Current through Register Vol. 56, No. 18, September 16, 2024
(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.
