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Indian Health Service The Federal Health Program for American Indians and Alaska Natives


     Indian Health Manual
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Part 3, Chapter 14:  Manual Appendix B

Program Review Indicators


  1. Emergency Services

    1. A written plan is to be established at each service unit or facility indicating resources to be utilized in providing emergency mental health services, contact persons, and means of contact including available telephone numbers.
    2. Selective training on the identification and handling of patients in psychiatric emergencies will be offered and provided to health care providers, social service providers, police and others.  Such topics as the identification of organic mental syndromes, techniques of crisis intervention, psychotropic medications used in emergency situations, and the handling of the violent patient may be included in such training programs.
    3. Mental health programs will have a written policy and procedure for the assessment and management of suicidal, homicidal, and other violent patients, including use of restraints.  Such policies will be consistent with other service unit or facility policies.
  2. Outpatient Services

    1. The program will provide or arrange for the full range of outpatient assessment, diagnostic services, treatment crisis prevention, and referral services. Diagnostic services shall include differential diagnosis of neurological, infectious, toxic, and other medical conditions that produce psychiatric symptoms.
    2. Service unit mental health program staff shall participate, when appropriate, in inter- and intra-agency meetings and case staffings in order to provide referral, continuity of care, liaison, and networking services for the client/patient.
    3. Mental health staff will be appropriately trained, credentialed or supervised for the services they are authorized to provide.
    4. Hours of service should be visibly posted and be related to the needs of the service population.  Provisions must be made for service delivery when a facility is closed.
  3. Inpatient Services

    1. The mental health program must provide or arrange for inpatient psychiatric services as indicated.  Each Area and service unit will maintain a resource directory of inpatient services available at the local, State and regional level, and develop a plan to access such services.
    2. Procedures will be developed and implemented for cases requiring written referral for mental health service.
    3. Each Area will have established priorities for inpatient hospitalization or residential treatment of adults and children.
    4. Mental health staff are required to keep track of cases in a referral facility in order to ensure continuity of care and adequate discharge planning.  A discharge summary should be requested from a referral facility and maintained in the patient file.  It is recommended that timely discharge summaries be required as a condition of payment when IHS is contracting for the services.
  4. Consultation/Liaison Services

    1. Mental health providers should participate in hospital/clinic activities and have input in the program and administrative planning of health services and treatment policies.
    2. Each mental health program will develop and maintain a local/regional resource directory.
  5. Forensic Services

    1. Each Area Office and service unit mental health program will have a policy and procedure describing the manner in which forensic services are provided.  A protocol advising steps for civil involuntary commitment is required.  Protocols for the care of abused and neglected children should be available as provided in the Maternal and Child Health Services manual issuances and in the Social Services Program manual issuance.  Protocols for custody and divorce hearings, legal incompetence, and criminal hearings are recommended.  Such policies and procedures will be based on tribal codes or applicable State and Federal law, and professional and ethical guidelines for mental health disciplines.
    2. An MOA with the courts and law enforcement agencies are recommended for the following issues:

      1. Making the patient available to Mental Health Program staff or outside experts.
      2. Transportation to the referral facility.
      3. Response of law and order staff in emergency situations.
      4. The IHS prior approval for payment where applicable.
  6. Auxiliary Services.  The mental health program will ensure that auxiliary services provided are relevant to the needs of the patients utilizing them, appropriately licensed, professionally staffed, and providing culturally sensitive services to referred patients.
  7. Health Promotion/Disease Prevention Services.  Each mental health program will develop a health promotion/disease prevention plan with objectives that are consistent with the overall IHS Health Promotion/Disease Prevention objectives.
  8. Case Management Services.  All mental health programs staff will actively work to coordinate services and resources with other IHS components and outside agencies.  In particular, mental health staff will participate in intra- and inter-agency case staffing activities intended to promote networking and to maximize utilization of available resources.
  9. Personnel

    1. Minimal staffing patterns should be based on the current IHS resource allocation methodology document.
    2. The mental health team should consider all mental health disciplines (mental health technician, psychiatrist, psychologist, psychiatric nurse, psychiatric social worker, other social scientists) in order to assure a comprehensive mental health program.  Needs and supporting resources can extend to outside consultants.
    3. Mental health programs should have on staff, or access to, the services of a child mental health specialist, consultant or similar personnel.
    4. To ensure delivery of optimal services, job descriptions will detail the skills represented or inherent in the health care provider.
    5. Standards of performance shall be based on the job description.
    6. Qualifications and demonstrated competencies should be consistent with those required by the Federal Service.
    7. All paraprofessional level mental health staff should function with adequate technical supervision by a mental health professional.
    8. Mental health providers shall establish liaison and provide consulting services to communities and agencies regarding the mental health needs of their clients.
    9. All metal health programs should develop materials and procedures to familiarize new employees about the specific functions and responsibilities of the individual mental health program.
    10. It is recommended that employee orientation should take place immediately or shortly after reporting to duty station.
    11. Mental health professional staff and consultants will be licensed in accordance with existing PHS Licensure Policy.
    12. Each Area mental health program shall establish policies and procedures for a privileging process for all staff providing clinical services.  These shall include:

      1. A process for delineation of privileges for all individuals who are permitted by law and by a facility to provide patient care services independently in a facility whether or not they are members of the medical staff.  The process for granting privileges should be based on verified information regarding the individual's licensure, specific training, experience, and current competence.


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