Resolution Policy: Clinical
In the past, clinicians have worked in relative isolation. The new system of care requires frequent communication and integration of services across settings and disciplines. It may be that this new model will bring to light differences in theoretical orientation, experiences, and training. LCCN clinicians will make every effort to convey respect for one another and one another’s divergent clinical perspectives. All personnel will convey this both to one another and to families in our community. If clinicians should have marked disagreement with regard to the direction of treatment, they will come together as a team, without the family members present, and reach a consensus regarding 2-3 possible alternatives. These options will subsequently be presented to the family with a clear description of the merits of each alternative. Both parties will agree to fully support the family’s decision about the course of treatment which best fits their situation.
Resolution Policy: Administrative
LCCN administrators have a long history of working together to reach consensus around serving the children of the county. Members of the Executive Council have demonstrated great respect for one another’s contributions and continue to express a common set of values which guide decisions. When conflicts arise, they consider 1) what will best serve the needs of children, 2) what will best serve the overall system, 3) what will best serve the personnel at their respective institutions, and 4) what will best serve the administrative needs of their respective institutions. Having never encountered a situation where these values have not ultimately led to a consensus, it is difficult to articulate, in the abstract, steps that would be utilized to resolve conflicts. Nonetheless, the Executive Council has proposed to take the following actions in the event an impasse is reached:
1) Each party articulates his/her position in writing and shares it with the members of the Executive Council.
2) Members of the Executive Council seek consultation from the literature and their professional organizations regarding accepted practice in similar situations.
3) If after a discussion of the additional information a consensus cannot be reached, a simple majority vote will determine the outcome.
4) All parties agree to fully support the decision of the Executive Council.
The Executive Council convenes in late November, early April and late June of each year to review data presented by the Tier I, II, III, & IV Liaisons. Formative assessments provide feedback on the fidelity with which LCCN protocols are being utilized across settings, and outcome data provide evidence of the effectiveness of the interventions. Modifications are considered as protocols are fine-tuned over time. When programs are being conducted according to expectations, both administrators and clinicians receive positive feedback in the form of verbal, written, and tangible appreciation. In addition, when data indicates that one or more of the institutions are not fulfilling the obligations outlined in their Memoranda of Understanding, Executive Council members hold one another accountable and generate strategies for remedying the situation prior to the next data review session.
When possible, administrators recruit from within for key LCCN positions, reassigning personnel based on their skills and interests. LCCN entities participate in pre-service training arrangements with local institutions of higher education and this serves as the primary avenue for securing employees with skills that are a good match for LCCN positions. All LCCN positions, with the exception of the Directorship, will be under the administrative umbrella of an LCCN entity, thus, all relevant personnel policies of the employing agency will apply for compensation, remediation, and termination. Administrators will solicit feedback forms from all LCCN entities within which the employee is engaged and the data gathered will be part of the annual evaluation. If staff under-performance compromises the LCCN entity’s ability to fulfill responsibilities, the Executive Council will assist the administrator in resolving the matter. With regard to the Director’s performance, co-chairs of the Executive Council will collect and compile feedback on an annual basis and suggest course adjustments as needed.
Confidentiality & Privacy Reminders
Except as required by law, providers refrain from sharing information with one another without a current, signed exchange of information form documenting the parent/guardian’s consent. Clinicians use considerable professional judgment when determining bounds of a child’s confidentiality with parents and other adults significant in the child’s life and discuss limits to confidentiality with both the client and parent/guardian as a part of informed consent for treatment. These limits of confidentiality, at a minimum, include when children are at risk of harming themselves or others or when children are at risk of being harmed.
All services will be documented in writing. Client records must be maintained in a secure medium consistent with the sector’s privacy regulations. For example, a locked file cabinet in a locked room for paper records or a protected data base on a secure server for electronic data. Removing records from the premises is highly discouraged. However, when these documents are necessary for reference at meetings, confidentiality should be maintained with the utmost care. If documents are transported in electronic format, they should be on password protected flashdrives.
While children 12 and older can provide release of records under the Illinois Mental Health Code, educational (FERPA) and medical (HIPAA) regulations require parent/guardian consent for children under the age of 18. Thus, there could arise a situation where one provider can release information to another while reciprocal communication is not allowed. Similarly, while under Illinois Mental Health Code, minors are allowed up to five sessions without parent/guardian consent to treat, it is customary to involve parents whenever possible. While it is legal to provide services to a minor with consent from one parent, best practice encourages the involvement of the other parent except under special circumstances (e.g., there is a court order against it, in some cases of domestic violence or when parental rights have been terminated). In addition, unless parental rights are terminated, a parent continues to have legal right to mental health records of offspring regardless of custody arrangements.
When consulting around “hypothetical scenarios,” providers refrain from including any identifying information about clients that could inadvertently result in the identification of the client, thus breeching the clients’ right to privacy.
Electronic communication regarding clients must be done with caution. Identifying information (including names or initials) should be in password protected attachments only and not in the text of an e-mail. Passwords should be developed verbally in advance and not included in the e-mail. Faxes should contain a notice of confidentiality on the cover sheet and best practice would include a confirmatory fax from the receiver.
E-mail communication with consumers is highly discouraged and should be limited to scheduling purposes only. Messages should not be left on consumer voice mail without advance permission.
Serving Clients from Out-of-County
Children in schools and doctor’s offices who fall within the LCSSU catchment area will receive all services available to children in those settings regardless of their county of residence. Children who require services funded by county dollars may need to be redirected to services available in their home county. For example, IHR is able to serve any child out of county that has a Medicaid card or insurance. They can also serve out of county SASS clients as long as there is a formal transfer from the out of county SASS provider. IHR will be unable, however, to provide therapy or crisis intervention to any non-insurance or non-Medicaid out of County students. Any out of County student with no third-party payor will be referred to their own County for services.