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Tim Winbush, LCSW and Leslie Phillips, LPC
Western Psychiatric Hospital/University of Pittsburgh Medical Center
Thursday October 7, 2021
www.pediatricbipolar.pitt.edu
Navigating Care Options
Disclosures
No Disclosures
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Referrals to CABS Contact: Donna Barham or Rita Scholle (412-246-5238 or 412-246-5235)
Tim Winbush (412-246-5273)
Treatment: Children ages 5-21 will be seen for an assessment, individual therapy, family therapy, and medication management services. Reason for referral should be a suspected diagnosis of Bipolar disorder (including flagged for Bipolar Track during WPH/PES assessment). Clients with mild substance use can be referred if this is not the primary issue.
Referral Process: During daylight hours, contact Donna, Rita or Tim to begin the appointment process. After hours, e-mail Donna and Tim with patient information (MRN, phone #, presenting problem) so that contact can be made by the next business day.
OUTPATIENT MENTAL HEALTH SERVICES
“The CABS Clinic”
An outpatient, but highly responsive and comprehensive model of care serving young people ages 4-22.
* We offer:
Consultation, Screening & Referral
Comprehensive Diagnostic Assessment
Outpatient Individual & Family Therapy – 1-2 hours weekly, or less often, depending on needs and goals
Medication Management – every 2-8 weeks, as needed for stabilization and maintenance
Ongoing Assessment of Safety and changing needs
Access to adjunctive and higher levels of care
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Determined by:
* Severity of symptoms
* Degree of functional impairment
* Safety to self and others
* Availability and Access
* Patient / Parent Agreement :
“Self-Determination”
Levels of Care in Behavioral Health
• Residential Treatment
• Inpatient Hospitalization
• Diversion and Acute Stabilization (DAS)
• Partial Hospitalization
Highest: most restrictive, most
intensive
• School Based Mental Health Provider
• Behavioral Health Rehabilitation Services
• Family Based Mental Health
• Intensive Outpatient Programs (IOP)
Intermediate: more intensive
• Primary Care Physician
• Outpatient Mental Health Provider
• Case Management Services
Lowest: least restrictive, least
intensive
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Case Management Services:
Role and Function
Administrative Case Management
• Assess & Link
Blended Service Coordination
• Assessing * Planning * Linking
• Coordinating * Monitoring * Advocating
County Case Management:
Human Services Administration Organization
Allegheny County Service Coordination
Milestones Centers, Inc.
Chartier’s Center MH/MR
Family Services of Western PA.
Mercy Behavioral Health
Mon Yough Community Services
Staunton Clinic
Turtle Creek Valley MH/MR
WPH
HSAO
Family Links
Pressley Ridge
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THE BASICS OF ADMINISTRATIVE
SERVICE COORDINATION
What is Administrative Service Coordination (Administrative Service Coordination is usually a starting point for most consumers. If a consumer receives services (such as outpatient or inpatient) from any provider in Allegheny County, he/she is eligible. An Administrative Service Coordinator will assess the consumer’s needs, help search for the appropriate providers, and make referrals to the services needed. An Administrative Service Coordinator provides assistance to adult consumers, families, and children in need. It is the “safety net” for the linking to services. It is a voluntary program.
Courtesy of Rosanne Pavlik MS
WPH Service Coordination Supervisor
How long does Administrative
Service Coordination last?
There is no time limit on the provision of Administrative Service
Coordination services. Once a consumer has registered with the
Service Coordination Unit of their choice, that SCU can provide
services as long as the consumer remains registered with them.
An Administrative Service Coordinator will meet with a
consumer in person or via phone to assess their needs and they
may not meet with that consumer again for weeks, months or
years, until another need requires attention.
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MYTH: Administrative Service
Coordination is a clinical service?
FACT: Administrative Service Coordination Services are not a
clinical service. The role of the ADMINISTRATIVE SERVICE
COORDINATOR is to link the individual to the professional
clinical service that is required.
MYTH: Administrative Service Coordination
provides the same level of service as
Blended Service Coordination. FACT: The two services are different in many ways.
