Guidance on Psychiatric Evaluation and Discharge Practices

KATHY HOC HU L Gov er nor Cor nin g Tow er, E mpire S tat e Plaz a, Albany, N Y 1223 7 | health.ny.gov 44 Holland Av e nu e, A lban y N Y 12229 | omh.n y.gov F eb r ua ry 1 1, 20 26 Dea r Collea gue s, P lea se f ind a tta ched u pd a te d jo int g uid a nce f r om the New Yor k Sta te Of f ice of M e nta l Hea lth (OM H) a n d Ne w Y or k S ta te Dep a r t m e nt of Hea lth (DOH) r eg a r d ing eva lua tion a nd discha rg e pr a ct ices f or individu a ls who p r ese nt with b eh a vior a l hea lth co nd itions withi n p sychia t r ic inpa tient pr o gr a m s, E m er ge ncy Depa rt m e nt s (ED s), a nd Com pr eh en sive Psychia tr ic Em er g en cy Pro gr a m s (CP EP s). T his u pd a te is a lign ed with r e cen t ch a n ge s to 10 NY CRR P a r t 4 05, M en ta l Hygiene La w S ectio ns 9.6 4 a n d 2 9. 15, a nd 14 NY CRR P a r ts 5 80, 5 82, a nd 5 90. We th a n k you f or yo ur f ee db a ck in up da ting th ese r eg ula t ions a n d f o r you r con tinu ed se r vice to th e pe op le o f New York Sta t e. Si nce r ely, A n n M a rie T. Sulli va n, M.D. Ja m es V. M cDo na ld, M. D., M.P.H. Com m ission er Com m ission er NY S O f f ice o f M en ta l He a lth NY S Dep a r t m e nt of Hea lth

KATHY HOC HU L Gov er nor Cor nin g Tow er, E mpire S tat e Plaz a, Albany, N Y 1223 7 | health.ny.gov 44 Holland Av e nu e, A lban y N Y 12229 | omh.n y.gov Gu id a n c e o n Evalu at io n an d Dis ch arge Pr a ct ic e s f o r E m erge n cy Dep a r t m en t s (ED), Co m p r eh e n s ive P s y ch iat ric Em er g en cy P r o g ram s (CPE P s), an d Ar tic le 2 8 a n d Pr iva t e Artic le 31 Psy c h iat ric In p at ie n t Pr og r ams F eb rua r y 20 26 (S u pe rse de s Oct ob er 2 02 3 ver sion) T he g oa l o f this d ocu m e nt is to of f e r gu id a n ce to h osp ita l -b a se d p r o g r a m s re ga rd ing eva lua tio n a n d discha rg e pla n nin g f or individu a ls who p r ese nt with b eh a vior a l hea lth co nd itions. T h is up da te r ef lects n ew p ro vision s in M e nta l Hygiene L a w (M HL) § §9.6 4 a nd 29.15, 1 0 NYC RR P a r t 40 5. 19, a n d 1 4 NY CRR Pa r ts 5 80, 5 82, a nd 59 0. T his g uid a n ce is n ot a p plica b le to a ll p r ovide r s or in a ll u nits. A pp lica bility is m a de clea r in e a ch sectio n o f th e g uid a n ce t o t he f ollowing ca te go r ies o f pr ovid er s a nd un its: 1. E M ER GENC Y DE P A RT M E NT S: A ll E m er ge ncy De pa rtm en ts in ho sp ita ls r eg ula t ed un d er A r ticle 2 8 of th e Pub lic Hea lth La w 2. 9.3 9 HOS PIT A L E M ER GENC Y DE P A RT M E NT S: §9.39 h osp ita ls a r e g en er a l h osp ita ls r eg ula te d un de r Article 2 8 of th e P ub lic Hea lth L a w an d ha ve a t lea st on e inpa tien t psych ia tr ic un it licen sed un de r Article 31 of th e M en ta l Hyg iene L a w 3. COM P RE HE NS IVE PS Y CHIA T RIC E M ER GENC Y P ROGRA M (CP E P): Specia li zed psych ia tr ic em er g en cy pr o gr a m licen sed un de r Art icle 31 of th e M e nta l Hygiene L a w a n d 1 4 New York Code o f Rules a nd Regu la tion s (NYC RR) Pa r t 5 90. 4. INP ATIENT P SY CH IAT RIC UNITS: Al l psych ia tr ic u nits licen sed u nd er Art icle 31 o f th e M en ta l Hyg iene L a w a n d 14 NY CRR P a r ts 5 8 0 a nd 58 2. 5. A L L PROGRA M S: All E m e r ge ncy De pa rtm en ts, CP E PS, a n d Inp a t ient Psychia tr ic Units T his g uid a n ce d et a ils the e va lua tion s th a t sho uld be com ple ted a t ea ch p a tie nt en cou nt er, a s well a s t he inte r ven tion s th a t will im pr o ve p a t ient ou tco m e s; r e du ce t he r isk of o ver d ose, self - ha rm, a nd violen ce; a nd r ed uce th e r isk o f re a d m ission a n d disconn e ctio n f r o m ca r e. T he se sta nd a r d s a r e n ot inte nd ed to r ep la ce clinica l jud gm en t, b ut r a t he r to he lp e nsu r e t ha t clinica l sta f f r ou tine ly ga the r a n d co nsid er a ll p ossib le inf or m a tio n wh en m a king dispo sition a n d tr ea tm e n t d ecision s. Rea d er s a re e nco ur a ged to sta rt with t he T a ble o f Cont en ts to ide nt if y which se ction s o f this gu ida n ce a r e a p plica b le to th eir p r og ra m. Section s f or “ ALL PROGRA M S” a r e a p plica b le t o em er g en cy de pa rt m e nt s (ED s), co m p r eh en sive p sychia tric e m er ge ncy pr og r a m s (CPE P s), a nd psych ia tr ic inp a tie nt pr o gr a m s. T h is gu ida nce do es n ot a p ply t o O M H -o pe r a te d P sychia tric Cent er s, which m ust a d he r e t o a dd itiona l policies, pr oce d ur es, a n d dir ect ives. T he r e a re co m p lica ted syste m ic, lega l, a nd r eg ula tor y issue s th a t im p a ct the a bility of ho spita l sta f f to coo r dina te a nd co lla bo ra te with co llea gu e s in r e siden tia l, ou tpa tient, a nd ca r e m a na gem en t pr o gr a m s. Non et he less, f o r m a n y pa tien ts, th er e a r e p ossibl e co lla bo r a tion s a nd inte r ven tion s th a t

2 ca n len gth en co m m un ity te nu r e a nd help pa tient s a ch ieve m e a nin gf ully im p r ove d ou tco m e s witho u t r ep ea ted ly re tu rn ing to a cu te ca r e se tting s. A s a re m inde r, p sychia t ric in pa tient pr o gr a m s m a y n ot de cline to a d m it individu a ls who o the r wise m e et a d m issi o n cr ite r ia sole ly ba sed on a n HIV dia g no sis, ot he r chr o nic m ed ica l com or b idity, histo r y of su icide a tte m p t, histo ry of violen ce, cr im in a l a n d juve n ile justice syste m involve m e nt, histo r y of p er so na lity d isor d er, d ia g no sis of sub sta nce use diso r de r, or a n inte llectu a l or de velop m ent a l d isa bility.

3 T ABL E OF C O NTENTS S cr ee ni ng, A s sessm en t, a nd Ga t h er in g Colla t e r a l In f o rm a t ion........................................................... 6 Review R eco r d s o f Prio r Enc ou nt e r s............................................................................................. 6 P sych ia tr ic In p a t ient Pr og ra m s................................................................................................... 6 S u icide Risk.................................................................................................................................6 A ll P r og r a m s.............................................................................................................................. 6 S u bsta nce Us e.............................................................................................................................. 6 E m er ge ncy Depa rtm e n ts............................................................................................................ 6 CP E Ps a nd Psychia tr ic In pa t ient Pr og ra m s................................................................................ 7 V iolen ce Ri sk................................................................................................................................ 7 E m er ge ncy Depa rtm e n ts a nd CP EP s......................................................................................... 7 P sych ia tr ic In p a t ient Pr og ra m s................................................................................................... 7 Com plex Ne e d s............................................................................................................................. 8 A ll P r og r a m s.............................................................................................................................. 8 Using PS YC KE S to De te r m in e i f a n In divid ua l Me et s th e Com ple x Nee d s D e f initio n...................... 9 A ll P r og r a m s.............................................................................................................................. 9 Checkin g PS Y CK ES a nd o th e r Elec tro nic Re so u r ces.................................................................... 9 A ll P r og r a m s.............................................................................................................................. 9 P sych ia tr ic A d va nce Di re cti ve (PA D).......................................................................................... 10 A ll P r og r a m s............................................................................................................................ 10 Obt a inin g C olla t er a l I n f o r m a tion................................................................................................... 10 E m er ge ncy Depa rtm e n ts.......................................................................................................... 10 CP E Ps..................................................................................................................................... 11 P sych ia tr ic In p a t ient Pr og ra m s................................................................................................. 11 E va lu a tio ns o f In d ividua ls wi t h F re q u e n t Pre sen t a tio n.................................................................. 12 E m er ge ncy Depa rtm e n ts a nd CP EP s....................................................................................... 12 Le vel o f Ca r e D ete rm ina tion....................................................................................................... 12 A ll P r og r a m s............................................................................................................................ 12 Invo lu n ta r y o r E m er g e ncy Adm issions........................................................................................ 13 E m er ge ncy Depa rtm e n ts a nd CP EP s...................................................................................... 13 A p pr o p r ia te n e ss for A ssis ted Ou t pa tient T r ea t m e nt (AO T).......................................................... 13 P sych ia tr ic In p a t ient Pr og ra m s................................................................................................. 13 Coor din a te d Dis cha r ge P la n ning..................................................................................................... 13 Consid er t h e W ho le P ers o n........................................................................................................ 13

