2PSR Individualized Treatment Plan

8/11/2019 2PSR Individualized Treatment Plan

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PSR IndividualizedTreatment Plan

April-May 2005


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PSR Services

16.03.09.453 The goal of PSR services is to aid participants inwork, school, family, community or other issuesrelated to their mental illness. It is also to aidthem in obtaining developmentally appropriateskills for living independently and to preventmovement to a more restrictive living situation.

All services provided must be clinicallyappropriate in content, service location and

duration and based on measurable andbehaviorally specific and achievable goals.


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PSR ServicesWritten Individualized

Treatment Plan IDAPA 16.03.09.453.02 Services must support the goals of PSR which are

maximum reduction of mental disability and

achievement of the highest possible functioninglevel for that participant. For adults this means becoming independent or

maintaining the highest level of independence. For children this means learning or maintaining

developmentally appropriate role functioning.


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Treatment Plan The individualized treatment plan identifies theissues, goals, areas of need, objectives and thetotal number of hours and types of servicesestimated to achieve all objectives based on theability of the participant to effectively utilizeservices.

The individualized treatment plan must bedeveloped by the participant, family, other

support systems and the provider agency. Must be documented by the provider agency.


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Treatment Plan Must include the following:

An issue statement specifically describing theparticipant's behavior that directly relates to

the mental illness and functional impairmentthat was identified in the assessment

A statement which describes the participant'sgoals relative to the goals of PSR


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Treatment Plan Must include the following: Overall goalsand concrete, measurableobjectivestobe achieved, including time

frames for completion. At least one objective is required for thefocus areas which will most likely lead to thegreatest stabilizing impact.

This should include at least one objective in

each of the two focus areas which qualify theparticipant for PSR.


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Treatment Plan Must include the following: Tasks that are specific, time limited activities

and interventions designed to accomplish the

objectives in the plan and are developed by theparticipant and the provider. Each task description must specify the

anticipated place of service, the frequency ofservices, the types of service and the person

responsible to assist the participant in thecompletion of tasks.


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Treatment Plan Must include the following: Documentation of who participated in the

development of the individualized treatment

plan. The participant must take part in the

development of the plan. The adult participant or guardian must sign the

plan or documentation must be provided whythis was not possible, including refusal to sign.


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Treatment Plan Must include the following:

For a minor child participant, the parent

or legal guardian must sign the plan. A copy of the plan must be given to the

adult participant and the guardian or tothe parent or legal guardian of the child.


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Treatment Plan The individualized treatment plan

must be developed within 30 calendar

days from the initial face to facecontact between the provider agencystaff and the participant, or theparent or legal guardian of a minorchild.


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Treatment Plan An individualized treatment plan review by theprovider agency staff and the participant mustoccur at least annually.

During the review, the staff and participant reviewany objectives which may be added or deleted fromthe plan.

Input from other participants in the plan includingservice providers must be considered.

Other attendees of the review may be chosen bythe participant/parent/guardian and the agencystaff.


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Treatment Plan Must be reviewed and signed by a

physician or licensed practitioner of thehealing arts at least annually indicatingservices are medically necessary.(licensed physician, physician assistant ornurse practitioner and clinical nurse

specialist with experience prescribingpsychotropic medication)


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Treatment Plan Once the date of a plan is established ( physiciansignature date unless past due), that date continuesto be the annual date of the plan.

Any subsequent plans must be received by the MHAon or before the expiration date of the plan.

If a subsequent plan is not received on or beforethe expiration date of the current plan, servicesthat are provided in the interim will not be

reimbursed.


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Treatment Plan The eligible participant will be allowed tochoose whether or not he desires toreceive PSR services and who the

providers of services will be to assist inaccomplishing the objectives stated in theplan.

Documentation must be included in theparticipant's file showing that the

participant has been informed of his rightsto refuse services and choose providers.


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Individualized Treatment Plan

Authorization Requirements Required documentation (16.03.09.451.03):

Participant demographic information

Comprehensive assessment

Written individualized treatment plan

Adult services- rehabilitation outcome data(MH Profile Form)

Children's services- CAFAS/PECFAS


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Changes in Plan Hours or

Service Type Must be approved by the MHA. A clear rationale for the change in

hours or service type must beincluded with the request.