Administrative Service Coordination does not provide 24/7 services and does not provide longer term service coordination. ASC caseloads number into the hundreds while BSC caseloads can be a maximum of 30. Most ASC’s are clinic based and meet with their consumers at the clinic. Most requests for ASC services are limited to one domain, or one area of needing assistance, that can be resolved in a relatively short period of time.. BSC referrals typically involve numerous domains that will be addressed over a longer period of time.
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THE BASICS OF BLENDED SERVICE
COORDINATION
WHAT IS BLENDED SERVICE COORDINATION?
Blended Service Coordination helps individuals find and connect
to supports in their communities that can help them during their
recovery journey. Service Coordinators might help an individual
to: apply for benefits like Social Security, find affordable housing,
return to the workforce, continue education, find spiritual
supports, volunteer, coordinate care with the primary care
physician, register to vote or advance wellness.
Service CoordinationService Coordinators assist parents and children who are involved
in the Juvenile Justice System and/or Children and Youth Services
and the mental health system obtain an IEP, obtain Wrap Around
Services or DAS placement. Service Coordination may take place
outside a central location or office.
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Blended Service Coordination Service Coordinators can meet individuals in their home or in
the community, in places like coffee shops or restaurants. Service
Coordination provides help to individuals in times of crisis or
during an emergency. Service Coordinators actively assist in the
resolution of the crisis or emergency, including providing access
to other crisis services beyond the Service Coordinators direct
role in such situations.
WHAT SERVICES DO BLENDED
SERVICE COORDINATORS
PROVIDE
Assessing the needs and strengths of each person-served, based on her/his input.
Service Planning to help each person organize all the different services s/he wants or needs
to have a successful life in the community of their choice.
Linking each person served and his/her family to services/supports that are convenient and effective
and that can help lead to positive changes.
Coordinating communication between different programs so there is a close working team.
Evaluating/Monitoring the different programs to ensure that they are consistently working
with each person served toward achieving goals and addressing identified needs.
Advocating on behalf of each person served to get the services needed while removing barriers and protecting rights.
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How long does Blended Service
Coordination last?
The length of time someone has a Blended Service Coordinator depends on the person’s needs. The goal of service coordination is to help each consumer take an increasingly active role in their recovery journey.
MYTH: Blended Service Coordinators provide shuttle service. False.
Service Coordinators do not provide shuttle service. Service Coordinators do help the person served to find and link them to transportation by helping him/her: apply for Access, obtain a bus pass, understand how to use public transit and arrange ride-sharing with other individuals. Transporting and escorting consumers is not a billable activity for Blended Service Coordinators.
Levels of Care in Behavioral Health
• Residential Treatment
• Inpatient Hospitalization
• Diversion and Acute Stabilization (DAS)
• Partial Hospitalization
Highest: most restrictive, most
intensive
• School Based Mental Health Provider
• Wrap Around Services
• Family Based Mental Health
• Intensive Outpatient Programs (IOP)
Intermediate: more intensive
• Primary Care Physician
• Outpatient Mental Health Provider
• Case Management Services
Lowest: least restrictive, least
intensive
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Outpatient Providers:
Community Mental Health Centers: Turtle Creek Valley
MH/MR, Staunton Clinic, Mon Yough MH/MR,
Mercy Behavioral Health
Hospital Systems: Southwood, Allegheny General
(Trauma Clinic), WPH, St. Clair Hospital
Independent Organizations: Family Services of Western
PA, Pressley Ridge, etc..
Private Practice Groups and Independent Operators (see
your insurance provider list)
Children’s Community Pediatrics We provide multidisciplinary services embedded within some of
our offices that treat children with a variety of behavioral health
issues in order to improve quality of life and functioning at home
and in the community.
www.childrenspeds.com
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Collaboration Our collaborative team of pediatricians, psychologists, therapists
and psychiatrists work together to provide complete evaluations
of psychiatric disorders and brief evidence-based treatment
within the pediatric office when indicated. Our experts will
make necessary referrals when additional care is needed.
