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§412.321: Crisis Services

(a) Coordinating provision of crisis services. The LMHA and MCO must develop and implement policies and procedures governing the provision of crisis services that:

(1) identify providers' roles and responsibilities in responding to a crisis;

(2) describe the coordination of crisis services to be required among providers of crisis services, law enforcement, the judicial system, and other community entities; and

(3) comply with Chapter 419, Subchapter L of this title (relating to Mental Health Rehabilitative Services).

(b) Immediate screening and assessment.

(1) Screening and assessment. All providers of crisis services must be available 24 hours a day, every day of the year, to perform immediate screenings and assessments of individuals in crisis, including assessments to determine risk of deterioration and immediate danger to self or others. Crisis assessments cannot be delegated to law enforcement officials.

(2) QMHP-CS assessment. Individuals experiencing a crisis, as determined by a QMHP-CS screening, must be assessed face-to-face or via telemedicine by someone who is at least credentialed as a QMHP-CS within one hour after the individual presents to the provider in a crisis, either via the crisis hotline or a face-to-face encounter (e.g., walk-in). The QMHP-CS must provide ongoing crisis services until the crisis is resolved or the individual is placed in a clinically appropriate environment.

(c) LPHA consultation. An LPHA must always be available for consultation with the QMHP-CS.

(d) Physician assessment. If the individual requires emergency care services, as determined by the QMHP-CS's assessment of risk of deterioration and danger as described in subsection (b) of this section, then the provider of crisis services must have a physician, preferably a psychiatrist, perform a face-to-face or telemedicine assessment of the individual as soon as possible, but not later than 12 hours after the QMHP-CS's assessment to determine the need for emergency services.

(e) Documenting crisis services. The provider of crisis services must maintain documentation of the crisis services, including:

(1) the date the service was provided;

(2) the beginning and end time of the crisis contact;

(3) the name and any other identifying information of the individual to whom the service was provided (if given);

(4) the location where the service was provided;

(5) the behavioral description of the presenting problem;

(6) lethality (e.g., suicide, violence);

(7) substance use or abuse;

(8) trauma, abuse, or neglect;

(9) the outcome of the crisis (e.g., individual in hospital, individual with friend and scheduled to see doctor at 9:00 a.m. the following day);

(10) the names and titles of staff members involved;

(11) all actions (including rehabilitative interventions and referrals to other agencies) used by the provider to address the problems presented;

(12) the response of the individual, and if appropriate, the response of the LAR and family members;

(13) the signature of the staff member providing the service and a notation as to whether the staff member is an LPHA or a QMHP-CS;

(14) any pertinent event or behavior relating to the individual's treatment which occurs during the provision of the service; and

(15) follow up activities, which may include referral to another provider.

(f) Communication of crisis contacts. If an individual who is currently receiving mental health services has experienced a crisis and has been assessed in accordance with subsection (b) of this section, the provider of crisis services must communicate in writing (e.g., e-mail or fax) the details of the crisis contact to the provider of ongoing mental health services to ensure that the individual receives continuity of care and treatment and include such communication in the medical record. This crisis contact communication:

(1) may not disclose any substance abuse-related information unless disclosed in compliance with federal law as described in 42 CFR Part 2;

(2) must take place no later than the next business day after conclusion of the crisis contact; and

(3) may disclose mental health information for the purpose of continuity of care and treatment without the individual's consent if disclosure is made in accordance with:

(A) Texas Health and Safety Code, §533.009 (relating to Exchange of Patient and Client Records), when the provider of ongoing services is part of the department's service delivery system; or

(B) in accordance with Texas Health and Safety Code, §611.004(a)(7) (relating to the Authorized Disclosure of Confidential Information other than in Judicial or Administrative Proceeding), when the provider of ongoing services is not part of the department's service delivery system.

Comments

Source Note: The provisions of this §412.321 adopted to be effective April 29, 2009, 34 TexReg 2603