Exodus Recovery Psychiatric Urgent Care Center

0600-515.09 | Revision Date: 04/02/15

Overview

This policy guide provides instruction on how to refer DCFS youth who are a danger to themselves or others, or who are gravely mentally disabled to the Exodus Recovery Psychiatric Urgent Care Center.

TABLE OF CONTENTS

Policy

Exodus Recovery Psychiatric Urgent Care Center

Wraparound and Full Service Partnership Services

Services and Staff

Mental Health Crisis Stabilization Services

Eligibility for Services

Consent for Psychotropic Medications

Referrals to Exodus

Prohibited Items at Exodus

DCFS Exodus Duty Manager or APT SCSW

Expedited Joint Response Referrals

CSW Referrals

Stays at Exodus

Procedure

Referring a DCFS Youth to Exodus

Case-Carrying/ERCP/ER CSW Responsibilities

Case-Carrying/ERCP/ER SCSW Responsibilities

DCFS Exodus Duty Manager or APT SCSW Responsibilities

Responding to a DCFS Youth who Agrees to Enter Exodus

Case-Carrying/ERCP/ER CSW Responsibilities

Case-Carrying/ERCP/ER SCSW Responsibilities

DCFS Exodus Duty Manager or APT SCSW Responsibilities

Preparing for a DCFS Youth to Exit Exodus

Case-Carrying/ERCP/ER CSW Responsibilities

Case-Carrying/ERCP/ER SCSW Responsibilities

DCFS Exodus Duty Manager or APT SCSW Responsibilities

Responding to a DCFS Youth’s Request to Leave Exodus Prior to Scheduled Departure Time

Exodus Staff Responsibilities

Case-Carrying/ERCP/ER CSW Responsibilities

Case-Carrying/ERCP/ER SCSW and DCFS Exodus Duty Manager or APT SCSW Responsibilities

Approvals

Helpful Links

Attachments

Forms 

Referenced Policy Guides

Statutes

Version Summary

This policy guide was updated from the 07/01/14 version due to changes to the referral process. This policy update cancels the FYI 13-22.

POLICY

Exodus Recovery Psychiatric Urgent Care Center

The Exodus Recovery Psychiatric Urgent Care Center is an outpatient, urgent care center that provides individuals in crisis with voluntary crisis stabilization services for up to 23 hours. It also provides, on a walk-in basis, medication evaluation and management, hospitalization as needed, social services, referrals to community resources, and aftercare planning and transportation. See Exodus Recovery Locations for addresses and contact information to specific services.

Exodus is not a placement. Re-entry is only permitted once an individual has been newly referred and authorized by the Bureau of Clinical Resources and Services (BCRS) Division or Accelerated Placement Team (APT)The team is made up of former RUM (Resource Utilization Management) staff who have experience in finding placement for high risk/needs children. APT Specialist CSWs can assist Regional CSWs expedite the process in finding placement/replacement after hours and/or when all other efforts have been unsuccessful. SCSW. Exodus is a Lanterman-Petris Short Act (PLS) certified facility. It has the legal authority to place individuals who meet WIC 5150 or WIC 5585 criteria on a psychiatric hold while arrangements are made to transport him/her to an acute psychiatric hospital.

If Exodus finds that a youth requires inpatient, acute psychiatric hospitalization in situations where a youth appears to present a danger to him/herself or others or where a youth is gravely disabled as a result of a mental disorder, Exodus may place a 5585 (for children) or 5150 (for adults) hold on him/her.

• Exodus will coordinate the youth’s hospitalization with the Department of Mental Health’s ACCESSLos Angeles County Department of Mental Health's (DMH) 24 hour, 7 (seven) day a week hotline: Emergency psychiatric services are coordinated through ACCESS. ACCESS offers information regarding all types of mental health services available in Los Angeles County. CSWs may request a joint response with FRO by contacting ACCESS at (800) 854-7771. and DCFS.

• As appropriate, Exodus staff will notify the youth’s attorney and the court of the youth’s crisis stabilization/stay episode.

