California Department of Corrections and Rehabilitation

1
California Department of Corrections and
Rehabilitation

• RELEASE PLANNING
• CONTINUITY OF
• MENTAL HEALTH
• AND
• MEDICAL CARE

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California Department of Corrections and
Rehabilitation

• Presented by
• The CDCR
• Division of Correctional Health Care Services

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Benefit Entitlements
Division of Adult Parole Operations

• Uses contracted staff within prisons to apply for
  federal and state benefit entitlements prior to
  inmates return to the community
• Benefits applied for
• Social Security
• Medi-Cal
• Veterans benefits

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Benefit Entitlements
Division of Adult Parole Operations

• Prioritize inmates by acuity and need
• Long-term medical care and inpatient mental
  health care.
• Board care/assisted living, in-home health
  care, and hospice.
• Chronic illness requiring life sustaining
  assistance (i.e., dialysis, continuous oxygen).

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Benefit Entitlements
Division of Adult Parole Operations

• Prioritize inmates by acuity and need
• Inmates with mental illness designated Enhanced
  Outpatient Program (EOP) or above
• HIV/AIDS (if qualified)
• Developmentally disabled or other qualifying
  disabilities
• Inmates with mental illness designated
  Correctional Clinical Case Management System
  (CCCMS)

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Benefit Entitlements
Division of Adult Parole Operations

• Current funding do not allow applications for
  benefits for all potentially eligible releasing
  inmates
• So, focus remains on first four priorities of
  which not all receive the service

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Benefit Entitlements
Division of Adult Parole Operations

• Transitional period of offender realignment and
  budget reductions
• Efforts will continue to provide benefit
  application assistance to releasing inmates
  within criteria 1-4, regardless of parole
  supervision status

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Benefit Entitlements
Division of Adult Parole Operations

• Funding and staffing levels may change from FY to
  FY
• If level services changes counties will be
  notified
• Counties should consider alternatives to the CDCR
  benefits program

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Benefit Entitlements
Division of Adult Parole Operations

• For additional information on the Division of
  Adult Parole Operations Transitional Case
  Management Program, please contact
• Patricia Lujan
• [phone] Patricia.Lujan_at_cdcr.ca.gov.

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Benefit Entitlements Additional Efforts

• California Correctional Health Care Services
• Implementing program to obtain Medi-Cal
  eligibility for inmates receiving inpatient
  medical treatment outside of the prisons
• May result in increase of inmates releasing with
  Medi-Cal established which can continue upon
  release from prison

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Patient Information Sharing

• Will attempt to obtain signed authorization to
  release information from inmates as part of
  release planning for continuity of care
• Not all inmates will sign a release

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Patient Information Sharing

• Both the California Medical Instrumentation
  Association (CMIA) and the federal Health
  Insurance Portability and Accountability Act
  (HIPAA) provide for the privacy and security of
  protected health information.

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Patient Information Sharing

• CMIA and HIPAA permit the use and disclosure of
  protected health information by health care
  providers without an authorization by the
  individual to whom the information pertains when
  that information is used or disclosed for
  treatment, payment or health care operations.

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Patient Information Sharing

• HIPAA
• Covered entity may obtain the consent of an
  individual to use or disclose protected health
  information
• Consent is not required by the individual whose
  medical information is being disclosed to another
  health care provider for treatment

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Patient Information Sharing

• HIPAA
• Arrangement for the continuity of care is a form
  of treatment.
• HIPAA defines treatment to mean, the
  provision, coordination, or management of health
  care and related services by one or more health
  care providers

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Patient Information Sharing

• CMIA
• CMIA does not define treatment but authorizes use
  or disclosure of medical information for each of
  the purposes in the HIPAA definition of treatment

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Patient Information Sharing

• An inmates refusal to sign an authorization is
  not a barrier to the disclosure of his or her
  medical information from provider to provider to
  arrange for treatment

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Community Based Medical and Mental Health Care

• Release Planning
• Planning and preparation for release of inmates
  who need continued mental health or medical care
  is essential to successful transition to the
  community

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Community Based Medical and Mental Health Care

• Release Planning
• CDCR staff attempt to arrange community-based
  care prior to an inmate-patients release when
  inmate
• Needs acute or sub acute care
• Is unable to arrange for care due to disability
• Needs dialysis
• Is unable to handle Activities of Daily Living

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Community Based Medical and Mental Health Care

• Release Planning
• For all AB109/PRCS mental health and dental
  related questions contact 
• DCHCS Operations Mental health and dental
  questions only
• Email AB109MHdentalhelp_at_cdcr.ca.gov
• Phone [phone], Pamela Michel 

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Community Based Medical and Mental Health Care

• Release Planning
• For all AB109/PRCS medical related questions
  contact 
• CCHCS Field Operations Medical questions
• only
• Email Renel.Alford_at_cdcr.ca.gov
• Phone [phone]

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Community Based Medical and Mental Health Care

• Release Planning
• All questions will be logged and forwarded to
  appropriate personnel for timely response

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Transitional Protocol Workgroup Mental Health
and MedicalSubcommittees

• The CDCR Office of Communications and External
  Affairs established Transitional Protocol
  Workgroup
• Co-hosted by the California State Association of
  Counties

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Transitional Protocol Workgroup Mental Health
and MedicalSubcommittees

• Representatives from several organizations
• Various CDCR Divisions
• California Correctional Health Care Services
• California Hospital Association
• California Mental Health Directors Association
• Chief Probation Officers of California
• County Counsels
• County Health Executives
• Public Guardians
• County Welfare Directors Association

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Transitional Protocol Workgroup Mental Health
and MedicalSubcommittees

• Purpose
• To bring together stakeholders to determine
  information needs, notification timelines, and
  treatment coordination roles for inmates
  releasing to post release community supervision

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Transitional Protocol Workgroup Mental Health
and MedicalSubcommittees

• Bi-weekly meetings
• Held in CDCR headquarters, Sacramento
• Conference call-in available

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Transitional Protocol Workgroup Mental Health
and MedicalSubcommittees

• For additional information or to request to be
  part of the process, please contact Thy Vuong,
  at [phone] or Thy.Vuong_at_cdcr.ca.gov.