4 A ll P r og r a m s............................................................................................................................ 13 Consid er H ea lth -Re la te d Socia l Nee d s a nd Socia l Det er m ina n ts (HRS Ns) i n Discha r ge Pla nn in g. 14 A ll P r og r a m s............................................................................................................................ 14 A p po intm e nt Withi n Sev en Ca len da r Da ys................................................................................... 14 9.3 9 hos p ita l Em er g en cy De pa rt m e nt s.................................................................................... 14 CP E Ps..................................................................................................................................... 14 P sych ia tr ic In p a t ient Pr og ra m s................................................................................................. 15 F ind i ng O utp a tien t M en ta l Hea lth Pr o g r a m s................................................................................ 15 A ll P r og r a m s............................................................................................................................ 15 P sych ia tr ic In p a t ient Pr og ra m s................................................................................................. 16 Discha r ge Sum m a r y.................................................................................................................... 16 A ll P r og r a m s............................................................................................................................ 16 Coor din a tio n wit h Ca r e M a na g er s............................................................................................... 17 A ll P r og r a m s............................................................................................................................ 17 Wa rm Ha n do ff s /Ver b a l Sign - o u t.................................................................................................. 17 CP E Ps a nd Psychia tr ic In pa t ient Pr og ra m s.............................................................................. 17 Initia ting Ca re M a n a g em en t R e f e rr a ls.......................................................................................... 17 CP E Ps..................................................................................................................................... 17 P sych ia tr ic In p a t ient Pr og ra m s................................................................................................. 17 P r e -Disc ha rg e I nte rve ntio n s to Im pr o v e Disc ha rg e O utc o m es.......................................................... 17 P e er Pr o g r a m s............................................................................................................................ 17 CP E Ps..................................................................................................................................... 18 P sych ia tr ic In p a t ient Pr og ra m s................................................................................................. 18 Com m u nity Suicid e S a f e t y Pl a n................................................................................................... 18 E m er ge ncy Depa rtm e n ts.......................................................................................................... 18 CP E Ps a nd Psychia tr ic In pa t ient Pr og ra m s.............................................................................. 18 M itiga tin g Ris k o f Vi olenc e in th e Com m un ity............................................................................... 18 E m er ge ncy Depa rtm e n ts.......................................................................................................... 18 CP E Ps..................................................................................................................................... 18 P sych ia tr ic In p a t ient Pr og ra m s................................................................................................. 19 A d dr es sing S ubst a nce Use......................................................................................................... 19 A ll P r og r a m s............................................................................................................................ 19 Long - A ctin g In j ecta ble M e dica tio ns.............................................................................................. 19 E m er ge ncy Depa rtm e n ts a nd CP EP s....................................................................................... 19 P sych ia tr ic In p a t ient Pr og ra m s................................................................................................. 19

5 P sych ia tr ic A d va nce Di re cti ves................................................................................................... 19 CP EP s a n d Psychia t ric I n pa tien t Pro g r a m s............................................................................ 19 Conclu si on...................................................................................................................................... 20 Hospita l P r og ra m s a re a Critica l F o u n da tion o f t h e M e n ta l Hea lth System.................................... 20 T ech nica l Assista nce & S u p po r t for A ll P r ogr a m s......................................................................... 20

6 S CRE E NING, A SS E SS MENT, AND G ATHERIN G C OL L ATERAL I NF ORM ATI ON R EVIEW R EC OR D S O F P R I O R E N C OUN TER S P SY CHIA TR IC I NPA TIENT P ROG RA MS T he a tten din g o f r eco rd m ust r eview e m er ge ncy d ep a r t m e nt (E D) a n d com pr eh en sive p sych ia tr ic em er g en cy pr o gr a m (CP EP) a ssessm ent s a n d inte rve nt ions a n d in cor p or a t e t he inf or m a tion int o the ove r a ll f o r m ula tion a n d tr ea tm e nt pla n. Hosp ita ls sh ou ld a lso re view d ocu m e nt a tio n o f pr ior visits a nd a tt em pt to ob ta in m edica l re cor ds f ro m oth er ho spita ls wher e the p a tie nt wa s p re viou sly a d m itt ed. OM H ha s issued g uid a nce g ove r ning sh a r ing of inf or m a tio n a m on g O M H- license d p r og r a m s, includ ing when su ch in f or m a tion ca n be sh a r e d in th e a b sen ce o f spe cif ic sig ne d co nse nt. S UICIDE R ISK A LL P RO G RAMS A ll individu a ls who a rr ive to ED s with a b eh a vio ra l he a lth pr e sen ta t ion a n d a ll in dividua ls ser ved in a CP E P or p sychia tr ic inp a t ient pr o gr a m m ust be scr e en ed f or su icide r isk. Use of a va lida t ed instr u m e nt (e.g., C olu m b ia - Suicide Seve r ity Ra t ing Sca le, S AFE-T) is re co m m en de d (a nd r eq uir ed in CP E Ps a nd In pa tien t Prog r a m s). As pa r t of th e scr e en ing, ind ividua ls shou ld b e a ske d a bo u t a cce ss to f irea rm s o r oth er wea p on s. Positive scr e en s m ust be f ollowed by a su icide risk a ssessm en t b y a license d p r of essio na l tra in e d in a sse ssing suicide r isk. T h e r e sults of th is a sse ssm e nt sho u ld b e con sider e d in th e de velop m ent of t he ind ividua l’s tr e a tm en t a nd /or discha rg e pla n. S UBSTANC E U SE E ME RG ENCY D E PA RTME NT S P u blic Hea lth L a w § 28 03 - u r eq uir es ho spita ls to d eve lop, m a inta in, a nd dissem ina te p olicies a nd pr o ced ur es for th e iden t ifica tion, a ssessm ent, a n d r ef er r a l o f individu a ls with do cum en ted su bsta nce use diso rd er o r who a p pe a r to h a ve or b e a t risk f or su bst a n ce use d isor d e r a n d re qu ire s the m to t r a in the ir license d a nd clinica l st a f f m e m ber s who pr ovid e d ir ect pa tient ca r e in su ch po lici es a n d pr o ced ur es. DOH p r eviou sly issue d a Dea r Adm inistr a to r Le tte r – DHDTC DAL 1 8 - 13 – t ha t clinica l a n d p r og r a m lea d e rs m a y f ind u sef ul. A s a be st p r a ctice, ED s sh ou ld a ssess p a tie nts f or Substa nce Use Disor d er s (SU Ds) with a n a ge - a p pr o pr ia te a n d va lida ted instr u m e nt (S a m ple S cr ee nin g T oo ls) tha t spe cif ica ll y scr e en f or d if f er e nt sub sta n ces (e.g., a lcoh ol, op ioids, ca nn a b is, to ba cco/n icotin e) t ha t m a y r e qu ire dif f er en t a cute inte r ven tion s, m a na ge m e nt, a nd r ef er r a ls. T he a sse ssm ent sho uld includ e r isk of a cu te withd ra wa l a n d r isk o f a cciden tal o ver d ose. Assessm e nt of a cute withd ra wa l sym p to m s sho uld include o bje ctive inf or m a tion, su ch a s th e Clinica l Opia t e Withd r a wa l Sca le (COWS) o r th e Clinica l In stitu te of Withdr a wa l A ssessm en t (CIWA) instr um en ts. Any ind ividua l det er m ined to be a t r isk of ove r do s e o r of a cu te withdr a wa l shou ld b e f ur the r e va lua ted a n d of f er ed n ece ssa r y tr e a tm en t. A d dition a lly, a t ea ch pr e sen ta t ion, a p r a ctition e r (a physicia n, n ur se pr a ct itione r, o r ph ysicia n a ssista nt a s d ef ine d b y Artic l e 33 of Public Hea lth L a w) sho uld c h eck t he In ter n et System f o r T r a cking Ove r- Pre scr ibing / Pre scrip tion M on itor ing Prog r a m Registr y (I- S T OP/P MP Reg istr y) f or a n y ind ividua l with a po sitive su bsta nce use

