ICG Rule 135 Rules Revision Workgroup Meeting Minutes 12/05/13


ICG Rule 135 Rules Revision Workgroup Meeting Minutes 12/05/13

Attendees: In Person: Ray Connor, Judy Griffeth, Roberta Allen, Lisa Betz, Kimberly Jenkins, Karah Kohler, Christina Kuczora, Dr. Renee Mehlinger, Jean Meister, Margo Roethlisberger, Rita Thorpe.

Phone: Denni Beddle, Rosemary Bussa, Michelle Carmichael, Hannah Chapman, Rob Connor, Cathy Cumpston, Jamie Germain, Kathy Henke, Judy Hutchinson, Susan Krause, Debra Lipman, Dr. Cynthia Mester, Ronica Patel, Dee Ann Ryan, John Schornagel, Meryl Sosa.

Discussion:

The meeting began with roll call and introductions. Last meeting minutes were approved pending addition of one attendee & removal of an extra word. The remainder of the meeting centered on reviewing drafts/proposed edits to the Rule based on the previous meeting.

135.5 Purpose

Approved meeting minutes and other relevant workgroup information will be posted on the DMH website. Information regarding accessing that site will be distributed to workgroup members this week.

Review of draft updates in this section included discussion of the program's role to reduce symptoms and maintain as a youth develops into adulthood. The group discussed capturing services up until adulthood as well as services that may be directed at a very young child. Participants discussed ideas of age appropriate reduction or that those may come through their functioning developmentally. Dr. Mehlinger explained that optimal functioning is based on their cognitive development The idea is that the child/adolescent have a role in the community and return to normality with symptom reduction. The independence is tied into the medical necessity.

Proposed changes:

Section 135.5 Purpose

This Part is intended to define the terms under which children are eligible to receive funds for residential placement due to their mental illness, including alternative in-¬home/community services in lieu of residential placement, when clinically appropriate. Comprehensive services are funded to assist in reducing the child's severe symptoms of the illness and to maintain such reduction.

Funds are provided to assist parents/guardians in obtaining such services at the appropriate level of care. Among the Part requirements are two primary mandates to be satisfied so that the grant can be approved for renewal on an annual basis. These are documentation of parental participation in the child's care, treatment and discharge to family and community and evidence of the child's continuing clinical need for the current level of care.

135.6 Vision

This section was rewritten by Jean Meister and included suggestions of calling this section objective, goal or vision. This vision doesn't have to be measured. She used the Systems of Care book author Sheila A. Pires, as a reference. Participants discussed enhancing the likelihood of positive outcomes within the least restrictive settings, as well as discussions about federal guidelines and, trauma, in connection with school's new buzzword "culturally responsive." Participants discussed seeking to maintain connectedness for optimal attachments and involvements.

Proposed changes:

Children with serious emotional disturbance are a population with distinct developmental needs, for whom a comprehensive array of services and evidence ¬informed treatments may enhance the likelihood of positive outcomes. Services should be individualized, strengths-¬based and trauma informed; youth¬ and family¬-driven; culturally and linguistically responsive; effectively coordinated across systems and a continuum of care; provided in the least restrictive setting; and seek to maintain and strengthen children's connectedness with family, school, peers, and community.

135.10 Eligibility Criteria

  1. Participants discussed utilizing definitions of residency that already exist. John Schornagel and Michelle Carmichael agreed to look through existing definitions and to report back relevant information to the group.
  2. Participants discussed the clinical definition of "severely impaired reality testing" and how that term is operationalized. Discussion included the following questions/ideas: Will kids be approved if they don't have a clear psychosis? Dr. Beadle stated that in defining the rule the rule process will want to know a clear definition of what is severe reality testing and how it is defined. It has to concrete and has to be measureable. Discussion included eliminating these criteria and sticking with a broader definition. Additionally, we discussed in length Severe Emotional disturbance (SED) and Severely Mentally Ill (SMI) and the need to determine which term will be used. Ray & Judy will review existing material and prepare a draft definition to capture the clinical definition needed. Participants are welcomed to contact Ray & Judy with input and/or literature for review.
    The clinical reviews of ICG applications scheduled for the following day may also shed light on the best definition in this area. The clinical reviews will be using a modified version of the CANS. Updated information will be provided at the next meeting.
  3. Participants discussed repeat of psychiatric hospitalizations when residential services are required. The defining of appropriate "trial period" needs to be operationalized. The discussion of the large amount of money spent on hospitalizations ($150 million DHS in hospitalizations and $200 million trying to integrate children in the community ) supports the need to look specifically at youth involved in repeat hospitalizations. There was discussion of having a side bar for ICG with recommendations from the psychiatrist from the hospitalization. There is a gap between youth receiving Medicaid and those that are privately funded kids. It was suggested to bring HFS to the table for discussion.
  4. Participants discussed the issues of "guardianship" and whether DJJ can provide that role or if all guardianship transfers are through DCFS. The group will need court clarification of DJJ role and will ask Dr. Ferguson and Sharon Coleman.
    Group discussed adding continuity of care to the appeal process when we get to that section of the rule.
  5. Participants discussed educational requirements for applying for and utilizing ICG. Specifically, participants discussed the question of whether a student needs an Individual Education Plan (IEP) to receive funding for education when in placement and/or when applying.
    It was reported that youth in private schools and faith based parochial schools only receive an Individual Service Plan (ISP). Clarification is needed on whether private schools receive IDEA funding will not follow them into placement Other questions included:
    • Can a child be non-attending while the eligibility process begins? Should requirements be eligible prior to or after the process. The child wouldn't receive the full funding and doesn't follow the same guidelines; there is a different process.
      John from CRSA stated that applicants had to provide an IEP in the 90's and there was a process for education and IEP for high end services but this is no longer the case. ISBE will provide reimbursement to the district when a child meets requirements.
    • Participants discussed the challenges connected with parents pursuing an IEP, including established deadlines (60 school days, which can be quite prolonged given the time of year).

135.90 Residential Placement

Participants discussed desire to know what percentage of youth don't have an ICG or wouldn't qualify are in private settings? Where are the kids coming from? How many kid packets come with an IEP?

ISBE and DMH will work out this language at the administrative level and then give this group that data


Next meeting Monday 12/16/13 10-12pm at Chicago Reed Annex.

Notes submitted by Roberta Allen.