N.J. Admin. Code § 10:31-2.3

Current through Register Vol. 56, No. 21, November 4, 2024

Section 10:31-2.3 - Screening process and procedures

(a) In accordance with N.J.S.A. 30:4-27.5.a, upon entry of a consumer to the screening service, staff at the screening service may detain the consumer for up to 24 hours from entry for the purpose of providing emergency and consensual treatment, medical clearance and conducting an assessment.

(b) The screening service or affiliated emergency service shall provide a thorough assessment of the consumer and his or her current situation to determine the meaning and implication of the presenting problem(s) and the nature and extent of efforts that have already been made.

1. The screening service or affiliated emergency service, consistent with State and Federal laws regarding patient confidentiality, shall contact the consumer's family, spouse, civil union partner or significant others and current or previous service providers to determine what the clinical needs of the consumer are and what services are in the best interest of the consumer.

2. The screening service or affiliated emergency service staff shall consult with each adult consumer, significant others as permitted by law, and the Division Registry established pursuant to N.J.A.C. 10:32-2.1, to determine whether the consumer has executed an advance directive for mental health care, has a guardian, or has executed a durable power of attorney, and shall take no action that conflicts with those documents, insofar as they exist and compliance is required by law.

3. The screening service or affiliated emergency service procedures shall require recording of pertinent consumer information, where available, including, but not limited to:

i. Basic identifying data as it relates to the presenting crisis;

ii. The history and nature of the presenting problem;

iii. The psychiatric and social history;

iv. The medical history, including current medical status problems, allergies and current medication;

v. The mental status and level of functioning;

vi. Any drug and alcohol use and history;

vii. Any indication of dangerousness;

viii. Exploration of available resources and natural support system;

ix. Preliminary diagnosis; and

x. Whether or not the consumer has executed an Advance Directive for Mental Health Care.

(c) All stabilization options shall be fully explored before involuntary commitment is considered. Such options shall include, but shall not be limited to:

1. Use of natural support system;

2. Referral and linkage to community resources;

3. Crisis intervention counseling;

4. Outpatient services for medication monitoring and follow-up;

5. Adult acute partial hospital, partial hospital, or partial care services;

6. Acute in-home services;

7. Extended crisis evaluation bed with medication monitoring;

8. Crisis housing;

9. Referral to other 24-hour treatment facility;

10. Admission on a voluntary basis to a psychiatric unit of a general hospital; and

11. Voluntary admission.

(d) After exploring the appropriateness of, and exhausting all options listed in (c) above, the screener shall ascertain whether the consumer is in need of involuntary commitment to treatment. In making thi

1. Has a mental illness;

2. Is dangerous to his or her self, others or property because of mental illness; and

3. Understands the nature of the recommended treatment and is unwilling to voluntarily accept appropriate, available outpatient treatment or inpatient care at an STCF, psychiatric facility, or special psychiatric hospital after it has been offered.

(e) If the screener determines that the individual is in need of involuntary commitment to treatment under the standard referenced in this section, the screener shall fully complete, within 24 hours of the individual's presentation for screening services, all sections of the screening document found at N.J.A.C. 10:31 Appendix A, incorporated herein by reference, after exhausting all reasonable efforts to stabilize the individual or divert him or her to less restrictive care. Through the screening document, the screener shall certify that the individual is in need of commitment.

1. The screener shall also complete the relevant sections of the screening document if the screener determines that the individual meets the criteria for a consensual admission.

(f) After fully completing the screening document, the screener shall contact the

1. The screening psychiatrist shall review the screening document and consult with the screener.

2. The screening psychiatrist shall conduct and document a thorough psychiatric evaluation of the consumer.

i. The psychiatric evaluation may be accomplished through technologically assisted means, also known as "telepsychiatry," when the conditions set forth at (i) below are met.

3. If the psychiatrist determines that the consumer is in need of involuntary commitment, the psychiatrist shall complete all applicable sections of the screening certificate (on the form approved by the Administrative Office of the Courts, designated a "screening/clinical certificate," and also known as the "physician's certificate").

i. The screening certificate shall be completed by the screening psychiatrist, except in those circumstances where the Division's contract with the screening service provides that another physician may conduct the assessment and complete the certificate.

ii. Where the consumer is dangerous by reason of a mental illness, but is willing and able to consent to treatment, the screening certificate should not be completed. Instead, the psychiatrist shall document those findings in the consumer's medical record and recommend that the consumer be admitted voluntarily to treatment. That documentation will become part of the referral packet for admission to the short-term care facility.