7 scr ee n; a n y ind ividua l wh o r e po r ts a pr escr ip tion of co ntr o lled m e dica t ions; a n y ind ividua l with a histo r y of o ver d ose; a nd a ny individu a l with a h istor y of withd ra wa l. CP E P S AND P S Y CHIATRIC I NPA TIENT P RO G RAM S A ll individu a ls o ver t he a g e of 1 2 m ust be scr ee n ed f or su bsta nce use u sing a va li d a te d in str um en t (S a m ple Scree nin g T o ols). In str um en ts sh ou ld b e a ge -a p p ro pr ia t e a nd spe cif ica ll y scr e en f or individu a l su bst a nce s (e.g., a lcoho l, op ioids, ca n na bis, to ba cco/n icotin e) th a t m a y r eq u ire dif f er en t inte r ven tion s or p sycho edu ca tion. Positive scr e e n s sho uld be f ollowed b y a n a ssessm en t con du cte d by a license d pr of e ssiona l who is t ra ined in wor king with ind ividua ls using sub sta nces bu t n ot ne cessa rily m eet ing the cr ite ria f o r a sub sta n ce use d isor de r dia g no sis (no te: a Cre de ntia led A lcoh olism a n d Sub sta n ce A bu se Coun selo r (CA S AC) ce rt if ica tion is NOT a r eq uir em en t). T he a sse ssm e nt sho uld includ e r isk of a cu te withd ra wa l a n d r isk o f a ccide nta l ove rd ose. A ssessm en t o f a cu te withdr a wa l sym p tom s sh ou ld inclu de o bject ive inf or m a tio n, such a s the Clinica l Op ia te Withdr a wa l S ca le (COWS) o r the Cli nica l Institu te of Withd ra wa l A sse ssm e nt (CIWA) instr um en ts. A n y ind ividua l d et er m ined to b e a t r isk of o ver d ose or o f a cu te withd ra wa l sho uld be eva lua te d a n d of f er ed ne ce ssa r y tr e a tm en t. A d dition a lly, a t ea ch p r ese nta tion, a pr a ct itione r (a ph ysicia n, nu r se pr a ct itione r, o r ph ysicia n a ssista n t a s de f ined by Article 3 3 o f Public Hea lth L a w) sho uld che ck th e Int er n et S yste m f o r T r a ckin g O ver -Pre scr ibing /Prescr ipt ion M on itor ing Prog r a m Reg istr y (I- S T OP/PMP Registr y) f or a n y ind ividua l wi th a po sitive su bsta nce use scr e en; a ny ind ividua l who r ep or ts a pr e scr iption o f con tr olled m ed ica tion s; a ny ind ividua l with a histo ry of o ver do se; a n d a n y individu a l with a h istor y o f withd ra wa l. V I OLEN C E R I SK E ME RG ENCY D E PA RTME NT S A ND CP E P S A ll individu a ls who a rr ive a t EDs with a be ha viora l he a lth pr e sen ta t ion a n d a ll individua ls ser ved in a CP E P m u st b e scr e en ed f or r isk o f violence. Mo st individu a ls with be ha viora l hea lth issu es a re n ot violen t a n d a r e a t g re a t er r isk of b eing victim s o f v iole nce r a th er t ha n p er p et r a t or s. Ho wever, th er e is a sm a ll pe r cen ta g e of ind ividua ls who d o ha ve e leva t ed r isk a n d id en tif ying th em e a r ly a n d dir ect ing the m into tr e a tm en t is cr itica l to p r eve nt ha rm a n d involve m e nt with t he cr im ina l justice system. E a ch p r og ra m m u st h a ve p olicies r eg a r d ing violen ce risk scr e en ing. T h e p r og r a m po licy m u st de scr ibe a pr o cess f or su bse qu en t a ssessm en t a nd inte rve nt ion in th e ca se of a po sitive scr e en. As pa rt of th e scre en ing, a ll ind ividua ls m u st b e a ske d a bo ut a cce ss to f irea rm s o r oth er wea p on s. T h e scr ee ning sho u ld includ e t he ind ividua l’s self - re por t; a de ta iled r evie w of the h istor y of p r ese nt ill ne ss; histo r y f ro m elect r on ic he a lth r eco r ds a nd ot he r elect r on ic sou rce s; a nd hig h - qu a lity co lla ter a l inf or m a tion f ro m f a m ily, f rien d s, a n d com m unity p r ovid er s. I de nt if ica t ion of r isks f or violen ce (i.e., po sitive scr e en s) m u st le a d to a m o r e com pr eh en sive clinica l a ssessm en t th a t is spe cif ica ll y con sider e d in th e de velop m ent of t he ind ividua l’s tr e a tm en t a nd disch a r ge p la n. P SY CHIA TR IC I NPA TIENT P ROG RA MS E a ch p r og ra m m ust h a ve policies r e ga rd ing violen ce r isk scr e en ing. M ost ind ividua ls with be ha vior a l he a lth issue s a r e no t violent a n d a r e a t gr e a te r r isk of b eing victim s of violen ce ra the r th a n pe r pe tr a to r s. Ho wever, the r e is a sm a ll pe r cen ta g e of ind ivid ua ls wh o d o ha ve e leva t ed r isk a n d

8 iden tif ying t he m ea r ly a nd dir ect ing the m into tr ea tm ent is cr itica l to pr e ven t h a r m a n d co n ta cts with the cr im ina l justice syste m. A ll individu a ls m ust be scr ee ne d, a n d th e p r og r a m po licy m u st d escr ibe a pr oce ss f or su bse qu en t a sse ssm e nt a n d inte rve nt ion in the ca se o f a p ositive scre en. As pa rt of th e scr ee ning, a ll individua ls m u st b e a ske d a bo ut a cce ss to f ire a r m s or o th er wea po ns. T h e violen ce r isk scr ee n ing sho uld be r ep ea ted a s in dividu a ls a r e r ea ssesse d t hr o ug ho ut the ir sta y in th e ho spita l. T he scr ee n ing sho uld includ e t he ind ividua l’ s se lf - r e po r t; a de ta iled r evie w of th e histo ry of p re sen t illne ss; h istor y f r om elect r on ic he a lth r e cor ds a n d o th er e lectr o nic so ur ce s; a nd high - q ua li ty co lla te ra l inf or m a tion f ro m f a m ily, f r iend s, a nd co m m u nity p r ovide r s. I de ntif ica tion o f r isks f o r violen ce (i.e., po sitive scr e en s) m u st le a d to a m o r e com pr eh en sive clinica l a ssessm en t th a t is spe cif ica lly co nside r ed in t he de velop m ent o f the ind ividua l’s tre a t m e nt a n d discha rg e pla n. C OMPLEX N EED S A LL P RO G RAMS A ll individu a ls who p r ese nt to E Ds with a be ha vior a l h ea lth co nd ition or t o CPE P s o r psych ia tr ic inpa tien t p ro gr a m s m ust b e scr e en ed to d ete r m in e if th ey ha ve co m plex n ee ds a s d ef ine d b y th e de f inition in 14 NY CRR P a r ts 5 80, 5 82, a nd 59 0 (b elow). F or a du lt s th is de f inition is a ligned with the eligibility cr iter ia f o r Hea lth Hom e P lus Ca re M a n a g em en t t o f a cilita te d ischa r g e p la n ning f r om inpa tien t se tting s. F or ch ildre n a n d yo u th, th e d ef inition is a li gn ed with cur r en t e nr o llm e nt in o r eligibility f or High F ide lity Wra pa r o un d Ca r e M a n a g em en t in Hea lth Hom es S er ving Childr e n; or eligibility f or o ur cu r r en t Childr e n’s Hom e a n d Co m m un ity Ba sed Service Wa iver f or ch ildr en with S e rio us Em o tion a l Distur b a n ce (SE D). Def inition – On e or m or e of th e f ollowing. (1) Dem onst r a te hig h u tiliza tion o f inpa tien t, cr isis, o r em er g en cy se rvice s, a s indica t ed by: (i) thr e e or m or e m ent a l h ea lth inp a t ient ho spita liza tions in th e pa st yea r; or (ii) f our o r m or e m e nt a l h ea lth p re sen ta tions to a n em er g en cy d ep a r tm en t (ED) o r com pr e he nsive psych ia tr ic em er g en cy p ro gr a m (CPE P) in t he pa st ye a r; o r (iii) thr e e o r m or e m e dica l/sur gica l h osp ita liza tion s in the la st yea r a n d ca rr ying a dia g no sis of schizop hr e nia or b ipo la r diso rd e r. (2) Discha r ge f r om a n OM H - license d re side nt ia l tr ea tm e nt f a cility (RT F) in th e pa st yea r. (3) Discha r ge f ro m inpa tient leve l of ca r e a t a n OM H - o pe r a te d psych ia tr ic cen te r wher e th e leng th of sta y wa s g re a t er t ha n 6 0 da ys in th e pa st yea r. (4) Cur r en t e nr o llm en t in, o r discha rg e in th e pa st yea r f ro m, Assert ive Com m unity T r ea t m e n t (A CT), includ ing bu t n ot lim ited to Adult ACT, Youth ACT, Y ou n g Adult A CT, Shelte r -p a r tn er e d A CT, a nd F or e nsic ACT. (5) Cur r en tly r ece iving se r v ices f r o m Critica l T im e In te rve nt io n (CT I), Sa f e Op tion s S up po r ts (SOS), P a t hwa y Hom e, Int en sive M o bile T r e a t m e nt (IM T), Ho m e Ba sed Cr isis Inte r ven tion (HB CI), o r oth er high -in ten sity a m b ula t or y se r vice(s).

9 (6) E ligible f or or cu r r en t e nr o llm en t in Hea lth Hom e Plus Ca r e M a n a g em en t Ser vices. (7) E ligible f or or cu r r en t e nr o llm en t in High F idelity Wr a p a r ou n d Ca r e M a n a g em en t in Hea lth Hom es Ser ving Childr en; e ligible f or or cu r re nt en r ollm ent in Childr e n' s Ho m e a nd Com m u nity B a se d S e rvice s Wa iver f or ch ildr en with Ser iou s Em ot iona l Di stu r ba nce (SE D). (8) A n a ctive Assert ive Ou tp a tie nt T r ea tm e nt or d er o r a n o r de r th a t exp ire d in th e p a st yea r. (9) E xp er ien cing h igh - r isk so cia l ne ed s, inclu ding bu t n ot lim ited to, cur r e nt ho m elessne ss, crim ina l or ju ven ile justice involve m e nt, a nd child we lf a re invo lvem ent in t he p a st ye a r. (10) Cli nica l d et er m ina tio n b y sta f f in th e licen sed p ro g ra m tha t, o n pr ese nt a tio n, the ind ividua l ha s a n ele va te d risk o f suicide, viole nce a n d/ or o ver d ose. (11) Ha s a cur r e nt com plexity clinica l f la g in the Psychia tr ic Service s a n d Cli n ica l K no wledg e E n ha n cem en t S yste m (PS YC KE S). U SING PSYCKES TO D ETER MINE I F AN I ND IVI DU AL M EETS T HE C OMPLEX N EED S D EF I N IT I O N A LL P RO G RAMS T he r e a re m a n y dif f er en t e lem ent s in t he Com plex Need s Def inition, so to a ssist E Ds, CPE P s, a nd psych ia tr ic inp a tien t p r og r a m s in d ete r m in ing which of th eir p a tien ts m ee t th e de f inition, the Sta te h a s de velop ed a f la g in P SY CK E S th a t ca n q uickly a ler t ho sp ita ls if the d ef inition ha s be en m et. Hosp ita l sta f f a r e r eq uir ed t o login int o t he PS Y CK E S a pp lica tion to d ete r m in e if th e Com plex Nee ds F la g is pr e sen t. E ve ry ho spita l in NY S i s e ligible t o h a ve a ccess to PS Y CK ES. In dividu a l ho sp ita l sta f f a cce ss is m a na ged b y loca l Secu rity M a n a ge r s a ppo inte d by h osp ita l lea de r ship. If pr o gr a m lea de r ship is un sur e whet he r th e h osp ita l ha s obt a ine d PS YC KE S a cce ss o r who th eir a ssig ne d Secur ity M a na g er s a r e, p lea se em a il PS Y CK E S-Help @om h.n y.go v (a n d includ e in th e e m a il na m e, title, clinica l ser vice, a n d t he ho sp ita l’s na m e a n d a dd r ess. Note: h osp ita ls in d if f e r en t r eg ion s of NYS m a y ha ve sim il a r na m e s). Addition a l log in h elp ca n b e f o un d her e. T r a ining m a te r ia ls ca n b e f ou nd he r e. C H EC KING PSYCKES AN D O THER E LEC TR ONIC R ESO U R CES A LL P RO G RAMS In a dd ition to u sing P SY CK E S to ch eck whe th er a Com plex Nee ds F la g is pr e sen t, EDs, CP EP s, a n d psych ia tr ic inp a tie nt pr o gr a m s m ust a lso lo ok u p individu a ls in PS Y CK E S to r e view th eir pr io r psych ia tr ic a n d m e dica l histor y, m e dica tion histo ry, a n d tr ea tm e nt en ga gem en t h istor y, a n d ob ta in con ta ct inf or m a tion f or o ut pa tient tr e a tm en t te a m s a nd ca r e m a na g e rs. Ob ta in ing the ind ividua l’s con sen t f or PS Y CK E S gives h osp ita ls a ccess to th e ind ividua l’s clinica l su m m a r y f or 3 ye a r s (re ne wing a u tom a t ica lly wi th a n y n ew b ill e d se r vice); h owe ver, e ven if th e in dividu a l do es no t h a ve ca p a city t o co nse nt, in em er g en cies, st a f f m a y a cce ss th e clinica l sum m a r y f o r 7 2 h ou r s. Sta f f ca n a lso che ck if a Psychia tr ic A dva nce d Dire ctive ha s be en up loa d ed to th e in dividu a l’s clinica l sum m a ry. A d dition a lly, if a p plica ble, ind ividua ls shou ld b e r eviewe d in a n y o the r a va ila ble in f or m a tion ne twor k da ta b a ses (e.g., the Sta te wide Hea lth In f or m a tion Networ k f o r New Yor k/Qu a lif ied Entities (SHIN -

