Adult Mental Health
The island’s organizational structure of its system of care is comprised of DMHSA (the single state agency of mental health and substance abuse services), private and non-profit providers, as well as services provided by the military sector. In addition, DMHSA collaborates with public child-serving agencies such as Dept. of Education, Child Welfare, Dept. of Youth Affairs, Juvenile Probation Dept. and Dept. of Integrated Services for Individuals with Disabilities (DISID), as well as private and non-profit providers.
Intake/Emergency Services:
This branch, comprised of 2 intake workers, provides screening interviews and mental status examination (psychiatric assessment) on every consumer coming into DMHSA. This is specialized social work requiring training and experience in the use of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) of the American Psychiatric Association. Intake Workers must consult with the Clinical Administrator, staff psychiatrist to determine immediate treatment needs in crisis cases and formulate diagnostically based treatment recommendations for routine cases. Intake workers respond to telephone calls by persons immediately and make proper referrals within or outside DMHSA, including drug and alcohol evaluations. On a case-by-case basis, intake workers provide outreach intake services or emergency situations.
Community Support Services (Case Management) Branch:
The Community Support Services (CSS) branch, comprised of 7 social workers and a Social Services Supervisor, operates under the Clinical Services Division and is an outpatient program. It provides intensive aftercare support and advocacy to long-term seriously mentally ill adults (159) SMI adults per month) and their families in the community. The CSS operates under the Generalist Model. Under this model, one individual or social worker is responsible for all case management functions. The advantage of this model is:
1. Provides each consumer with a single person whom they can relate to on an individual basis;
2. Allows staff to use a variety of skills;
3. Provides staff more autonomy in their daily activities;
4. Facilitates clear record keeping and greater staff accountability.
The categories of services are community-based which include Assessment; Comprehensive Care Plan; Service Procurement; Monitoring; Tracking; Evaluation; Crisis Intervention; Home-Based Services; and Supportive Counseling; short-time case management services on an as-needed basis to Adult Inpatient Unit and Medication Clinic to those SMI adults not yet with an assigned social worker. Depending on their level of functioning, consumers are seen monthly or more often.
Outpatient Adult Counseling:
One (1) therapist trained in the area of individual, marriage, and family therapy staff the Adult Counseling Branch. As psychiatric social workers, they address the psychotherapy needs of Consumers who meet the diagnostic criteria within the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association. In addition to providing therapy, the therapist provides consultations, referrals, and collaborations with agencies both in government and private sectors.
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Medical Records
HEALTH INFORMATION MANAGEMENT
(Formerly Medical Records Management)
Information is the lifeblood of the health care delivery system. The medical record, in manual or automated form, houses the medical information that describes all aspects of every consumer’s care.
Physicians, nurses, and other health care providers require health information for treating a consumer. The medical record serves as a communication link among caregivers. Documentation in the medical record also serves to protect the legal interests of the consumer, health care provider, and the Department of Mental Health and Substance Abuse. Medical records are important to the financial well being of our facility as they substantiate reimbursement claims. Other uses of medical records include provision of data for medical research, education of health care providers, public health studies, and quality review. (10th edition Health Information Management)
Understanding Your Medical Records
To receive quality healthcare, accurate and timely health information is required. Your health information referred to as medical records serve—the following purposes in the delivery of quality care:
- Basis for planning your care and treatment
- Legal document describing the care you received.
- Basic data for healthcare funding, research and planning
- Means of communication for the many health professionals who contribute to your care.
Your Health Record
Who owns your medical records? The health record is the physical property of the Department of Mental Health and Substance Abuse. However, the fact that the provider owns the physical record does not prevent you from submitting a request to access it. If you would like to access your health record, contact your doctor or social worker or the Medical Records Branch.
Access, content, confidentiality—knowledge of these important aspects of your health information is vital in becoming an informed healthcare consumer.
Accessing Your Health Record
There are many good reasons why you should have access to your health record including:
- Verifying information and charges for your care
- Knowing what is released when you authorize disclosure of your records to other parties
- Being able to provide your past medical history and treatment to new healthcare providers for continuum of care.
- Establishing and updating a personal health record.
When you request copies of your health record, contact DMHSA’s Medical Records Branch, you will be required to complete a standard Consent To Release Confidential Information Form. Be sure to complete the form in its entirety to avoid delays. Requesting for recent information rather than the entire chart or requesting specific documents such as summaries or medication forms will save you time and money as we may charge you a fee.
Content: Documents common to most health records
- Intake Screening and Evaluation is a form originated at the time of registration. This form lists your basic demographic information, provisional diagnosis and treatment recommendations.
- Master Treatment Plan is a form listing specific treatment goals and objectives.