Child Development Unit (CDU)
The Child Development Unit (CDU) promotes a family-centered
approach to health care in which families participate actively in the
assessment. The Child Development Unit is made up of a team of
professionals who specialize in assessing a child’s delays
developmentally, behaviorally or emotionally; developmental
disorders; genetic disorders; or long-term consequences of medical
conditions. The staff includes developmental/behavioral pediatricians,
nurse practitioners, psychologists, behavioral consultants and trainees
who collaborate to provide a comprehensive assessment tailored to the
specific needs of children and families.
http://www.chp.edu/our-services/child-development-unit
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Referral Requirements
Referrals are required from primary care physicians or other
Children’s Hospital specialty services. Referrals for patients
enrolled in managed care insurance plans also may require
authorization from the insurance provider and primary care
physician. All necessary referral and authorization forms must be
received before the patient’s visit. Referrals from schools, early
intervention programs and self-referrals are accepted with
primary care physician authorization.
Locations Child Development Unit (CDU)
Oakland Medical Building
3420 Fifth Ave.
Pittsburgh, PA 15213
412-692-5560
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Locations Children's Pine Center
11279 Perry Highway
Wexford, PA 15090
412-692-7337
Intermediate levels of care
More intensive treatment
services.
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Intensive Outpatient
Adolescent and Transition Age Adult – ages 13-22
9 hours per week – three days/week, 3 hour long visits
Aimed at relieving severe functional impairment, managing suicidal risk, and preventing hospitalization
Involves:
group skills training – to enhance coping and problem solving skills
peer support
weekly individual therapy
weekly medication management
Focused, need-specific treatment
(examples: OCD IOP, STAR IOP, SUD IOP)
Family-Based Therapy
Family-Based Mental Health Services (FBMHS) is a community-based service provided in an individual’s home which seeks to involve the family as a whole in the treatment process.
Typically, services include:
A team of therapists offering Structural Family Therapy (SFT)
Sessions involving individual client (child) as well as any combination of family members (parents, siblings, grandparents)
24 hour crisis on-call services offered seven days a week
Case management services (or Service coordination)
Linking to and coordination of medication management
Length of treatment: 6-8 months
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Behavioral Health Rehabilitation Services
BHRS (a.k.a. “Wrap-Around”) Necessary when the child or adolescent’s functional impairment is evident
across environments and needs cannot be met adequately in an outpatient setting.
BHRS services are prescribed by clinical professionals, typically a psychiatrist and/or psychologist.
Services are typically approved for 6 month spans, often prescribed in time increments (hours of service) per week/month.
A TEAM of professionals: psychiatrist/psychologist, a behavioral specialist consultant (BSC), a mobile therapist (MT) and therapeutic staff support (TSS).
Includes consultation with the child’s natural supports (family/friends), educational supports (teachers, administrators) and other caregivers (daycare staff) to provide education on use of effective behavioral interventions.
School-Based Services
Often, a child or adolescent’s need for support are particularly
evident in the school setting. Some behavioral health providers
actively collaborate with a community’s school system to provide
the most at-risk children and adolescent’s with additional
therapeutic supports.
School based therapists meet with individuals in the school
setting, typically once per week for therapy and support.
A goal of school based therapy is to meet a child’s needs in their
school environment, lowering the risk for need for partial
hospitalization or approved private school.
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Allegheny County Department of Human
Services
1. Community Liaisons
2. Education Specialists
www.alleghenycounty.us/human-services/index.aspx
Community Liaisons School Based Liaisons: Professionally trained to serve as links
between educational systems, mental health providers and social
service agencies and comprise the Student Assistance Team. They
can provide intervention quickly and decisively in situations
when students need mental health services. The objective is to
improve communication between systems and to streamline
service delivery.
