional behavior, including histrionic, narcissistic, antisocial and borderline personality disorders.
Cluster C personality disorders are characterized by anxious, fearful behaviorand include obsessive-compulsive, avoidant and dependent personality disorders.
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11/5/12 7
Personality DisordersAt Risk
Social isolation
Suicide
Substance abuse
Depression anxiety and eating disorders Depression, anxiety and eating disorders
Self-destructive behavior
Violence and homicide
Incarceration
Substance Abuse and Mental Illness
As much as 50% of adults with mental illness also have substance abuse problems
Substances used to augment medication / treatment
Need for referrals
Suicide and Mental Illness
Greater incidence of suicide in people with mental illness
Greatest amongst those with severe depressionp
Incidence increases with substance abuse
Incidence increases in old age
Higher among men than women
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11/5/12 8
Assigning Functional Index
Determine Functional Index ranking both on physical capabilities and functioning as impacted by mental illness
Recognize that functioning can be impaired equally by physical impairments and mental illness
Determine ability to make choices
Mental Illness – Teach Back Activity
Report out should include:
How the consumer relates to the diagnosis / content
Characteristics
IHSS Functional Limitations
Techniques In Interacting With
Collateral information would be helpful to your accurate assessment of this consumer’s needs.
Needs consumers with this impairment will probably have.
Community resource or other referrals would you make.
Common Themes…
Don’t buy into delusions
Be non-confrontational
Use clear and concise questions
Make sure the consumer understands who Make sure the consumer understands who you are and why you are there
Utilize mental health professional resources
Be cognizant of your safety
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11/5/12 9
Thanks for your participation!
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11/5/12 1
IHSS Training AcademySpecial Areas in IHSS
Day 2Day 2
Protective Supervision Eligibility
Regulations
Protective Supervision consists of observing recipient behavior and intervening as appropriate in order to safeguard the recipient against injury hazard or accidentrecipient against injury, hazard, or accident. [MPP 30-757.17]
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11/5/12 2
Regulations
Protective Supervision is available for observing the behavior of nonself-directing, confused, mentally impaired, or mentally ill persons only [MPP 30-757 171]persons only. [MPP 30 757.171]
Regulations
Protective Supervision may be provided through the following or combination of the following arrangements:
(1) In-Home Supportive Services Program;
(2) Alternative resources such as adult or child day care centers, community resource centers, senior centers, respite centers; and
(3) Voluntary resources.
[MPP 30-757.171(a)(1-3)]
Protective Supervision is NOT available under the following conditions:a. Friendly visiting or other social activities
b. A medical condition where the type of supervision required is medical
I ti i ti f di lc. In anticipation of a medical emergency
d. To prevent or control anti-social or aggressive recipient behavior
e. To guard against deliberate self-destructive behavior, such as suicide, or when an individual knowingly intends to harm himself/herself.
[MPP 30-757.172(a-e)]
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11/5/12 3
Regulations
Social services staff shall explain the availability of Protective Supervision and discuss the need for twenty-four-hours-a-day supervision with the recipient or recipient’ssupervision with the recipient, or recipient s parent(s), or the recipient’s guardian or conservator, and the appropriateness of out-of-home care as an alternative to Protective Supervision. [MPP 30-757.174]
Lawsuits that Affect PS
Marshall et al., v. Linda McMahon PS not available in anticipation of medical
emergency
Calderon v. Anderson Consumer must be able to put self at risk
PS not available in anticipation of environmental emergency
Garrett / Lam v. Anderson PS and kids
Memory/Orientation/Judgment
FI 5 in all three areas does not necessarily mean consumer will need PS.
CMIPS will give soft edit if total of the 3 is 7 or more.
This is a question for consideration – not a hard edit.
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11/5/12 4
Remember: The Need for Protective Supervision is NOTDiagnosis Driven
24-Hour Need
SafetyObserving & Monitoring
IHSS PS
Assessment of Need for Protective Supervision Form [MPP 30-757.173(a)(1-4)]
Factors that Affect Calculation of Protective Supervision Hours
PCSP / IPO / Residual
NSI and SI
Number of recipients in household Number of recipients in household
Number of recipients receiving PS
Alternative resources
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11/5/12 5
Example 3
PCSP / IPO / Residual?
NSI or SI?
Number of recipients in household?
SI
PCSP
1Number of recipients in household?
Number of recipients receiving PS?
Amount of other authorized services?
Actual alternative resources for PS? N
1
1
35.69
Steps
Determine Total Need
Calculate Adjustments
Calculate Individual Need
Calculate PS Authorized to Purchase Calculate PS Authorized to Purchase
Calculate Alternative Resources
Enter Unmet Need
Calculation of Protective Supervision Hours
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11/5/12 6
Removing Services
Consider progression of condition may lessen need.
Authorization should change when the consumer deteriorates and is no longer capable of putting self at risk.
Consider family stress and refer to alternative resources.
Document clearly for possible consumer challenge of decision.
Other Resources for People Who Do Not Qualify for Protective Supervision
Local mental health agencies
5150 if suicidal
APS APS
Day programs
County mental health
Caregiver Issues
Recognize
Refer
Follow up
Support
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11/5/12 7
Activity: Protective Supervision
Paramedical Services
Paramedical Services [MPP 30-757.19]
Characteristics of Services:
Functional limitations prevent recipient from performing (self-care)
Are necessary to maintain the recipient’s health due to their physical or mental condition
Tasks include: administration of medication
puncturing the skin
inserting a medical device into a body orifice
activities requiring sterile procedures
activities requiring judgment based on training given by a licensed health care professional
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11/5/12 8
Services are provided when ordered by the licensed health care professional.
Services are provided under the direction of the licensed health care professional.
Paramedical Services [MPP 30-757.19]
The SOC 321 should indicate the time and frequency necessary to perform the ordered services.
Services are provided by IHSS providers at the IHSS hourly rate.
A signed and dated SOC 321 form must be obtained from the licensed health care professional.
The Paramedical services order must be
Paramedical Services [MPP 30-757.19]
received prior to authorization of Paramedical services.
Other IHSS services can / should be authorized without delay, even if there is a delay in obtaining the authorization for Paramedical services.
When Considering Need for Paramedical Services
Does the consumer require injections?
Are they able to safely self-administer them?
Do they require a bowel program or other y q p ginvasive medical type procedure?
Is the consumer physically or mentally able to perform the function?
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11/5/12 9
Confirm
Nature of services approved Are they paramedical?
Time period for which the services are authorized Services should be reassessed at the time of
reassessment.
Time authorized on the form Is it excessive?
Working with the Doctor
Evaluating the ‘real’ functional need
They don’t understand IHSS criteria or program limitations.
May not understand services that he/she is yasking for.
May not understand the functional abilities of the consumer.
They do not see consumer in the home.
Strategies for Communicating with the Doctor’s Office
If county has IHSS nurses, discuss concerns with him/her first.
Be prepared.
Talk with the doctor’s back-office nurse first.
Give the doctor facts and let them know what you need.
Be concise and respectful of their time, but be persistent.
Be careful of taking offense or defense when approaching the doctor.
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11/5/12 10
Puzzle Exercise
Thanks For Your Participation!
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