Wraparound and Full Service Partnership Services

WraparoundWraparound is a multi-agency initiative. The Wraparound approach is a family-centered, strengths-based, needs-driven planning and service delivery process. It advocates for family-professional partnership to ensure family voice, choice and ownership. Wraparound children and family teams benefits children by working with the family to ensure Permanency. Wraparound is funded through Title IV-E funds. The average length of involvement with the program is 8 months. The primary focus of the program is to keep children out of residential placements and maintain them safely in their family and community. (Wrap) services and Full Service Partnership (FSP) services are available to youth and families for crisis stabilization 24 hours a day. A youth’s Wrap or FSP agency should be in contact with Exodus to assist with crisis stabilization, mental health services, and/or medication support services prior to seeking services at Exodus.

Exodus should only be considered if the youth’s needs exceed Wrap or FSP agency’s capacity. In such a case, the youth’s CSW will contact the agency when DCFS is considering Exodus as a resource for the youth. If Exodus services are sought, the Wrap or FSP agency should support the youth and assist Exodus as needed.

Services and Staff

Exodus Recover Psychiatric Urgent Care Center services include the following:

• Intensive crisis stabilization services for up to 23 hours

• Intervention services for youth and families in a mental health crisis

• Urgent psychiatric services for youth in crisis

• Immediate assessment and connection to appropriate services for youth in a welcoming and attractive environment

• Treatment planning and assessment, including health care screening when appropriate

• Treatment for youth in an acute setting

• Aftercare planning that incorporates direct communication with the youth’s CSW.

• Medication services

Exodus psychiatrists and nurse practitioners prescribe medications to youth and provide medication management and education. Psychotropic medication is available on-site on an as-needed basis. It must be ordered, administered, and dispensed through the existing Dependency court authorization process. Youth will receive prescribed medication through designated DMH Prescription Authorization Tracking System (PATS) program pharmacies or other pharmacies in accordance with DMH policies and procedures.

Mental Health Crisis Stabilization Services

Mental health crisis stabilization services are provided to DCFS youth who have a condition that requires a more timely response than a regularly scheduled visit. Exodus can provide a maximum of 23 hours of crisis stabilization and assessment services. The maximum 23 hour period for a stay begins at the time of the youth’s entry.

The 23 hour stabilization period allows DCFS to do the following:

• Explore the child’s underlying needsA need is what drives a behavior and what makes a behavior functional for the person. The child and/or youth's needs should be the focus of the teaming process to ensure their safety and well-being. Recognizing the individual and family needs is central to the family-engagement and planning process., past placement successes, goals and perceptions regarding placement

• Team with parents/caregivers, clinicians, and other members of the child’s team

• Identify other potential relatives and nonrelative extended family members who could support the child’s stability and participate in the child’s team

• Formulate a placement plan to support the child’s needs

• Locate a new placement or to stabilize an existing one for a child, as needed

Initial mental and physical assessments are conducted to help formulate treatment planning, medication services, and aftercare planning. An individualized plan is developed by the youth’s clinical team based on his/her needs. This plan serves as a foundation for the youth’s ongoing mental health services and care.

Youth should not stay longer than 23 hours, and immediate action is required if they do. This is considered an emergency and requires the highest level of intervention. To avoid this situation, the Exodus Duty Manager or APT SCSW will check-in with Exodus and the CSW several hours prior to the end of the 23 hours period during business hours for each youth. The Exodus Duty Manager or APT SCSW will:

• Confirm that there are no barriers to the plan to transfer the youth to a placement.

• Oversee and assist the CSW to complete an expedited transfer for the youth to his/her placement within the 23 hour time frame.

Eligibility for Services

Youth who meet the following criteria may be referred to Exodus:

• Are twelve (12) years of age or older

• Have urgent mental health needs but do not require immediate hospitalization

A youth may be found eligible to receive services at Exodus if he/she:

• Will run out of medication and cannot access a psychiatrist in a timely manner

• Has mental health issues that may require crisis stabilization and does not have mental health services

• Is connected to services but needs more intensive stabilization than the Wraparound or Full Service Partnership team can offer

In most cases, youth must consent to enter, receive services, and/or stay at Exodus. Exodus staff will work with the CSW to obtain consent for access and treatment when the youth arrives. Youth may revoke their consent at any time. If a youth later withdraws his/her consent, DCFS must take immediate action to pick the youth up from Exodus within one (1) hour.