4. Upon the psychiatrist's determination that the consumer is in need of involuntary commitment to treatment and completion of the applicable sections of the screening certificate, screening service staff, in consultation with the psychiatrist or another physician, as appropriate, shall determine the least restrictive environment for the appropriate treatment to which the person shall be assigned or admitted, taking into account the person's prior history of hospitalization and treatment and the person's current mental health condition. Screening service staff shall designate:

i. Inpatient treatment, if the consumer is immediately or imminently dangerous or if outpatient treatment is deemed inadequate to render the person unlikely to be dangerous to self, others, or property within the reasonably foreseeable future; or

ii. Outpatient treatment, when outpatient treatment is deemed sufficient to render the consumer unlikely to be dangerous to self, others, or property within the reasonably foreseeable future.

5. Upon determination of the designation in (f)4 above, the remainder of the screening certificate shall be completed.

(g) In accordance with N.J.S.A. 30:4-27.9.c, within 72 hours of the psychiatrist's completion of the screening certificate, the following events must occur:

1. The consumer must be admitted to a designated outpatient treatment provider, a short-term care facility, psychiatric facility, or special psychiatric hospital;

2. A psychiatrist on staff at the designated outpatient treatment provider or the admitting facility must complete the clinical certificate; and

3. Staff at the designated outpatient treatment provider or the admitting facility must commence court proceedings for involuntary commitment by filing with the court both the screening certificate (completed by the screening psychiatrist) and the clinical certificate (completed by the treating psychiatrist on staff at the admitting facility).

(h) The screening psychiatrist completing the assessment delineated in (f) above shall not be the consumer's treating psychiatrist.

1. The screening service's policies and procedures shall specify that the psychiatrist who assesses the consumer in the screening service and who completes the screening certificate shall not be the psychiatrist who treats the consumer in the STCF, psychiatric facility, special psychiatric hospital, or designated outpatient treatment provider and who completes the clinical certificate, unless, and only after, reasonable but unsuccessful attempts were made to have another psychiatrist conduct the assessment and execute the certificate.

i. The screening service policies and procedures shall stipulate that the "reasonable attempts" referred to in (h)1 above shall include, but not be limited to, reassignment, scheduling changes, or any other mechanism that may result in another psychiatrist treating the patient in the STCF, psychiatric facility, special psychiatric hospital, or designated outpatient treatment provider.

ii. The screening service policies and procedures shall require the documentation in the consumer's medical record of all reasonable but unsuccessful attempts made to avoid the same psychiatrist completing both the screening and clinical certificates.

(i) The psychiatric assessment may be completed through use of telepsychiatry, provided that the screening service has a Division-approved plan setting forth its policies and procedures for providing a psychiatric assessment via telepsychiatry that meets the following criteria:

1. The consumer shall be afforded, in all instances, the opportunity to have a face-to-face assessment with a psychiatrist rather than a telepsychiatric assessment, unless clinical circumstances require a more timely assessment;

2. Telepsychiatry shall not be used where it is clinically contraindicated;

3. Screening staff shall obtain and document the consumer's valid consent to being assessed through the means of telepsychiatry;

4. A screener or registered nurse shall be with or available to the consumer at all times during the telepsychiatric assessment;

5. Pursuant to State and Federal laws, confidentiality shall be preserved by both electronic safeguards and through the training of on-site and off-site staff;

6. The psychiatrists involved in telepsychiatry may be employed as staff of the screening service or may be under contract with the screening service. A screening service that contracts for telepsychiatry shall still be required to hire credentialed psychiatrists to perform any other duties or services required by this chapter;

7. The psychiatrist performing the telepsychiatric assessment shall hold a full, unrestricted medical license in New Jersey;

8. The psychiatrist performing the telepsychiatric assessment shall be capable of performing all the duties that an on-site psychiatrist can perform, including prescribing medication, monitoring restraints, and other related interventions that require a physician's orders or oversight;

9. As appropriate, the screening service shall ensure that the telepsychiatrist performing the assessment maintains privileges with the general hospital affiliated with the screening service, and is actively and routinely involved in the quality improvement process of the screening service;

10. The psychiatrist performing the telepsychiatric assessment shall be considered an active part of the treatment team and shall be available for discussion of the case with facility staff, or for interviewing family members and others, as the case may require;

11. The technology used in the telepsychiatric assessment shall be consistent with the current technological state of the art acknowledged in the profession; and

12. The psychiatrist performing the telepsychiatric assessment shall receive training based on a Division-supplied curriculum that will address the New Jersey commitment standards and the local mental health system of care including, but not limited to, information about all least restrictive community treatment settings.