10 NY /QE) o r Epic Ca r e Ever ywhe r e). F or ind ividua ls who r e po r t u sing con tr olled m ed ica tion s, t he ir pr e scrip tion histo r ies sh ou ld b e re viewed in the P M P Registr y by a uth or ized p ra ctition er s. P SY CH IAT R IC A D VAN C E D IR EC T IVE (PAD) A LL P RO G RAMS E Ds, CPE P S, a nd psych ia tr ic inp a tie nt pr og r a m s sho uld a sk if ind ividua ls h a ve a psych ia tr ic a d va n ce dir ect ive (PA D) a nd incor p or a t e t he ir pr e f e r en ces into th e a ssessm en t, t re a t m e nt, a nd discha rg e pla n nin g. F ollowing th e e xp re ssed wishe s in a PA D ca n h elp i m p ro ve th e t he ra pe utic a lli a n ce with sta f f a n d in cr ea se e ng a g em en t a f t er th e ind ividua l h a s be en tr a n sition ed ou t of th e ED, CP EP, or psych ia tr ic inp a tie nt pr o gr a m. O BT AINING C OLL AT ER AL I NFO R MAT I ON E ME RG ENCY D E PA RTME NT S S cr ee nin gs, a ssessm ent s, p hysica l a nd m e n ta l sta tus exa m ina tions, ob ser va tion, inf or m a tion f r om P SY CK E S a n d o th er h ea lth/a dm inistra tive r eco r ds, a n d inf or m a tion ga the r ed f ro m colla te r a l so ur ces a r e a ll im p or ta nt f a ct or s th a t m ust b e co n sider e d wh en m a king d ispo sitio n decisio n s. It is in su f f i ci en t t o m a ke a d is p o si ti o n d e c isi o n s o le ly b as ed o n b e h a vio ral o b se r va t io n i n t h e ED s et t in g. Wher e pa tien t co nse nt is re qu ir ed by la w a n d wh er e ver p ossible, EDs m u st ide nt if y a nd con ta ct th e individu a l’s f a m il y m em be r s or clo se f r ien d s who inte r a ct with th e pa tient to ob ta in colla te r a l inf or m a tion, inclu ding a ny p sychia t ric a dva n ce dir ect ive. When ind ividua ls pr ese nt on th eir o wn to th e ED d ue to a no n - e m e r ge nt r ea son, includ ing bu t n ot lim ited to, a n a sym p tom a t ic individu a l p re sen ting fo r a m e dica tion r e f il l, co lla ter a l inf o r m a tion m a y n ot be r eq uir ed p ro vide d th e r e m a inde r of th e e va lua tion i s n ot con cer n ing, th e in dividu a l ha s low r isk f or ha rm, a nd the y a re well - con ne cted to co m m u nity se r vices. When a sse ssing ind ividua ls who a re b ro ug ht in b y th e po lice d ue to be ha vior a l d istur ba nce s in t he com m u nity or individu a ls who a r e invo lun ta r ily r em ove d f r om th e com m u nity (i.e., pu r sua nt t o M e nt a l Hygien e L a w (M HL) § 9. 37, 9.4 1, 9.4 5, 9.58, o r 9. 60), EDs s hou ld o bt a in co lla te ra l inf or m a tion f ro m the p a r ty who initia te d t he invo lunt a r y r e m o va l a nd f ro m oth e r im p or ta nt so ur ce s o f inf or m a tion, includ ing f a m ily m em be rs a n d f r ien ds, ou tpa tien t p ro vide r s, r esid en tia l o r long -t er m ca r e pr o gr a m s, he a lth ho m e ca r e m a na g e rs, Adult/Childr e n’s Single Point of A ccess (SP OA/C - S POA), sch oo ls, child welf a re, p a r o le/p r ob a tio n /p er so ns in ne ed o f sup er vision (P INS) o f f icer s, a n d/o r M ed ica id Ma na ged Ca r e (M CO) ca re m a na ge rs. When co nta cting sou r ces o f colla te r a l inf or m a tio n, E Ds m ust a ssess wh eth er t he so ur ce is a b le to pr o vide su f ficien tly h igh - q u a lity inf o r m a tion to de te rm ine risk, sym p to m a tolo gy, a n d f un ction ing in t he com m u nity; tr e a tm en t h istor y; en ga gem en t in tr e a tm en t; a n d on go ing str esso r s. I f th e so ur ce is no t a b le to p ro vide suf f iciently h igh - q ua li ty in f o r m a tion, a ttem pt s sho uld b e m a d e t o iden tif y a nd co nt a ct a d dition a l so ur ce s of co lla ter a l inf o r m a tion.

11 CP E P S A cq uir ing colla te r a l inf or m a tion is a f oun da tiona l com pon e nt of a CP E P E va lua tion. Scree nin gs, a sse ssm e nt s, p hysica l a n d m ent a l sta tus e xa m ina t ions, ob ser va tion, inf or m a tion f r om PS Y CK E S a nd oth er he a lth /a d m inistra tive r e cor ds, a n d inf or m a tion ga the r ed f ro m colla t er a l so ur ce s o f inf or m a tion a r e a ll im p or ta nt f a ct or s th a t m ust b e co n sider e d wh en m a king d ispo sition decisio n s. It is in s u ff i c ient t o m ak e a d is p o s it io n d e ci sio n s o lel y b as ed o n b e h av io ral o b se r va ti o n i n t h e CP EP se t ti n g. Wher e pa tient con sen t is r eq uir e d b y la w a n d wh er e ver p ossible, CP EP s m u st ide nt if y a nd con ta ct t h e individu a l’s f a m il y m em be r s or clo se f r ien d s who inte r a ct with th e pa tient to ob ta in colla te r a l inf or m a tion, inclu ding a ny p sychia t ric a dva n ce dir ect ive. When ind ividua ls p r ese nt on th eir own to the CP EP du e t o a no n - e m e r ge nt r ea son, includ ing bu t n o t lim ited to, a n a sym p tom a t ic individu a l p re sen ting fo r a m e dica tion r e f il l, co lla ter a l inf o r m a tion m a y n ot be r eq uir ed p ro vide d th e r e m a inde r of th e e va lua tion is no t con cer nin g, th e in dividua l ha s low r isk f o r ha rm, a nd the y a re well - con ne cted to co m m u nity se r vices. M en ta l Hyg iene L a w §9.6 4 (e f f e ctive A ug u st 2 02 5) r e qu ire s CP EP lea d er sh ip to e nsu r e t ha t r ea so n a ble ef f or ts a r e m a de to ide nt if y a nd pr o m ptly n otif y a n y co m m un ity p ro vide r of m en ta l h ea lth ser vices cur r en tly se rvin g a ny p a t ient who is a cce pte d into th e CP E P. When a sse ssing ind ividua ls who a re b ro ug ht in b y th e po lice d ue to be ha vior a l d istur ba nce s in t he com m u nity or individu a ls who a r e invo lun ta r ily r em ove d f r om th e com m u nity (i.e., pu r sua nt t o M e nt a l Hygien e L a w (M HL) § 9.3 7, 9. 41, 9.45, 9.58, o r 9. 60), CPE P s sho uld obt a in co lla te ra l inf o r m a tion f ro m the p a r ty who initia te d t he invo lunt a r y r e m o va l a nd ot he r im p or ta nt so u rce s o f inf or m a tion, includ ing f a m ily m em be rs a n d f r ien ds, ou tpa tien t p ro vide r s, r esid en tia l o r long - te r m ca r e pr o gr a m s, h ea lth ho m e ca re m a na ger s, Adu lt/Childr en ’s Si ng le Point of Access (SP OA /C - SP OA), sch oo ls, ch ild welf a re, p a r o le/p r ob a tio n /p er so ns in ne ed o f sup er vision (P INS) o f f icer s, a n d/o r M ed ica id Ma na ged Ca r e (M CO) ca re m a na ge rs. OM H ha s issued gu ida nce th a t de ta il s whe n inf or m a tion sh a r ing is pe r m itt ed eve n withou t sp e cif ic signe d con sen t, which in clude s clinica l co m m un ica tion a m o ng CP EP s a n d O M H -licen sed o utp a t ient ser vices. OM H ha s a lso issued gu ida n ce to o utp a t ient, r e siden tia l, a nd ca r e m a na gem en t p r ovid er s on pr o a ct ively con ta ct ing CP EP s to com m unica t e t he r ea son ind ividua ls we re tr a nspo r te d t o t he ho spita l. When con ta cting so ur ce s o f colla ter a l inf o r m a t ion, CP EP s m u st a ssess whe th er t he so ur ce is a b le to pr o vide su f ficien tly h igh - q u a lity inf or m a tion to d ete r m ine r isk, sym pt om a to logy a n d f u nctio ning in the com m u nity; tr e a tm en t h istor y; en ga gem en t in tr e a tm en t; a n d on go ing str esso r s. I f th e so ur ce is no t a b le to p ro vide suf f iciently h igh - q ua li ty in f o r m a tion, a ttem pt s sho uld b e m a d e t o iden tif y a nd co nt a ct a d dition a l so ur ce s of co lla ter a l inf o r m a tion. P SY CHIA TR IC I NPA TIENT P ROG RA MS A cq uir ing Colla ter a l Inf or m a tion is a F ou nd a tio na l Com p on en t o f In pa t ient Psychia tr ic T r ea tm ent. S cr ee nin gs, a sse ssm e nt s, p hysica l a nd m ent a l sta tus e xa m ina t ions, ob ser va tion, inf or m a tion f r om P SY CK E S a n d ot he r he a lth /a d m inistra tive r e cor ds, a n d inf or m a tion g a th er e d f r om co lla ter a l so ur ce s of inf or m a tio n a re a ll im por ta nt f a ctor s tha t m ust b e con side re d when m a king tr e a tm en t a nd dispo sition de cisions. It is insuf f icient t o m a ke a dispo sition de cision solely ba sed on be ha vior a l ob ser va tion in th e inpa tient un it.