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Education Specialists Education specialist provide consultation to families and schools
in order to facilitate the development of appropriate and
meaningful Individualized Education Plans (IEPs) for students
with special needs. They support families by providing
information, initiating contacts and referrals and attending
meetings as an advisor in developing these plans
Levels of Care in Behavioral Health
• Residential Treatment
• Inpatient Hospitalization
• Diversion and Acute Stabilization (DAS)
• Partial Hospitalization
Highest: most restrictive, most
intensive
• School Based Mental Health Provider
• Wrap Around Services
• Family Based Mental Health
• Intensive Outpatient Programs (IOP)
Intermediate: more intensive
• Primary Care Physician
• Outpatient Mental Health Provider
• Case Management Services
Lowest: least restrictive, least
intensive
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Partial Hospitalization
A “step-down” from inpatient hospitalization; PHPs are “day programs” and typically offer:
Thorough assessment, intensive behavioral management and comprehensive therapy (group, family, individual) implemented on a 5 day per week schedule.
Emphasis is on building resilience through skill building.
Medication management by child psychiatrists and nursing staff on site daily.
Length of stay: 4-6 weeks
Goal: Clarify diagnosis, stabilize symptoms, develop long term treatment plans.
Providers: Partial Hospitalization
WPH Adolescent Day Treatment
Program – South Side and Wexford
Mercy Behavioral Health (ages 6-18)
Wesley Spectrum
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Diversion & Acute Stabilization
“DAS”Short term placement of children and adolescents in crisis.
Typical services include:
24/7 monitoring provided by clinical professionals
Day programming comparable to PHP programs
Medication management by on-staff psychiatrists and nurses
Comprehensive individual, group and family therapy
Trauma-informed care and family-style living environment
Length of stay: 4-6 weeks
Providers:Child and Adolescent
DAS
Mercy Behavioral Health
Mars Home for Youth
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Psychiatric Emergency Services The Psychiatric Emergency Services(PES)at WPH provides
emergency and crisis intervention services to people of all ages
24 hours a day, including:
Psychiatric emergency and substance abuse evaluations
Referral to outpatient providers
Facilitation of inpatient admissions
Acute Hospitalization
Commitment is required, either voluntary (201) or involuntary (302)
Most restrictive level of care, used when individuals are at imminent risk
of harm to themselves or others, or unable to care for themselves.
Services offered:
•24/7 supervision in a locked facility by clinical and nursing staff and
removal of contraband objects
•Most aggressive way to manage/titrate medications under
direct supervision of clinical and nursing staff
•Daily med-management with a child psychiatrist
•Psychoeducation/skills-based groups
•Shorter length of stay, evaluated daily based on
medical necessity
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Acute Hospitalization:
The “IN-CABS” Program at WPIC
Serving adolescents ages 13-18 (18 year olds still in high school)
who have bipolar disorder or are at risk to have bipolar disorder
Comprehensive assessment and observation used to diagnose or
rule out bipolar disorder
Innovative technology used to assist with mood and energy
monitoring, as well as tracking sleep
Bipolar disorder-specific workbooks
Wellness approaches: yoga, music and art therapies
Synergy and coordination with outpatient services
201 (Voluntary Admission): A person who is 14 years old or older (or the guardian of a child under
age 14), signs a 201 commitment for voluntary admission to inpatient mental health services.
Under a 201 commitment, the person may sign him/herself out prior to the attending doctor's release, but must give 72 hours written notice of intent to leave.
A child 14 and older can sign in to receive treatment even if the legal guardian/parent does not agree
A legal guardian/parent can sign in for the child (under age 18) even if the child does not agree
Common presentations: Depression, suicidal/homicidal, self-harm, aggression, inability to care for self, psychosis
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302 (Involuntary Admission):
A 302 commitment is petitioned to a county mental health delegate by someone who has first hand knowledge of a person (not hearsay) who is dangerous to him/herself or others or unable to take care of self.
Once the 302 is authorized, the person is subject to an involuntary psychiatric evaluation by a doctor. If the examining physician upholds the petition (usually in ER), the person is admitted to the hospital for up to five days.
Within that five days, one of three things can happen: 1) the person is allowed to sign a 201 voluntary commitment; 2) the person is discharged by the attending doctor; or 3) an extended involuntary stay is petitioned to the court and a hearing is held to evaluate the clinical evidence for the petition.
