1. (a) The Family Service Worker will:

   1. (1) Make a referral to the CMHC when a child needs mental health services (including any twenty-four-hour services);
   2. (2) In the case of an emergency, contact the CMHC immediately for an assessment; and
   3. (3) If the CMHC assessment indicates that the child needs acute psychiatric services, contact the county supervisor, or designee.

2. (b) The County Supervisor or designee will:

   1. (1) Contact the Administrator On-Call at 501-538-7960 to obtain prior approval before a child is placed;

   2. (2)

      1. (A)

3. (i) Provide the Administrator On-Call with the information listed below.

   1. (ii) The information may be conveyed by telephone but is also required via email the following business day.

      1. (B)

         1. (i) An assessment by a licensed mental health professional from the local CMHC that recommends acute psychiatric services as the least restrictive level of care that can meet the child’s needs.
         2. (ii) This recommendation should include a preliminary mental health diagnosis.
         3. (iii) If child is in a therapeutic foster home, a licensed mental health professional employed by the TFC provider may perform the mental health assessment and provide recommendation for acute inpatient services.
      2. (C) Description of current behavior, emotional condition, and any precipitating events that could have contributed to the current condition of the child.
      3. (D) Current medications and purpose for the prescriptions.
      4. (E) Information about current placement and reasons the child cannot remain in that placement.
      5. (F) Reason that outpatient evaluation, crisis intervention services, and community supports cannot meet the current needs.
      6. (G) History of mental health services provided for the child and his or her family, including both outpatient and inpatient.
      7. (H) Any other information deemed helpful in determining a disposition on the level of services needed; and

   2. (3) Inform the Area Director of the administrative case consultation and disposition within twenty-four (24) hours.

      1. (c) If the Family Service Worker is approved to make a referral, he or she will:
   3. (1) Provide comprehensive and accurate information about the child during the assessment and admission phase to the acute psychiatric treatment program;

   4. (2)

      1. (A) Attend the first appointment with the child to sign consents and facilitate treatment and treatment planning.
      2. (B) Whenever possible, expedite access to appropriate documents from previous treatment to reduce delay in the authorization of services by the Division of Medical Services;

   5. (3)

      1. (A) Ensure that the adults with the most complete information about the child will accompany the child to the assessment.
      2. (B) This may mean the FSW, foster parents, or legal/biological parents, as appropriate;
   6. (4) Update the treatment team on changes of custody status and/or discharge plans;
   7. (5) Take timely action to ensure the continuity of the PCP’s referral;

   8. (6) Once the child has been admitted to an acute psychiatric treatment program, collaborate with the facility in the development of the plan-of-care:

      1. (A) Establish a schedule regarding dates for treatment sessions with the inpatient acute treatment provider;

      2. (B)

         1. (i) Remain engaged in the treatment process and determine with the therapist at the beginning of treatment the degree and methods of engagement (phone, conversation, written reports, and conferences).
         2. (ii) At a minimum, the FSW must maintain weekly phone contact with the child;
      3. (C) Ensure discharge planning begins at the time of admission and continue involvement in that planning;
      4. (D) Ensure contact between the child and the appropriate adults; and
      5. (E) Determine in coordination with the therapist, which adults, if any, need to accompany the child to treatment and/or be involved in the child’s treatment, including family therapy sessions;
   9. (7) Attend each appointment scheduled with a psychiatrist or physician;
   10. (8) Review and sign all master treatment plans and updates;

   11. (9) Obtain a copy of the child’s records including:

       1. (A) Assessments;
       2. (B) Treatment plans;
       3. (C) Updates; and
       4. (D) Discharge plan;

   12. (10)

       1. (A) Make contact with the child’s clinical treatment team three to five (3-5) times per week.

       2. (B) This includes the primary therapist, case manager, and/or any other person on the clinical treatment team, in order to obtain information related to:

          1. (i) The child’s progress;
          2. (ii) Medications management and changes;
          3. (iii) Recommendations for discharge planning; and
          4. (iv) Other information that pertains to the child’s treatment; and

   13. (11) Coordinate after care plans from the acute psychiatric treatment program:

       1. (A) Facilitate a timely discharge by identifying specific placement plans as early as possible to promote a positive transition from one level of care to another;
       2. (B) Coordinate with the CMHC or other contracted outpatient provider before, during, and immediately following discharge from an acute psychiatric treatment program;
       3. (C) When appropriate, participate in a CASSP staffing to complete a MAPS plan;
       4. (D) When appropriate, participate in a system of care (SOC) team meeting to complete a wraparound plan;
       5. (E) Obtain an outpatient appointment within seven (7) working days following discharge from an inpatient facility;
       6. (F) Obtain a PCP referral to an outpatient provider if needed; and

       7. (G)

          1. (i) Ensure compliance with all scheduled outpatient appointments.
          2. (ii) When necessary, cancel appointments at least twenty-four (24) hours in advance, except in genuine emergency situations such as illness, and reschedule as soon as possible.
          3. (d)
   14. (1) If the FSW is not approved to make a referral, a temporary crisis plan will be implemented by the FSW and County Supervisor or designee in collaboration with the Administrator On-Call.
   15. (2) The crisis plan will involve other interested parties, such as foster parents, legal/biological parents, the CMHC, and any others involved in the care of the child.
   16. (3) The crisis plan will be documented within twenty-four (24) hours and communicated to all involved parties.
   17. (4) Parts of the crisis plan may be incorporated into the child’s case plan as necessary.

   18. (5) The crisis plan may include, but is not limited to, the following services and supports:

       1. (A) Twenty-four-hour respite;
       2. (B) No-harm contract with the child;
       3. (C) Increased frequency of mental health services;
       4. (D) Medication changes;
       5. (E) Local phone numbers for emergency response to escalating behavior;
       6. (F) Behavioral interventions appropriate for the child’s diagnosis and symptoms; and
       7. (G) Safety plan.

4. (e)

   1. (1) If the FSW, county supervisor, or foster parent feel that the child poses an immediate threat to himself or herself or others, the child should be taken to the nearest emergency room for evaluation by a physician and a request should be made for an immediate assessment by the local CMHC for information that the Division of Children and Family Services can use to determine the most appropriate placement.
   2. (2) The administrative case consultation is still required if the child is to be referred to an inpatient facility.

5. (f) The Division of Children and Family Services can expect that the CMHC will:

   1. (1) Evaluate within two (2) hours any client who has a psychiatric crisis or an outpatient mental health emergency (see 9 CAR § 40-102, definitions, for definitions) and offer triage/assessment by a mental health professional to the level deemed appropriate;
   2. (2) Assist the Division of Children and Family Services in making appropriate referrals to other facilities if the CMHC does not have the specialized services required for the child;
   3. (3) Assist in securing appropriate mental health services in the Division of Children and Family Services area;
   4. (4) Assign a mental health clinician to coordinate mental health treatment for the child, including but not limited to coordination with other agencies, convening staffings, or assisting with the location of a twenty-four-hour mental health placement;
   5. (5) Work with the Division of Children and Family Services to ensure that mental health services complement case planning, management, and the wraparound plan and/or MAPS plan; and
   6. (6) Share information about past treatment and coordinate treatment services/discharge plans with inpatient/residential provider, providing the appropriate consent forms have been signed.
6. (g) The Division of Children and Family Services retains ultimate case planning and management responsibility for placement and permanency issues.

Codification Notes: This section as promulgated prior to codification into the Code of Arkansas Rules provided as follows: "11/2011"