12 With th e in dividu a l’s con sen t wh er e r eq uir ed b y la w, h osp ita ls m ust iden tif y a n d co nt a ct the individu a l’s f a m il y m em be r s or clo se f r ien d s who inte r a ct with th e pa tient to ob ta in colla te r a l inf or m a tion, inclu ding a n y p sychia tr ic a dva n ce dir ective. Colla t er a l inf or m a tion m ust a lso be ob ta ined f ro m ou tpa tien t a nd re side ntia l pr ovide r s, p a r ticu la rly if th e individu a l wa s a dm itted a s a r e sult f r om ou tpa tien t o r r eside nt ia l pr o vider s a ctiva t ing E M S. M en ta l Hygie ne La w §9. 64 (ef fect ive Augu st 2 02 5) r e qu ire s p sychia t ric in pa tient pr o gr a m lea de rsh ip to ensu r e t ha t re a so na ble e f f o r ts a r e m a de to ide nt if y a nd pr o m p tly n otif y a n y co m m un ity p r ovide r of m e nt a l h ea lth se rvice s cur r e nt ser ving a n y p a tie nt who i s a dm itted int o t he inp a tie nt un it. OM H ha s issued gu ida nce th a t de ta il s whe n inf or m a tion sh a r ing is pe r m itt ed eve n withou t sp e cif ic signe d con sen t, which in clude s clinica l co m m un ica tion a m o ng inp a tie nt psych ia tr ic un its a nd OM H - license d o ut pa tient ser vices a s we ll a s a d ditio na l ser vices. When co nta cting sou r ces o f colla te r a l inf or m a tio n, inpa tien t p ro gr a m s sh ou ld a ssess wh eth er the sou r ce is a ble t o p r ovid e su f f icien tly h igh - q ua lity inf or m a tion to de te rm ine r isk, sym pto m a tolo gy a nd f unct ioning in the co m m un ity, t r ea tm e nt histo r y, e ng a g em en t in t r ea tm e nt, a nd on go ing str esso r s. If the so ur ce is no t a ble to pr ovid e su f f icien tly h igh - qu a lity inf or m a tio n, a tt em pts sho uld be m a de to iden tif y a n d co nt a ct a d dition a l so ur ce s of co lla ter a l inf o r m a tion. E VALU ATI O N S O F I N D I VIDU AL S WI T H F R EQ U EN T P R ESEN TAT IO N E ME RG ENCY D E PA RTME NT S A ND CP E P S T he r e a re ind ividua ls who f re qu e n tly p re s en t to EDs a nd /or CPE P s du e to d if f icu lty e sta b lishing socia l con ne ction s o r un m e t b a sic n ee ds, su ch a s f ood, sa f e ty, ho using, e tc. (i.e., pr im a r y or seco nd a r y ga in). Addition a lly, ch ildre n a n d a do lescen ts m a y pr ese n t f r eq ue nt ly du e t o r e a ctive or m a la da ptive be ha viors. While th ese ind ividua ls m a y be f a m ili a r t o st a f f, th er e is a lwa ys t he po ssibility of n ew o r wor sen ing m e dica l, psych ia tr ic, or o th er co nd itions. Sta f f m a y de velo p p r eco nce ived no tion s d ue to ch a lleng ing be ha viors by t he se individu a ls, a nd th ese pr e con ceive d no tion s m a y b e inf luen ced by im p lici t b ia s. T he se individua ls shou ld b e a ssesse d a t eac h p rese n t a t io n to e nsu r e t he y ob ta in the ca r e the y n ee d a n d EDs a nd CPE P s do n ot m iss tre a t a ble con ditio ns o r int er ven tion o pp or tu nitie s. T h ey sho uld no t be r ef lexively d ischa r g ed o r ha ve th e ir co nce r ns dism issed b a se d o n eva lua tio ns in pr ior visits. L EVEL OF C AR E D ETER MINATI O N A LL P RO G RAMS When m a king a d m issi on o r disch a r ge d ecision s, it is a be st p r a ctice to con side r a n ind ividua l’ s o wn sta t ed go a ls a nd, f or m inor s, th e p a r e nt/ gu a r d ia n’s g oa ls (a s a pp r op r ia te). Also con sider cur r en t sym p to m s, r isk a sse ssm ent ba sed on inf or m a tio n f r om co lla t e r a l so ur ce s a n d o b ser va t ion on site, ove r a ll clinica l histo r y, e ng a g em en t in ca r e, a n d a va ila b ility of existin g se r vices in the su r ro un din g com m u nity. T he L eve l of Ca r e Utiliza tion System f o r Psychia tr ic a nd Addiction Ser vices (LOCUS) b y the Am er ica n A sso cia tion s f or Com m unity Psychia t rists (AA CP) a n d th e Ch ild a n d Ado lescen t Ser vice I nte nsity

13 Inst r um en t (CA SII) by the Am er ica n Aca de m y of Child a nd A d olesce nt Psychia tr ists (AA CAP) a r e peer - r evie we d, evide n ce - b a se d in str um en ts th a t ho sp ita ls sho uld con side r a d op ting to n a viga te t his com plexity a n d e nsu r e a dm ission de cisions a re co nsiste nt a n d h a ve a r a tiona l ba sis. I NVOLU N T AR Y OR E MER G EN C Y A DMISSI O N S E ME RG ENCY D E PA RTME NT S A ND CP E P S Ind ividua ls a t a n e leva t ed r isk f o r ha rm ing th em selves or o th er s, wh o a re f un ction a lly im p a ir ed to th e po int o f be ing un a b le t o m ee t t he ir b a sic n ee ds, o r who ha ve m ultiple com or b idities t ha t pr e ven t com m u nity - ba sed tr ea tm e n t m a y n ee d a n involu nta ry a d m iss io n. T he Sta te Of f ice of M e nta l Hea lth (OM H) ha s pr e viously issue d g uid a n ce on invo lun ta r y a nd em er g en cy a d m issi on s a nd cer ta in situa tions wher e th ey a r e a p pr o pr ia te. T he r e a re t im e s whe n p r a ctitio ne rs m a y de te r m ine t ha t a n inp a t ient a d m issi on is b en ef icia l to a n individu a l e ven if the ind ividua l doe s n ot m eet invo lunt a r y o r em er g en cy a d m issi on cr ite ria. In th ese ca se s, th e individua l over 1 6 shou ld b e o f fer ed a volun ta r y 9.13 a dm issi on. F or ind ividua ls un de r 16, the f ollowing m a y a pply f or a volu nta ry 9.1 3 a d m ission: ▪ A pa re nt, leg a l g ua rd ia n, o r ne xt o f kin; ▪ a Socia l S er vices o f f ic ia l or a uth or ized a gen cy with ca re a n d cu sto dy o f the p er son pu r sua nt t o the Socia l Service s La w, sub ject to the te r m s of a n y co ur t o r de r o r a n y instr u m e n t e xecu ted pu r sua nt t o Section 3 84 - a of th e S ocia l Ser vices L a w; ▪ the Com m issi o ne r f or th e Ne w Y or k S ta te O f f ice o f Childr en a nd F a m ily S er vices (O CFS), a ctin g in a cco r da nce with Section 50 9 of th e E xecu tive La w; ▪ a p er so n o r a n a u th or ized r ep r ese nt a tive of a n en tity h a vin g cu stod y o f the pe r son p u rsu a n t t o S e ction 75 6 or Section 1 05 5 o f th e F a m ily Cou r t Act. A PPR OPR IAT ENESS FO R A SSIST ED O U TPAT I EN T T R EATMENT (AOT) P SY CHIA TR IC I NPA TIENT P ROG RA MS Ind ividua ls who ha ve a n e leva t ed r isk or f r eq ue nt a d m issi on s d ue to n on - co m p lia nce sho uld be eva lua te d t o d et er m ine if Assi ste d O utp a t ient T r ea tm e n t (AOT) would be b en ef icia l. In August 20 2 3, OM H issued guida nce f or p hysicia n s o n co nd uct ing a n AOT eva lua tion. A dd ition a l gu ida nce on AOT ca n be f ou nd he r e. C OORDINATED D ISCH ARGE P L ANN ING C ONSIDER THE W H OLE P ER SON A LL P RO G RAMS When d ete r m in ing whet he r a n ind ividua l ca n be disch a r ge d a n d t he m ost a pp ro p ria t e discha rg e sett ing, th e who le clinica l p r ese nta tion a n d histo ry, co - occu r rin g co n dition s, co lla ter a l inf o r m a tion, a s well a s t he a va il a b ility of existin g se r vices a nd sup po r ts in th e ind ividua l’s co m m un ity, m ust be