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Changes to Plan Objectives

451.06 Include recommendation and rationale inthe next 120 day review.

Substantial changes requiring immediatechanges in the plan need to be submittedto the MHA for approval. The requestmust include the recommendation and

rationale for the change.


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Minor Changes toIndividualized Treatment Plan

Tasks 451.07 Submit amended plan to the MHA detailing

the necessary and specific changes to theplan so long as there is no change in hoursor types of services.

If no response received from the MHAafter 10 working days proceed to

incorporate those specific changes.


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Treatment Plan PSR services that must be specifically identifiedon the Individualized Treatment Plan Pharmacological Management Individual PSR Group PSR Collateral Contact Nursing Service Psychotherapy

Occupational Therapy


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PSR Individualized Treatment

Plan Client Name

Social Security Number

Healthy Connection Physician Medicaid Number

Healthy Connections Number

CAFAS Score- Children only Provider Agency Completing the Plan


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PSR Individualized

Treatment Plan Date of Amendment- when applicable Amendment comments- Justification

and description of what is beingamended in the plan


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PSR Individualized

Treatment Plan Diagnostic Summary- Indicate Primary Diagnosis with (P)

Axis I: Clinical Disorders, Other Disorders That

May Be a Focus of Clinical Attention Axis II: Personality Disorders, Mental Retardation Axis III: General Medical Conditions Axis IV: Psychosocial and Environmental Problems Axis V: Global Assessment of Functioning (GAF)

scores for both current and highest past GAF


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PSR Individualized

Treatment Plan Duration of Principal Diagnosis Select one

Less than one year On to two years

More than two years


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PSR Individualized

Treatment Plan Functional Areas Identified as Deficits inthe Assessment

Must be documented and justified in theassessment Health/Medical - Housing

Social Interpersonal - Family

Vocational/Educational - Community/Legal Basic Living Skills - Financial


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PSR Individualized

Treatment Plan Functional Areas Areas identified in the assessment to be

addressed in the plan Psychiatric 2 functional areas identified in the

comprehensive assessment Health/Medical - Housing Social Interpersonal - Family Vocational/Educational - Community/Legal Basic Living Skills - Financial


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Issues Issues- identified for each functional area Brief summary statement that specifically

describes the participant's behavior thatdirectly relates to the mental illnessandfunctional impairment

Should also describe their strengths


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Goals

If you dont know where you are going, youwill probably end up somewhere else.

Lawrence J. Peter


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Goals

Broad general statements

Express the participant's desires,

what they want to change Written in their words

Tied to discharge criteria


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Goals

Goals can reflect Life goals

Service or treatment goals Quality of life goals


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Goals

Directed towards recovery

Responsive to need

Strengths based Written in I want to statements


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ObjectivesMeasurable, objective steps to

accomplish the goal

Short term, time limited with timeframes for completion


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Objectives Immediate focus of treatment but not adescription of the intervention

Focus on positive changes in behavior,

improving functioning, attaining new skillsnot just decreasing symptoms or stoppinga behavior

Written in The participant will

statements Specify one change at a time


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Objectives Reasonable Measurable

Appropriate to the treatment setting Achievable

Understandable to the participant


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Objectives Time specific Written in behaviorally specific

language Responsive to the participants needsand recovery goals

Appropriate to the participants age,development and culture


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Objectives At least one objective for every goal Keep the plan manageable


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TasksThe services, interventions, andactivities that will be provided by the

treatment team Assist the participant achieve theirgoals and objectives


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Tasks Describe the services to be delivered Specify

Who What Where When- frequency, intensity, duration

Why


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PSR Individualized

Treatment Plan Expected End Date Dates may vary depending on the

objectives and tasks needed toaccomplish the goals


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PSR Individualized

Treatment Plan Type, Frequency & Hours Summarize totals by service code

H2017 (RHIP)1hr/1x/wk

52 hrs/ yr


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PSR Individualized

Treatment Plan Signatures- must be hand written, withcredential and date also hand written

Participant/guardian

PSR professional that wrote the plan

Physician

Others involved in the plan development


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PSR Individualized

Treatment Plan Service Plan Authorization Form Provider/Region

Client Name Provider Number

Agency Phone Number

Agency FAX Number


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ReferencesTreatment Planning for PersonCentered Care: The Road to Mental

Health and Addiction RecoveryNeal Adams and Diane M. GriederElsevier Academic Press 2005

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2PSR Individualized Treatment Plan

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