Consent for Psychotropic Medications

Youths under eighteen (18) years of age may not provide consent for the administration of their own medication.

When consent for emergency psychotropic medication is necessary, refer to the following table:

When consent for psychotropic medication is needed for non-emergency situations, refer to the following table:

Back to Policy

Referrals to Exodus

All referrals must go through the Bureau of Clinical Resources and Services (BCRS). Direct referrals by CSWs to Exodus are not permitted.

• During weekdays, referrals must be made through BCRS between 9 am - 6 pm

• On weekdays between 7 am - 9 am and 6 pm - 12:30 am and weekends and holidays, referrals must be made through the Accelerated Placement Team (APT)

BCRS and APT will serve as the single points of contact at these times. APT will coordinate after hours, weekends and holidays regarding potential access to Exodus. When a psychiatric hold (5150 or 5585) is being considered, Exodus and APT staff, when applicable, will make every effort to consult with the case-carrying CSW.

If the referral is accepted, the Exodus Duty Manager or APT SCSW will instruct CSWs to come to one of two sites:

• Marengo Site - Exodus Urgent Care Center at 1920 Marengo St. Los Angeles, CA 90033, (323)276-6400 (across the street from LAC+USC)

• MLK Site - Exodus Urgent Care Center at 12021 S. Wilmington Ave. Los Angeles, CA 90059, (562)295-4617 (on the grounds of Martin Luther King Jr./Charles Drew Medical Center)

Exodus cannot accept youth with existing medical conditions who arrive without their medication(s).

Prohibited Items at Exodus

In order to ensure a safe and therapeutic environment, youth who access Exodus Urgent Care Center will not be allowed to have the following items in their possession while at Exodus. These items will be returned when they leave.

• sharp objects - razors, scissors, nail files, knitting needles, glass bottles, mirrors, etc.

• matches, lighters and aerosol cans

• anything with cords (e.g., cell phone chargers, shoelaces, belts, etc.)

• recording equipment

• lethal weapons are sent to the security department

• any illicit drugs and alcoholic beverages are sent to security

• cell phones - Youth must turn in their cell phone during their stay at Exodus because use of cell phone cameras pose a risk to confidentiality. Upon request, staff will allow youth to access their cell phones in a private room

DCFS Exodus Duty Manager or APT SCSW

For the purpose of this policy guide, the DCFS Exodus Duty Manager or APT SCSW is considered either a BCRS staff member or an APT SCSW who is responding to an Exodus referral.

The DCFS Exodus Duty Manager or APT SCSW is primarily responsible for assisting in gaining access for DCFS-involved youth who are on new referrals and on open cases to Exodus. The DCFS Exodus Duty Manager or APT SCSW will be assigned when an Exodus referral is initiated. The Exodus Duty Manager or APT SCSW will transfer responsibility, as needed, at shift changes.

The DCFS Exodus Duty Manager or APT SCSW will also ensure that:

• CSWs and SCSWs have a clear expectation of Exodus’ services and limitations

• Exodus is well informed of the youth to whom they are providing services

Expedited Joint Response Referrals

DCFS, DMH, and Exodus have developed a protocol to coordinate information sharing, regarding DMH Psychiatric Mobile Response (PMRT) activities involving DCFS youth to provide them urgent care services for youth, as needed. A youth for whom an expedited referral is sought must be identified by either PMRT or DCFS and must be brought to Exodus at the initiation of PMRT or DCFS. See Response Times for Referrals for further information.

CSW Referrals

CSWs may initiate an Exodus referral for any DCFS involved youth, age twelve (12) or older, with urgent mental health needs. The youth must not require hospitalization.

DCFS involved youth (dependent or non-dependent) may enter Exodus only after approval from the BCRS. BCRS will ensure coordination of care and the transportation for the youth from Exodus before the 23 hour time limit.