14 con sider e d. T h e p la n m ust b e de velop ed th r ou gh sh a r ed d ecision - m a king a n d re f lect ind ividua l str en gt hs. C ONSIDER H EALTH -R EL AT ED S O CIAL N EED S AN D S O CIAL D ETER MI N AN TS (HRSN S) I N D ISCH AR GE P LAN N ING A LL P RO G RAMS T his se ction d oe s no t a pp ly to a ll E Ds, r a the r on ly E Ds in 9.3 9 ho spita ls d ischa rg ing individu a ls with com plex ne ed s. Hospita ls m u st co nsid er Hea lth - Rela ted Socia l Need s (HRS Ns) when p la nn ing discha rg e s of individu a ls with com plex ne ed s. Whe n sub m itt ing cla im s f o r ser vices, includ ing th e I CD - 10 S ocia l Dete r m in a nt s of Hea lth Z co de s in th e cla im s, a s a p pr o pr ia t e, would g r ea tly a ssist th e Sta te’s d a t a f or pu blic he a lth a na lyses a n d f ut ur e inve stm ent s. A PPO INTMENT W I T H I N S EVEN C ALEN D AR D AY S 9.3 9 HO SP ITAL E ME RG ENCY D E P ARTME NTS T his se ction d oe s no t a pp ly to a ll E Ds, r a the r on ly E Ds in 9.3 9 ho spita ls d ischa rg ing individu a ls with com plex ne ed s. Hospita l E Ds m ust sch ed ule a n d con f ir m a n a p po intm en t f o r psych ia tr ic a f te rca re with a n ide ntif ied pr o vider with in se ven ca le nd a r d a ys f ollowing d ischa r g e. A r e f e r r a l to a wa lk - in int a ke clinic a lon e is no t a be st p r a ctice to m eet th is re qu ire m en t. If, a f te r m a king diligen t e f f o r ts, a h osp ita l ca nno t id en tif y a n a f ter ca re p ro vide r with a n a va ila ble a p po intm en t within seve n ca len da r da ys, th e h osp ita l sh a ll do cum en t its ef f or ts, in cludin g e f f o r ts t o sche du le th e a p po intm en t f or a s soo n a s p ossib le th e r ea f t er. I n t he e xtr a o rd ina ry e ven t a n a p po intm en t f or p sychia tric a f t er ca r e ca n no t be secu r ed a t a ll (ple a se r ef er b elo w f or f inding ou tpa tien t m en ta l h ea lth p r og ra m s), th e h osp ita l sh a ll do cum en t its ef f or ts b ef or e disch a r gin g t he pa tient a n d pr ovid e su c h d ocu m e nt a tio n t o t he Dep a r tm en t o f Hea lth up o n r e qu est. If you h a ve dif f icu lty m a king a n a p po intm en t f o r psych ia tr ic a f te r ca r e within 7 d a ys, plea se co nta ct Hospita lCa re @om h.n y.go v. Plea se includ e in yo ur m essa ge th e b est wa y f or t he OM H Reg ion a l T ea m t o con ne ct with the co r re ct p er so n in th e E D. Ind ividua ls who a r e lea ving th e ho spita l a ga inst m ed ica l a d vice o r who sta te t he y do n ot wish to r ece ive a f te r ca r e se r vices m ust be o f f e re d inf or m a tion a b o ut a va ila b le t re a t m e nt op tion s a nd sho uld ha ve a n a p po intm en t sch e du led when eve r p ossible. Of f er ing a pp o intm ent s a n d inf or m a tion a b o ut tr ea tm e nt r eso ur ce s sign if ica ntly incr e a se s r a te s o f successf u l ca r e tr a n sitions, eve n a m on g t ho se pa tient s who decline a f te r ca r e a nd a r e a t th e g r ea test risk f o r re a d m issi o n a nd ot he r po or o ut com es. CP E P S Hospita ls m u st sch ed ule a n d con f ir m a n a p po intm en t f o r psych ia tr ic a f te r ca r e with a n ide nt if ie d pr o vider with in se ven ca le nd a r d a ys f ollowing d ischa r g e. If, a f te r m a king diligen t e f f o r ts, a h osp ita l ca n no t ide nt if y a n a f te rca re p r ovide r with a n a va ila ble ap po intm en t with in se ven ca len d a r d a ys, the

15 ho spita l sha ll do cum en t its ef f or ts, in cludin g e f f o r ts t o sch ed ule th e a pp oint m e nt f or a s soo n a s po ssible t he r ea f te r. A r e f er ra l to a wa lk - in in ta ke clinic is insu f f icien t to m ee t th is r eq uir em en t. When a n a ppo intm en t f or m e nt a l h ea lth se rvice s ca n no t b e m a de within seve n ca lend a r d a ys, cr isis out re a ch te a m s o r ot he r a va il a b le CP E P sta f f sha ll p r ovide cr isis ou tr ea ch u nti l the initia l a ppo intm en t o ccur s. Ind ividua ls who a r e lea ving th e ho spita l a ga inst m ed ica l a d vice o r who sta te t he y do n ot wish to r ece ive a f te r ca r e se r vices m ust be o ffe r e d info r m a tion a b ou t a va ila ble t r ea t m ent op tion s, a nd ha ve a n a p po intm en t sch ed uled whe n eve r po ssible. Of f e r ing a p po int m en ts a nd inf or m a tion a b ou t t r ea t m ent r eso ur ces significa n tly incr ea ses r a t es o f succe ssf ul ca r e tr a nsitions, even a m o ng th ose p a tien ts who de cline a f t er ca re a n d a r e a t the g r ea t est r isk f o r r ea dm ission a nd oth e r po or o ut com es. If you h a ve dif f icu lty m a king a n a p po intm en t f o r psych ia tr ic a f te r ca r e within 7 d a ys, plea se co nta ct Hospita lCa re @om h.n y.go v. Plea se includ e in yo ur m essa ge th e b est wa y f or t he OM H Reg ion a l T ea m t o con ne ct with the co r re ct p er so n in th e CP E P. P SY CHIA TR IC I NPA TIENT P ROG RA MS Hospita ls m u st sch ed ule a n d con f ir m a n a p po intm en t f o r psych ia tr ic a f te r ca r e with a n ide nt if ie d pr o vider with in se ven ca le nd a r d a ys f ollowing d ischa r g e. A r e f e r r a l to a wa lk - in int a ke clinic is insuf f icient t o m e et th is re qu ir em en t. If, a f te r m a king diligen t e f f o r ts, a h osp ita l ca nno t id en tif y a n a f ter ca re p ro vide r with a n a va ila ble a p po intm en t within seve n ca len da r da ys, th e h osp ita l sh a ll do cum en t its ef f or ts, in cludin g e f f o r ts t o sche du le th e a p po intm en t f or a s soo n a s p ossib le th e r ea f t er. A r e f er ra l to a wa lk - in in ta ke clinic is insu f f icien t to m ee t th is r eq uir em en t. Ind ividua ls who a r e lea ving th e ho spita l a ga inst m ed ica l a d vice o r who sta te t he y do n ot wish to r ece ive a f te r ca r e se r vices m ust be o ffe r e d inf or m a tion a bou t a va ila ble tr ea tm ent op tion s a nd ha ve a n a p po intm en t sch ed uled whe n eve r po ssible. Of f e r ing a p po intm en ts a nd inf or m a tion a bou t t re a t m e nt r eso ur ces significa n tly incr ea ses r a t es o f succe ssf ul ca r e tr a nsitions, even a m o ng th ose p a tien ts who de cline a f t er ca re a n d a r e a t the g r ea t est r isk f o r r ea dm ission a nd oth e r po or o ut com es. If you h a ve dif f icu lty m a king a n a p po intm en t f o r psych ia tr ic a f te r ca r e within 7 d a ys, plea se co nta ct Hospita lCa re @om h.n y.go v. Plea se includ e in yo ur m essa ge th e b est wa y f or t he OM H Reg ion a l T ea m t o con ne ct with the co r re ct p er so n on th e u nit. F I ND ING O U T PATI ENT M EN TAL H EAL T H P R OG R AMS A LL P RO G RAMS P SY CK E S ca n a le rt h osp ita ls whe re a n ind ividua l m a y a lr ea dy b e r e ceiving ser vice s (or h a s pr e viously r e ceived ser v ices). Co nn ect in g with cur r e nt or r e ce n t o utp a tien t p r ov ide r s f o r a f te r ca r e ca n en sur e con tinu ity a nd im p ro ve en ga gem en t. OM H ha s a n o nline m ent a l h ea lth p ro gr a m d ire cto r y tha t p ro vide s inf or m a tion o n a ll pr og ra m s in New Y o rk S ta te t ha t a r e op er a ted, licen sed, o r f und ed b y OM H. T his site includ es thr e e sea r ch o ptio ns: B a sic Sea r ch, Adva n ced Sea r ch, a nd F ull Dire ctor y. Adva nce d S e a r ch of f er s th e m ost op tion s t o

