TITLE I HIV QUALITY MANAGEMENT PROGRAM

QUALITY PERFORMANCE INDICATOR DEFINITIONS AND CALCULATIONS FOR MENTAL HEALTH
      
Review Eligibility: All clients enrolled in a mental health program during the past 12 months.

1. Comprehensive Mental Health Evaluation and Reassessment

Cognitive Assessment
A cognitive assessment should be performed annually through the use of a Mini Mental Status Exam that assesses:

Orientation (place, date)
Registration and Recall (3 objects)
Attention/Calculation (serial 7s or world)
Language: Naming, Repetition, Command (Reading, Writing, Drawing)

Multi-axis Diagnosis
A multi-axis diagnosis should be performed annually and included in the client chart, with statements regarding all five axes as listed below:

I – Clinical Disorders; Other conditions that may be a focus of clinical attention
II – Personality Disorders; Mental Retardation
III – General Medical Conditions
IV – Psychosocial and Environmental Problems
V – Global Assessment of Functioning

Assessment of dangerousness
A baseline assessment of dangerousness should be performed and included in the client chart, including a history of suicidality and homicidality, as well as current suicidal and homicidal ideation or potential.

Current Medications
An assessment of current medications should be performed as part of the initial assessment.

Side Effects
An assessment of whether the client has experienced side effects from psychiatric medications should be conducted monthly, with statements concerning any side effects the client is experiencing, or that the client is not experiencing any side effects.

Past Psychiatric History
A baseline past psychiatric history should be performed, which includes the following elements: psychiatric treatment history, including past psychiatric hospitalizations and past psychiatric medications.

2. Psychosocial Assessment
A psychosocial assessment should be performed annually and included in the client chart that includes, at a minimum, the following elements:

• Family/Social Support (family status, including children/other relationships)
• Financial issues: (income/insurance/benefits)
• Educational background
• Occupational status
• History of physical or sexual abuse or neglect (including domestic violence)
• Housing status

3. Substance use assessment and treatment

Indicator 3a: Identification and assessment of substance use disorders

An assessment for substance use disorders should be performed annually that includes a history of substance abuse, identifying first, last and current substance use, as well as type, frequency and route of use. The following substance use disorders should be documented as having been assessed: alcohol, cocaine/crack and heroin.

Indicator 3b: Provision of care, or referral to appropriate care, for patients with co-morbid active substance use

Appropriate care should be provided to clients identified in the record as active substance users. This includes referral for treatment, with appointment specified, for substance use treatment, rehabilitation, detoxification or methadone maintenance, OR documentation of provision of substance abuse treatment on site.

If the client actively used substances within the last 6 months, clients should have either been in treatment or received referral to treatment.

If last use was prior to six months from the date of the review, but client had history of substance use within the last two years, relapse prevention or ongoing treatment should be discussed with the patient.

If appropriate care is not provided directly by the mental health clinician, clients may be referred for appropriate care for management of active substance use. Documentation that indicates the substance use treatment provider has seen the client should be included in the client chart.

4. Mental health treatment services

Eligibility: All clients

Mental health treatment services should include the following components:

• Initial treatment plan that addresses issues identified in the comprehensive mental health and psychosocial assessments.
• Quarterly treatment plan review – Documentation that the treatment plan was reviewed and/or updated on a quarterly basis will constitute sufficient documentation.
• Multidisciplinary care: psychiatrist, psychologist, social worker – Documentation can include progress notes, treatment plan notes, or case conference notes.

5. Coordination of care with client’s primary care provider (quarterly)

Eligibility: All clients

Coordination of care between the mental health provider and the primary care provider should be documented in the client’s mental health chart. Quarterly documentation in the form of a progress note is sufficient.

6. Program Services
The following program components should be offered as part of the continuum of mental health services provided.

• Case management
• Crisis intervention
• Individual psychotherapeutic counseling
• Psychotherapeutic group counseling (including family counseling, etc.)
• Support groups (including self-esteem, HIV and substance use, etc.)
• Grief/bereavement services
• HIV expertise as part of the team (medical or psychiatrist)

Evidence that program services are in place will include the following:

• Statement that they are being offered, PLUS
• Some supporting documentation in a select number of charts showing that at least some clients are receiving the service on site.

Primary Care Indicators
1. Access to Primary Care
Clients should have one visit with their primary care provider at least every six months.

• For clients who have not had a visit with their primary care provider in the first or last six months of the calendar year, there should be documentation of referral to primary care
• For patients with a referral to primary care, there should be documentation of follow up within 30 days to determine whether the primary care appointment was kept
• If documentation of follow up exists, there should be documentation that the client kept the appointment

2. Assessment of whether clients eligible for ARV Therapy are receiving it.
Clients will be reassessed for ARV status at least once every six months.

• For clients not on ARV, is there information on viral load or CD4 test results?
• If yes, is the patient eligible for therapy based on viral load (>100,000 copies) or CD4 count (< 350 cells)?
• If yes, is the patient referred to primary care for assessment of treatment eligibility?
• If yes, is there documentation of follow up on patient’s status within 30 days?
• If yes, was the patient placed on ART?

3. Viral load and CD4 Counts
Clients will have lab work completed to assess their viral load and CD4 counts at least once every six months.

• For clients who have not had a CD4 or viral load test performed in the first or last six months of the calendar year, is there documentation of referral to primary care for these tests?
• For patients with a referral to primary care, was there documentation of follow up within 30 days to determine whether the laboratory tests were performed?
• If documentation of follow up exists, is there documentation that the client received the viral load and/or CD4 tests?