(j) If the assessment reveals that a consumer is not in need of involuntary commitment, the screening service shall refer the consumer to the least restrictive, appropriate treatment or social service agency(s).

(k) After the screening psychiatrist has completed the screening certificate, the screener shall:

1. Determine the appropriate facility in which the consumer shall be placed taking into account the consumer's prior history of hospitalization and treatment and the least restrictive level of care that is locally available.

i. If a consumer has been admitted three times or has been an inpatient for 60 days at a short-term care facility during the preceding 12 months, consideration shall be given to not placing the consumer in a short-term care facility.

ii. The consumer shall be admitted to the appropriate facility as soon as possible;

2. Arrange for the transport of the consumer to the receiving facility; and

3. Ensure compliance with the medical clearance requirements of the accepting facility for the transfer.

(l) Screening staff shall ensure that the screening process is documented in the clinical record.

1. Clinical decision-making and rationale for decisions must be clearly delineated in documentation included in the clinical record.

2. Copies of the screening document and screening certificate shall be maintained in consumers' charts.

(m) Screening staff shall maintain, review and update annually written policies and procedures concerning the screening process. Specifically, these policies and procedures must be located in a manual and must:

1. Clearly describe the procedures and contain those individuals authorized to complete screening documents;

2. Delineate individual responsibilities and authority of the members of the screening team, including a process that addresses conflict resolution between screeners and psychiatrists; and

3. Include copies of all forms used in the commitment process.

(n) Each screening service shall have the capability to provide mobile screening outreach in the community, 24 hours per day. Outreach teams shall be utilized, when it is appropriate to do so after an evaluation of clinical and safety considerations. Such outreach shall take place whenever clinically relevant information indicates that a person may be mentally ill and a danger to himself, herself or others, and is unwilling and/or unable to come to the screening service for evaluation. The mobile team shall determine priority. Screening outreach shall take place wherever the consumer is located, whether in a private home, hospital, boarding home or other location. Police shall be requested to accompany the mobile team when necessary. The outreach screener shall provide appropriate intervention, referral and linkage following a face-to-face assessment whether or not the consumer is found to meet the commitment standard.

(o) The screening of consumers seen in an AES may be accomplished in any of the following ways, in accordance with affiliation agreements developed between the screening service and the AES, based upon the best interest of the consumer, and with the goal of avoiding the transportation of the consumer, except where necessary for treatment purposes:

1. Outreach by a screener to the AES: If this option is utilized, the screener shall be available within the timeframe stipulated in the affiliation agreement to provide the outreach. There shall be sufficient staff and space at the AES to care for the consumer until the screener arrives.

2. By a screener stationed in the AES: If AES utilization justifies this option, a screener, employed by the designated screening service and credentialed by the host AES, shall be stationed at the AES during peak hours.

3. By transportation of a consumer to the screening service: This option shall be utilized only after a telephone consultation with the screening service confirms that there is reason to believe that the consumer may meet the criteria for commitment and the screening center has given approval for the transfer. If this option is utilized, alternative treatment planning shall occur at the screening service if the consumer does not require commitment; that is, the consumer shall not be transferred back to the AES for such alternative treatment planning. During the telephone consultation, if there is a disagreement about disposition, a face-to-face evaluation by the screener shall take place prior to transport.

4. In the case of (m)1 and 2 above, if the screener has seen the consumer, explored all options and involuntary commitment is needed, the screener shall fill out the screening document and the consumer may be seen by the AES psychiatrist for assessment and, if necessary, the completion of a screening certificate, prior to admission to an inpatient service. The AES psychiatrist who completes the screening certificate shall not be the consumer's treating psychiatrist, unless the procedures described in 10:31-2.3(g) are followed.

i. If the consumer is in an inpatient unit at the hospital, the screening certificate cannot be completed by the consumer's treating psychiatrist.

ii. This process must be delineated in a Division approved affiliation agreement between the AES and the screening service.

N.J. Admin. Code § 10:31-2.3

Amended by 50 N.J.R. 537(a), effective 1/16/2018