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Division of Correctional Health Care Services
Mental Health Pre-Release Workgroup

• Goals
• Redesign prison-based mental health pre-release
  process/services to be more effective
• Meet the needs of counties in linking high risk,
  high need inmates to care
• Focus on inmates in EOP or higher levels of care
• Increase involvement of families to increase
  success of inmates

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Division of Correctional Health Care Services
Mental Health Pre-Release Workgroup

• Participants
• DCHCS Pre-Release Programs
• California Mental Health Directors Association
• Chief Probation Officers of California
• NAMI (National Alliance on Mental Illness)
• Other interested stakeholders

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Division of Correctional Health Care Services
Mental Health Pre-Release Workgroup

• To participate contact
• Michael Morrison
• Michael.Morrison_at_cdcr.ca.gov
• 916-323-6299

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Accessing Health Records InformationAfter
Release from Prison

• After release from prison, inmate-patient Unit
  Health Records are stored and managed at the
  California Correctional Health Care Services
  Health Records Center

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Accessing Health Records InformationAfter
Release from Prison

• Requests for inmate health records after release
  from prison
•  
• Mail request to
•         Health Records Center    P.O. Box
  942883    Sacramento, CA 94283
• Fax Request to [phone]

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Accessing Health Records InformationAfter
Release from Prison

• All requests should include an Authorization for
  Release of Information, which can be accessed at
  http//www.cphcs.ca.gov/docs/resources/CDCRForm738
  5.pdf.

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Accessing Health Records InformationAfter
Release from Prison

• For additional information on requesting Health
  Records after an inmates release from prison,
  please contact
• The California Correctional Health Care
• Services Health Records Center
• [phone]

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CDCRs Mental Health Program

• Provide services to inmates with serious mental
  illness or those meeting medical necessity
  criteria
• Interdisciplinary treatment teams
• Psychiatrists
• Psychologists
• Licensed Social Workers
• Recreational Therapists
• Psychiatric Technicians

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CDCRs Mental Health Program

• Four Basic Levels of Care
• Correctional Clinical Case Management System
  (CCCMS)
• Stable/functioning in the general population or
  Administrative Segregation
• Exhibit symptom control or are in partial
  remission
• Assessment by a mental health clinician
• Treatment team - primary clinician, psychiatrist,
  and correctional counselor
• Primary clinician contact no less than every 90
  days
• Seen annually by treatment team
• If prescribed medication are seen by psychiatrist
  at least every 90 days

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CDCRs Mental Health Program

• Four Basic Levels of Care
• Enhanced Outpatient Program (EOP)
• Acute onset/significant decompensation and unable
  to function in the prison general population
• Inability to program in work, education, etc.
• Dysfunctional or disruptive social interaction or
  impairment in the activities of daily living
• Need structured therapeutic living environment
  but do not require inpatient care
• Initial clinical assessment and treatment team
  every 90 days
• Weekly clinical contact with primary clinician in
  individual or group
• Individual clinical contact at least every other
  week
• At least ten hours per week of structured
  therapeutic activities
• Seen by a psychiatrist at least once per month

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CDCRs Mental Health Program

• Four Basic Levels of Care
• Mental Health Crisis Bed (MHCB) - Short term
  (less than 10 day) inpatient treatment
• Marked impairment/dysfunction requiring 24 hour
  nursing care, danger to others due to serious
  mental disorder or danger to self
• Pre-admission screening by a psychiatrist or
  licensed psychologist
• Admission note, initial mental health assessment
  to begin initial treatment planning, nursing
  assessment, and physical examination in first 24
  hours
• Treatment team meets within 72 hours of admission
  and at least every 7 days
• Daily assessment and monitoring by the primary
  clinician.
• Evaluation by a psychiatrist at least twice a
  week
• Twenty-four hour nursing care
• Brief intensive therapy as needed
• Rehabilitation therapy activities as needed
• Aftercare planning

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CDCRs Mental Health Program

• Four Basic Levels of Care
• Acute Care or Intermediate Care Facility (ICF)
• CDCR/DMH Memorandum of Understanding for
  inpatient psychiatric care.
• Provide care to patients whose conditions cannot
  be successfully treated in the outpatient setting
  or in short term MHCB placements

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MENTAL HEALTH POPULATION AND PERCENTAGES AS OF
AUGUST 24, 2011

• Total Mental Health Inmate Population
• 37,200
• of Overall CDCR Inmate Population
• 23.1

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MENTAL HEALTH POPULATION AND PERCENTAGES AS OF
AUGUST 24, 2011
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MENTAL HEALTH POPULATION AND PERCENTAGES AS OF
AUGUST 24, 2011
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Questions?