Back to Policy  

Stays at Exodus

The progress and experience of each youth at Exodus will be monitored on a case specific basis. DCFS must maintain close contact with Exodus staff during a youth’s stay and must check-in with him/her to coordinate care and exit planning. DCFS may ask Exodus staff to work with a youth and his/her families on issues that include, but are not limited to, the following:

• Medication compliance

• Differential diagnosis

• Identification of the youth’s placement resources and desires

• Communication with parents

• With parents, education regarding treatment, medication, mental illness, and safety planning around mental health issues

Back to Policy  

PROCEDURE

Referring a DCFS Youth to Exodus

Case-Carrying/ERCP/ER CSW Responsibilities

1. Complete sections A and C of the DCFS 6017 Emergency Access & Placement Referral Form. No signatures are required for Exodus. Email the form, the most recent court report and the Psychiatric Medication Authorization (PMA) report to DCFS-Exodus@dcfs.lacounty.gov, the case-carrying SCSW, ARA, RA and the Deputy Director to initiate a referral.

2. Respond to any requests for additional information from the DCFS Exodus Duty Manager or APT SCSW.

3. To request access to Exodus for a youth on the day before a weekend or holiday, coordinate with APT for the youth to leave Exodus in a timely manner.

4. Upon receipt of the email providing formal notification of a youth’s acceptance to Exodus from the DCFS Exodus Duty Manager or APT SCSW, bring all of the youth’s medication to Exodus staff for dispensing.

1. Ensure that the youth is transported to Exodus and that the required paperwork accompanies the youth.

Back to Procedure

Case-Carrying/ERCP/ER SCSW Responsibilities

• Prior to referring a youth to Exodus, ensure that all other placement resources have been exhausted.

DCFS Exodus Duty Manager or APT SCSW Responsibilities

1. Receive requests for access to Exodus from BCRS or the APT SCSW and participate in consultations with CSWs to determine whether or not a youth would benefit from access to Exodus.

2. Forward the information to Exodus staff and attach all appropriate documents.

1. Briefly summarize the situation.

2. Ask if the youth may enter Exodus and, if so, which site (Marengo or MLK).

3. Review the DCFS 6017 form to ensure that the document includes the 24 hour contact information of the identified provider staff.

4. If an email response is not received from Exodus within fifteen (15) minutes, contact the Exodus staff person on duty by telephone.

3. Upon receipt of the email from Exodus formally accepting the youth for entry, notify all parties and reply to all.

1. Change the email subject line to: “[youth’s name] Exodus Access.”

2. Include everyone on the original email and all additional emails.

4. Send an “end-of-day” email notice to the next shift DCFS Exodus Duty Manager or APT SCSW.

1. Provide a summary of information regarding the status of all youth who have yet to leave Exodus and/or cases that have come to the attention of the Exodus Duty Manager for consultation or mental health follow up by the Coordinated Services Action Team (CSAT).

2. APT SCSWs email DCFS Exodus for all Exodus access and service requests for next shift Exodus Duty Manager only. No formal "end of day" is required.

Back to Procedure 

Responding to a DCFS Youth who Agrees to Enter Exodus

Case-Carrying/ERCP/ER CSW Responsibilities

1. Receive the update on the youth’s progress from Exodus on the morning following the youth’s entry to coordinate care.

2. Telephone the Exodus charge nurse as needed to coordinate care, treatment, and exit planning for a youth.

3. Maintain contact with Exodus and participate in care planning, and respond to all communication from Exodus regarding the youth.

Case-Carrying/ERCP/ER SCSW Responsibilities

• Ensure communication and cooperation with Exodus staff by the CSW.

DCFS Exodus Duty Manager or APT SCSW Responsibilities

1. Assist Exodus in obtaining information regarding the youth.

1. Contact the SCSW or the ARA if the SCSW is not available, on the case to alert him/her of Exodus’ need for contact by the CSW or SCSW.

2. Send a follow up email to the CSW and SCSW that gave clearance for the youth’s entry to Exodus and reply to all.

2. If there is a problem placing the youth, ensure that the APT Unit and Emergency Shelter Care (ESC) staff are actively involved in search efforts.

3. Ensure that all parties are communicating directly with each other.

4. Consult with the BCRS Division Chief or the CSAT Manager, when needed.

5. Respond to all calls from Exodus that request consultation about a youth who may not be under DCFS supervision. Upon request, determine if a youth is DCFS involved. Due to confidentiality, only share that a family has an active DCFS case and not information about a closed DCFS case.