303/304 (Involuntary Admission): This is an extension of a 302 commitment.
Local Child/Adolescent Inpatient Facilities
Western Psychiatric Hospital – Pittsburgh, PA
Southwood Psychiatric Hospital – Pittsburgh, PA
Clarion Psychiatric Center – Clarion, PA
Excela Latrobe Hospital – Latrobe, PA
Millcreek Behavioral Health – Erie, PA
Conemaugh Memorial Medical Center – Johnstown, PA
Belmont Pines Hospital – Youngstown, OH
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Residential Treatment Facility RTF
Long-term out of home placement:
Things to keep in mind:
RTF is an exceptionally high level of care. Out of home placements last
anywhere from 3 to 12 months and beyond.
This recommendation is typically made due to a child’s demonstration
of a high level of impairment in less restrictive environments (home,
school and the community) despite previous treatments/interventions
in high levels of care.
RTF RTF’s are highly structured. Residents engage in individual,
group and family therapy frequently, attend school (usually
“on campus” at the RTF) and are monitored by a
comprehensive treatment team including psychiatrists,
nurses, clinical staff and special educators.
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Crisis Services Allegheny County
re:solve Crisis Network 1-888-7-YOU CAN Telephone, walk-in, mobile, or residential crisis services
CACTIS – for identified children at risk of hospitalization/out of home placement
Telephone support, mobile crisis, school and scheduled visits
WPH/PES Psychiatric emergency evaluations
Referral to outpatient/intensive outpatient services
Facilitation of inpatient admission
911/nearest Emergency Room
Surrounding counties
Westmoreland Community Action 1-800-836-6010
Washington County Crisis Line 877-225-3567
Beaver County Crisis Help-Line 1-800-400-6180
Butler - Center for Community Resources 1-800-292-3866
http://www.cor.pa.gov/Documents/PA%20County%20Crisis%20Contacts.pdf
Surrounding counties
Westmoreland Community Action 1-800-836-6010
Washington County Crisis Line 877-225-3567
Beaver County Crisis Help-Line 1-800-400-6180
Butler - Center for Community Resources 1-800-292-3866
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Helpful Books on Bipolar Disorder
New Hope for Children and Adolescents with BPD – B. Birmaher (2004)
Raising a Moody Child – M. Fristad & J. Goldberg (2003)
The Bipolar Teen: What You Can Do to Help Your Child and Your Family – D.
Miklowitz & E. George (2007)
DBT skills Manual for Adolescents – J. Rathus & A. Miller (2015)
What Works for Bipolar Kids: Help and Hope for Parents – M. Pavuluri (2008)
Treating Bipolar Disorder: A Clinician's Guide to Interpersonal and Social
Rhythm Therapy (Guides to Individualized Evidence-Based Treatment) – E. Frank
(2015)
Resources for Patients & Families
Step Bipolar Program (STEPBD.ORG)
Child and Adolescent Bipolar Foundation (BPKIDS.ORG)
Depressive and Bipolar Support Alliance (NDMDA.ORG)
National Alliance for the Mentally Ill (NAMI.ORG)
National Institute of Mental Health (NIMH.NIH.GOV)
Bipolar Significant Other Mailing List (BPSO.ORG)
National Alliance for Research on Schizophrenia and Depression (NARSAD.ORG)
Juvenile Bipolar Research Foundation (JBRF.ORG)
International Society for Bipolar Disorders (ISBD.ORG)
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Thank you to all the families for their participation in the COBY and BIOS Studies. Their commitment over the years has been invaluable.
Thank you to the investigators and staff. Many people have worked countless hours over the last 20 years to gather, maintain, analyze and interpret the data. Their hard work has resulted in a greater understanding of the course of bipolar disorder which has improved treatment and outcome.
Thank you to the staff of the Child and Adolescent Bipolar Services (CABS). The dedication of the staff both inpatient and outpatient is greatly appreciated.
Thank you also to the…
National Institute of Mental Health
The Alicia Koplowitz Foundation (Spain)
The Fine Foundation (Pittsburgh)
Thank You
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