16 na rr o w re sults by m ultip le cr iter ia. Def inition s f or a ll p r og ra m s a r e a va ila b le u nd er the Supp or t ta b, a lon g with d ire ctor y he lp a nd inf or m a tion on p ro g ra m da t a co llection. Hospita l lea d er sh ip sh ou ld f oste r a wor king r ela t ionsh ip with th e Dir ecto r s o f Com m u nity Ser vice (DCS) of th e Coun ties in th eir ca tchm en t a re a. T he DCS ove r see s b eh a vior a l hea lth f or t he Cou nty go ver n m e nt. Ever y yea r, the Coun ty is r e qu ire d to de ve lop a Lo ca l Ser vices Pla n (L SP) a n d t he DCS is f a m ilia r with lo ca l ou tp a tie nt re sou r ces. T h e Single P oin t o f A ccess (S POA) a n d Ch ildre n’s Single P o int o f A ccess (C- SP OA) in ea ch co un ty DCS o f f ice a re sp ecif ic con ta ct s f or loca ting re sou r ces. T he OM H Of f ice of Hosp it a l Ca r e a nd Com m un ity T r a n sition Reg iona l Te a m s a r e d eve lopin g Co un ty - spe cif ic r e f er ra l re sou r ces which will be dissem ina t ed whe n com plet e a nd will b e m a int a ine d. F o r m o r e inf or m a tion on th is r eso ur ce, p lea se co nta ct Hospita lC a r e @om h.n y.g ov. OM H is inve sting in a n e xpa nsion of Cer t if ied Com m unity B eh a vio ra l Hea lth Cen ter s (CCBH Cs), de signe d to tr e a t bo th m e nt a l he a lth a n d sub sta n ce use diso rd er n ee d s; Sa f e Op tion s Supp or t (SOS) T ea m s f o r individu a ls e xpe r iencin g h om ele ssne ss; a nd Critica l T im e I nte r ven tion (CT I) to p ro vide tim e - lim ite d ca re m a na ge m e nt to he lp ind ividua ls conn ect to ou tp a tien t lo ng itud in a l se r vices. F o r m ing r ela tio nsh ips with the se pr o gr a m s a s the y d eve lop wil l lea d to b ett er r e f er ra l op tion s a n d a dd ition a l a ssista n ce f or ind ivid ua ls t o a ccess o ut pa tient ser vices. T h ese pr o gr a m s ca n b e f o u nd in t he on line dir ect or y m en tion ed a b ove. OM H clinics, f or m a lly known a s M en ta l He a lth Out pa tient T r ea tm ent a n d Reha bilita tion Service s (MHOT Rs), a nd CCB HCs a re r eq uir ed in r e gu la tio ns to p rio r itize r ef er r a ls f r om ho sp ita ls. M o st § 9.3 9 Hospita ls op er a t e o ut pa tient m ent a l he a lth se r vices – a ppr o xim a tely 7 0% op er a t e clinics/M HOT Rs pr o gr a m s. While re f er r a ls sh ou ld b e in dividu a lized to th e n ee ds of e a ch pa tient, lea de rsh ip o f E m er ge ncy a n d O utp a t ient Beha vio r a l Hea lth Dep a r tm en ts sh ou ld d eve lop wor kf lows to f a cilita te inte r na l r e f er r a ls whe n a clinic/M HOTR is t he m ost a pp ro pr ia t e n ext leve l of ca r e. M ed ica id M a n a g ed Ca r e a n d o th er m a n a g ed pla ns a r e r eq u ire d t o su pp o rt th eir m em ber s in se eking a p pr o pr ia te ca r e. Building a r ela t ionsh ip with insur er s tha t co ver h igh pe r cen ta g es of ind ividua ls who pr e sen t to th e ho spita l ca n a lso b e a sou r ce o f inf or m a tio n on a va ila ble r e sou r ces in th e co m m u nity. New ne twor k a de qu a cy la ws a nd r eg ula t ions r eq uir e in sur e rs to a ssist p a t ient s a n d ho spita ls loca te in - ne twor k se r vices o r a p pr ove se r vices b y ou t - of -n et wor k pr o vide rs a t no a d ditio na l co st - sh a r ing. K n ow Your Righ ts a nd Go ver no r ’s Annou nce m en t. P SY CHIA TR IC I NPA TIENT P ROG RA MS Ind ividua ls who m igh t be ne f it f r o m m o r e socia liza tio n, psych oe du ca tio n, a n d/o r p sycho socia l r eh a b ili ta tion ca n b e r e f er r e d to P er son a lized Reco v er y O rie nte d S er vice s (P ROS) p r og ra m s or loca l Clubh ou se p r og r a m s. PROS pr o gr a m s o f ten ha ve a n a f f ilia ted clinic tha t ca n p ro vide on go ing ph a r m a colo gica l tr e a t m e nt. D ISCH AR G E S UMMAR Y A LL P RO G RAMS T his se ction d oe s no t a pp ly to a ll E Ds, r a the r on ly E Ds in 9.3 9 ho spita ls d ischa rg ing individu a ls with com plex ne ed s.

17 Within se ven da ys of d ischa r g e, th e p r og r a m m ust f or wa r d a writte n discha rg e no te de ta iling th e histo r y of p re se nt ill ne ss, h osp ita l co ur se, a nd ot he r r eleva nt inf or m a tion to t he o utp a t ient, r eside nt ia l, a n d/o r lon g - ter m ca re tr ea tm e nt pr o gr a m. C OO R D INATI O N WI TH C AR E M AN AGER S A LL P RO G RAMS T his se ction d oe s no t a pp ly to a ll E Ds, r a the r on ly E Ds in 9.3 9 ho spita ls d ischa rg ing individu a ls with com plex ne ed s. If th e in dividua l is en ro lled in a ca r e m a na g em en t p r og r a m (e. g., Hea lth Hom e, Hea lth Hom e P lus, High F idelity Wr a p a r ou nd, a ctive AOT o rd er, AC T), t he ho spita l m u st co or d ina t e d ischa rg e p la n ning with th e ca r e m a na g em en t pr og r a m. Hosp ita ls sh ou ld in vite ca r e m a na ger s in to the p r og ra m to m e et with th e pa tient (a n d g ua rd ia n (s), if the p a tie nt is a m ino r), eve n when th e ca r e m a na ger is n ot a n em ploye e or o th er wise a f f ilia ted with t he ho spita l. W AR M H AN D OF F S /V ER BAL S IGN - OUT CP E P S AND P S Y CHIATRIC I NPA TIENT P RO G RAM S F or in dividu a ls with co m plex n e ed s, th e discha rg ing CP EP or Psychia tr ic In pa tient Prog r a m m ust pr o vide a ve r ba l cli nica l sign - o ut on th e da y of d ischa r g e, or a s soo n a s p ossible th er e a f ter t o the r ece iving o ut pa tient pr o gr a m. I f a pp lica ble, ve rb a l sig n - out sho uld a lso b e give n t o r e siden tia l pr o gr a m s (license d o r f un de d b y OM H, th e Of f ice of Addictio n Ser vices a nd Suppo r ts (OAS AS), the Of f ice f or Peop le with Develo pm en ta l Disa b ili ties (OPW DD), o r th e DOH) wh er e th e in dividu a l will r eside a f te r disch a r ge. T h is m u st b e do ne in a ccor da nce with se ction 3 3.1 3 of th e M en ta l Hygie ne La w, f o r which a d dition a l g uid a n ce ca n b e f o un d h er e. I NIT I ATI NG C AR E M ANAGEMENT R EF ER R AL S CP E P S F or in dividu a ls with co m plex n e ed s who a r e en r olled in a M ed ica id M a na g ed Ca r e Or g a n iza tion (MCO) a nd who a re e ligible b ut no t e nr o lled in inte nsive ca r e m a na ge m e nt or wh o n e ed m or e inte nsive ca r e m a na gem en t, CP E Ps m u st ca ll th e M CO a n d inf or m a n M CO Ca r e M a n a g er o f the discha rg e. P SY CHIA TR IC I NPA TIENT P ROG RA MS F or in dividu a ls with co m p lex n ee ds wh o a re eligib le bu t n ot en r olled in in ten sive ca re m a n a g em en t o r who ne ed m or e inte nsive ca r e m a na gem en t, the h osp ita l m ust m a ke a re f er r a l to a n int en sive ca re m a na gem en t p r og r a m (e.g. He a lth Hom e Plus, High F ide lity Wr a pa ro un d). P RE -D IS CHA RGE I NT E RV EN T IO NS T O I M PROV E D I S CHAR GE O UT COM E S P EER P R O GR AMS