Back to Procedure

Preparing for a DCFS Youth to Exit Exodus

Case-Carrying/ERCP/ER CSW Responsibilities

1. Ensure that the youth is picked up from Exodus within 23 hours of entry.

2. Show DCFS identification to the Exodus staff at the time the youth exits.

3. Pick up any medication brought in when the youth entered Exodus as well as any new medication issued while the youth was at Exodus.

4. Obtain a copy of the youth’s Exodus generated discharge aftercare summary and psychiatric assessment. File it in the youth’s case file.

5. Share the Exodus discharge aftercare plan and psychiatric assessment with the youth’s Wraparound team and/or mental health provider.

6. If the youth is not linked to a current mental health provider, make a referral through CSAT for DMH services and linkage.

7. Revise the youth’s Case Plan and planned services as needed in consultation with the youth’s team. Consider the following when making updates:

• The events that lead to the youth’s entry to Exodus

• The youth’s experience with Exodus

• The Exodus aftercare plan

Case-Carrying/ERCP/ER SCSW Responsibilities

• Ensure the youth’s stay at Exodus ends within 23 hours

DCFS Exodus Duty Manager or APT SCSW Responsibilities

1. If informed by Exodus that a youth’s departure may not occur on time or that a youth has already stayed over 23 hours, contact:

• The CSW or SCSW directly

• If neither are available, contact the ARA regarding the urgent need for the youth's discharge and contact by the CSW or SCSW

• The BCRS Division Chief or the CSAT Manager to support and assist

Back to Procedure

Responding to a DCFS Youth’s Request to Leave Exodus Prior to Scheduled Departure Time

Exodus Staff Responsibilities

1. When a youth states that he/she wants to leave Exodus, immediately arrange for the youth to talk with his/her case-carrying CSW, ERCP, or ER CSW.

2. If it is decided that the youth will leave Exodus and be picked up by DCFS, prepare the youth for departure.

Case-Carrying/ERCP/ER CSW Responsibilities

1. Upon notification from Exodus staff that a youth has stated he/she wishes to leave, immediately speak with the youth by telephone.

2. If the youth continues to state that he/she wishes to leave, make an arrangement for him/her to be picked up within one (1) hour.

3. For assistance in arranging pick up of the youth, discuss the situation with the case-carrying/ERCP/ER SCSW and contact the DCFS Exodus Duty Manager or APT SCSW.

4. Continue to make placement arrangements for the youth.

Case-Carrying/ERCP/ER SCSW and DCFS Exodus Duty Manager or APT SCSW Responsibilities

• Ensure that the youth is picked up from Exodus within one (1) hour.

Back to Procedure  

APPROVALS

DCFS Exodus Duty Manager or APT SCSW Approval

• Exodus referrals

HELPFUL LINKS

Attachments

Current Psychotropic Medication Authorizations (PMAs) attached to CWS/CMS Cases

Forms

CWS/CMS

Case Plan

Health and Education Passport

JV223/PMA

LA Kids

Exodus Information Sheet

DCFS 6017 Emergency Access & Placement Referral Form

Referenced Policy Guides

0050-503.15, Response Times to Referrals

0070-516.15, Screening and Assessing Children for Mental Health Services and Referring to the Coordinated Services Action Team (CSAT)

0300-506.05, Communication with Attorneys, County Counsel, and Non-DCFS Staff

0600-514.10, Psychotropic Medication: Authorization, Review, and Monitoring for DCFS Supervised Child

Statutes

California Rules of Court 5.640(g) – States, in part, that psychotropic medications may be administered without court authorization in an emergency situation.

Welfare and Institutions Code (WIC) Section 5150 – States, in part, when a person, as a result of a mental disorder, is a danger to others or to himself/herself, or gravely disabled, a peace officer, member of the attending staff of a county designated evaluation facility, mobile crisis team , or other county designated professional person may, upon probable cause, take, or cause to be taken, the person into custody or place him/her in a facility designated by the county and approved by the state Department of Mental Healthy as a facility for 72-hours treatment and evaluation.

WIC Section 5585 – Details the Children’s Civic Commitment and Mental Health Treatment Act of 1988.

Back to Helpful Links