18 CP E P S CP E Ps wi th est a b lished P e er Specia list p r og ra m s sho uld ha ve Peer s e ng a g e individu a ls d ur ing th eir sta y to de velop r a ppo r t, d im in ish stig m a, sha re r e sou r ces, a n d e nco ur a ge on go ing ca r e. Peer S p ecia lists sh ou ld a lso a ssist in dividu a ls with a ccessing a d d ition a l su pp or ts in th e com m u nity to pr o m o te inte gr a tion a n d r e cove r y. P SY CHIA TR IC I NPA TIENT P ROG RA MS If the h osp ita l h a s Peer S up po r t Ser vices, pee r s ca n e ng a ge ind ividua ls du rin g t he ir sta y to de velop r a pp o rt, d im inish stigm a, sha re r eso ur ce s, a nd en cou r a g e o ng oin g ca re. T he y sho u ld a lso a ssist individu a ls with a ccessing a d ditio na l supp or ts in th e com m u nity to pr o m o te inte gr a tion a n d r e cove r y. C OMMUN IT Y S U ICIDE S AF ET Y P L AN E ME RG ENCY D E PA RTME NT S It is a r e com m e nd e d b est pr a ctice tha t ind ividua ls wi th a n eleva ted r isk o f self - ha rm or su icide ha ve a com m u nity suicide sa f e ty p la n com plete d b ef o re discha rg e (e.g. the Sta nley - B r own Brie f Inte rve nti o n). T his p la n sho uld be d eve lop ed with th e individu a l a nd sha re d wi th ou tp a tie nt, r eside nt ia l, a n d/ or lo ng - ter m ca r e p ro vide r s. F o r m inor s living with th eir f a m ily, the f a m ily shou ld b e pa r t of p la nn ing. CP E P S AND P S Y CHIATRIC I NPA TIENT P RO G RAM S A ll individu a ls m ust be scr ee ne d f or suicida lity pr ior to th eir d ischa r g e. In dividu a ls with a n e leva ted r isk of self - h a r m or su icide m ust ha ve a com m u n ity suicide sa f et y p la n co m plete d be f or e d ischa rg e (e.g. th e Sta nle y- Brown Brief Int er ven tion). T h e p la n m u st b e de velo pe d co lla bo r a tive ly a nd r o ote d in the ind ividua l’s histor y – t he pla n is n ot m e r ely a pr ep o pu la ted f or m th a t is ha nde d to the ind ividua l. Le tha l m e a n s sh a ll be ide nt if ied a nd a p la n f or th eir r est rictio n a dd re ssed. Hospita ls sha ll d ocu m ent the ir wor k with ou tpa tien t a n d r eside nt ia l pr o gr a m s to co m m un ica te a nd im p lem ent th e p la n. F o r m in or s living with th eir f a m ily, the f a m ily shou ld b e pa rt of p la nn ing. M IT I GAT ING R ISK O F V IO LEN C E I N T HE C OMMUN IT Y E ME RG ENCY D E PA RTME NT S It is a r eco m m en de d be st p r a ctice th a t discha rg e of ind ividua ls wi th a n e leva t ed r isk of violen ce includ e clo se co lla bo ra tion with ke y com m u nity pa r tn er s (e.g., cu r re nt o utp a t ient, r esid en tia l, o r lon g - ter m ca r e pr o vide r, ca r e m a na ger s, shelte r s, th e lo ca l gove r nm en t u nit, p ee r a d voca tes) in the o ver a ll str a te g y to a d dr e ss violen ce r isk f a ctor s a nd a cce ss to wea pon s. CP E P S Discha r ge o f individua ls with a n ele va te d r isk o f violence sha ll i n clude, to e ver y e xte nt po ssible, close colla b or a t ion with cu rr e nt a n d ne w ou tpa tien t p ro vide r s, r esid en tia l p ro vide r s if a p plica ble, sch oo l if a p plica ble, a nd the Coun ty Dir ecto r of Com m uni ty S er vice (DCS) to inco rp o r a te st ra teg ies t o a dd re ss violen ce r isk a nd a cce ss to wea pon s int o t he ove r a ll disch a r ge p la n. Peer Specia lists sh ou ld b e en ga ged to h elp with d ischa r g e pla n ning f or t he se in dividu a ls. Co or din a tio n m ust be d on e in a cco rd a n ce with pr o te cted h ea lth inf or m a tio n (PHI) p r iva cy la ws; p lea se se e a ddition a l g uid a n ce on inf or m a tion sha rin g.

19 P SY CHIA TR IC I NPA TIENT P ROG RA MS Discha r ge o f individua ls with a n ele va te d r isk o f violence sha ll i n clude close colla b or a tion with cu rr e nt a n d n ew o ut pa tient pr ovide r s, r esid en tia l pr o vider s if a p plica b le, sch o ol if a pp lica ble, a nd the Cou nt y Direct or o f Com m un ity Service (DCS) t o in cor po r a te str a t eg ies to a d dr e ss violen c e r isk a nd a cce ss to wea p on s int o t he ove r a ll disch a r ge p la n. Coo r dina tion m u st b e do ne in a cco rd a n ce with p ro te cte d he a lth inf o rm a t ion (PHI) pr iva cy la ws; plea se se e a dditio na l guid a n ce o n inf or m a tion sha rin g. A DD R ESSING S UBSTANC E U SE A LL P RO G RAMS It is a r eco m m en de d be st p r a ctice th a t individu a ls a t r isk f or a n o pioid ove r do se or who live with som eo ne a t r isk be d ispen sed o r pr e scr ibed n a loxo ne a n d give n e du ca t ion on ho w to use it. T he se individu a ls sh ou ld a lso be e du ca te d on h ow to o bta in n a loxo ne in the co m m un ity a f te r d ischa r g e. A d dition a l e du ca tion a bou t h a r m r ed uct ion str a te gie s, su ch a s ne ver u sing a lon e, usin g f ent a n yl test str ips, a nd inf or m a tion a b o ut con ta m ina n ts sh ou ld b e pr o vided to ind ividua ls a t r isk o r living with som eo ne a t risk o f ove r do se. It is a r e com m e nd e d b est pr a ctice tha t ind ividua ls who m ee t cr iter ia f or o pio id u se d isor d e r be of f er ed bu pr e no rp h ine or lon g - a ctin g n a ltr e xon e, if a p pr o pr ia te, a nd r ef er r ed to a n o utp a t ient pr o vide r who ca n con tinu e the t re a t m e nt a n d be give n a br idg e pr e scr ipt ion un til the a ppo intm en t. S im ila r ly, individu a ls who m ee t cr ite ria f o r a lcohol o r to ba cco u se disor d er s sh ou ld b e of f er ed a p pr o pr ia t e ph a r m a colo gica l int er ve ntio ns a nd r ef er r ed t o a ne w or e xisting pr o vider who ca n con tinu e the tr ea tm e nt. L ONG -A CTI NG I N JEC T ABL E M EDICATI ONS E ME RG ENCY D E PA RTME NT S AND CPE P S F or in dividu a ls o n a ssisted ou tp a tien t t r ea tm e nt (A OT) or de r s, EDs a nd CPE P s sho uld of f er a nd a d m in ister m issed do ses o f lon g - a ctin g in jecta b le m ed ica tio ns wh en clinica lly a p pr op r ia te. P SY CHIA TR IC I NPA TIENT P ROG RA MS Ind ividua ls who ne ed tr ea tm ent with a ntipsych o tic m e d ica tion who ha ve a kno wn h istor y o f ha ving dif f icu lty con sisten tly ta king m ed ica tio ns p ost -d ischa rg e sh ou ld b e con sider e d f or tr ea tm ent with a long - a cting in jecta ble a ntipsych ot ic m e d ica tion. If a ppr o pr i a te, th e in du ction d ose (s) sho uld be a d m in ister ed p r ior to d ischa r g e. S im ila r ly, ind ividua ls who m a y be ne f it f r o m long -a cting injecta ble na ltre xon e o r b up r en or ph ine sho u ld r ece ive t he ir indu ction d ose pr ior to discha rg e. P SY CH IAT R IC A D VAN C E D IR EC T IVES C PEP S A ND P S YCHIA TRIC I NPA TIENT P ROG RAMS If, o n p r ese nta tion, th e individu a l d id n ot ha ve a P sychia tric Adva n ce Dire ctive (PA D), the p r og ra m sha ll p r ovide a cop y a n d exp la na tion of th e PA D on ce the ind ividua l is no lon ge r in cr isis. If th e individu a l ch oo ses to com plet e a PA D, it sho uld be inco r p or a t ed into t he tr ea tm ent a n d discha rg e pla n, p la ce d in th e ch a r t, a n d f or wa r de d a long with o th er d ischa rg e in f or m a tion to th e r e ceiving

20 ou tpa tien t o r r eside nt ia l pr o vider. F or individu a ls e nr o lled in M ed ica id, sta f f sho uld up loa d th e P AD into PS Y CK E S (p lea se se e instr uct ions). PA Ds de ta il a n ind ividua l’ s p r ef er e nce s f or f utu r e m e nt a l he a lth tr ea tm ent de cisions a nd m a y n a m e a n ind ividua l to m a ke tr e a tm en t d ecision s if the individu a l is in a crisis a n d un a b le t o m a ke de cisions. An exa m p le o f a PA D ca n be f ou nd h er e. C ONCL US ION H OSPI T AL P R O GR AMS AR E A C R I TI CAL F O U N DATI ON O F THE M EN TAL H EALTH S Y ST EM Cli n icia ns, a dm inistra tor s, a nd ot he r sta f f who ser ve p a t ient s in ED s, CPE P s, a nd P sychia tric I np a tien t Units a re tr u e h er o es in New Yor k’s M en ta l Hea lth System who ha ve sh own th eir d ed ica tion in e ver incr ea sing wa ys since the be ginn ing of th e COVID -1 9 pa nd em ic, th r ou gh th e p o st - COVID beh a vior a l he a lth cr isis, a n d in to a n eve r m or e com plex f isca l envir on m ent. Rece nt cha ng es t o M e nt a l Hygie ne La w a nd NY S Regu la tion s a r e a im ed a t en su rin g t ha t th e syst em in its en tire ty b et te r com m u nica tes a n d co or d ina t es to he lp New Yor ker s with be ha vior a l h ea lth n ee ds ge t th e ca r e the y d ese r ve. T h e NY S Dep a r t m e nt of Hea lth a nd Of f ice of M e nta l Hea lth a r e d ee ply th a n kf ul to a ll ho sp ita l sta f f f or im p lem ent ing the se n ew r eq uir e m e nt s a nd r eco m m e nd ed be st p r a ctice s to r ed uce r e a dm issions a nd ho pe f ully pr eve nt tr a g ic ou tco m es. T ECH N ICAL A SSI ST AN CE & S U PPOR T F O R A LL P R O G R AMS OM H’s Of f ice of Hosp ita l Ca r e a n d Com m u nity T r a nsition s (OHCCT) h a s six re g iona ll y - b a se d tea m s f o cu sed on p r oviding t ech nica l a ssista nce a n d sup po r t to OM H - license d A r ticle 2 8 a n d 3 1 ho spita l pr og r a m s. OHCCT is colla b or a t ing with DOH to su pp or t 9.3 9 E m er ge ncy Depa rt m e nt s in m e et ing th e n ee ds of ind ividua ls wi th be ha vior a l h ea lth cr ises. T o co nn ect with O HCC T, plea se con ta ct Hosp ita lCa r e @om h.n y.go v.