- Medication Record is a list of medicines that have been prescribed or given to you. This form also contains medication allergies you may have.
- Integrated Progress Notes are notes made by the doctors, nurses, social workers and others in caring for you. Your response to treatment and their observations and plans for continued treatment.
- Physicians Orders are specifically for your physician's directions to other members of your healthcare team regarding your medication, tests, diet and treatment.
Protecting the Confidentiality of Your Health Record
Keeping your health record confidential is an important and ethical responsibility of healthcare professionals and listed below are things you can do to help too.
You should first be aware of what health information is being collected about you and by whom. Remember workplace, clinics and employer-sponsored wellness and employee assistance programs may maintain information about you. Find out who is in charge of that information, and ask about safeguards they use to keep your information confidential.
Take time to read the fine print before you consent to release your health information. The consent should be specific to the type and time period of your intended purpose. The consent should be limited in scope and think carefully before you sign the consent form that grants another party the right to view and/or receive “any and all documents”. A simple question to ask yourself is “do they really need all information and also could they do with less such as the only a date of service?
Where are we going with your health record?
DMHSA collects and stores your health information into an electronic medical record system using the Tier program. You may wonder what effect computerization has on the confidentiality of your health record. It’s important to remember that manual record keeping systems presents many of the same risks to confidentiality on computer systems. Some of the security measures as well-designed computerized health information systems offer better protection than file catalog systems, by imposing technological barriers such as passwords and encryption.
Guma IFIL (Transitional Residential Program):
The adult Residential Program began operations March 1990, providing 24-hour supervision and support to persons suffering from serious mental illness. Eight psychiatric technicians, a Support Services Supervisor, 1 social worker, and 1 Community Program Aide. There were 9 SMI adults placed at Guma IFIL in FY 2004.
This program provides residents who suffer from chronic mental illness with the necessary training and skills, helping them to attain greater independence and self-sufficiency within the community. Residents receive case management, psychiatric follow-up, supportive counseling, and Day Treatment Services
Guma Hinemlo’ (Permanent Supportive Housing):
Jointly run by DMHSA and Guma Mami Inc., a non-profit organization Guma Hinemlo’ (healing home), serves homeless adults with a serious mental illness at a permanent supportive housing program. Guma Mami Inc. runs the home and provides care worker services, and DMHSA provides day treatment, case management services, and psychiatric consultation. The program serves individuals who are clinically stable, yet are not able to live independently without supervision. A program manager, social worker, psychiatrist, and care workers serve and monitor the residents of the supportive housing program. Guma Hinemlo’ aims to provide a “surrogate family milieu” to people who may at time of admission have no family or significant other, or who are separated or alienated from the ones they have. Residents of the program will be assisted in acquiring and/or improving life management skills to include: personal management; nutritional management; money management; home management; medical medication management; daily activity time management; social skills; resource utilization; problem solving; coping behaviors; and safety. Guma Hinemlo’ staff provide 24 hour monitoring daily; residential transportation to supportive services. The residents are internal transfers who will come from within the department’s services, DMHSA’s Adult Inpatient, Community Support Services Branch, or Guma IFIL. There are currently 4 SMI adults living at Guma Hinemlo’.
- Intake/Emergency/ Adult Inpatient Unit or
- Guma Hinemlo’ or
- Outreach Services
- Community Support Services
- Independent Living
- Guma IFIL
Day Treatment Services:
The Day Treatment Services (DTS), with 3 psychiatric technicians and a Support Services Supervisor (who supervises DTS, Guma IFIL, and Guma Hinemlo’), is a service under the Clinical Services Division. This program is designed to provide structured, therapeutic activities for the long-term, serious mentally ill adults. These includes those acute mentally ill adults still hospitalized at the Adult Inpatient Unit, and are in need of a less restrictive environment to assist in a smooth transition to home and community living. The primary objective of the DTS program is to promote and enhance the psycho-social, economic and physical well being of each consumer enrolled with the program. This is done through therapeutic group work, a primary focus of DTS, whereby the consumers are involved in a variety of activities such as social skills, arts and crafts, personal hygiene, independent living skills, recreational and work activities. In FY 2004, there were approximately 24 SMI adults who participate at DTS at any given time; in FY 2003, an average of 30 SMI adults participated at DTS at any given time.
Sagan Mami (Drop-In Services):
Sagan Mami is a drop-center for SMI adults who need a place to socialize and feel a sense of ownership and need. Many of them seek acceptance from the community. The center serves as a transition to other community venues. Guma Mami, Inc., and DMHSA also collaboratively run Sagan Mami. DMHSA provides the venue for the drop-in center and Guma Mami, Inc. operates the center. Funding is provided by the Project for Assistance in Transition from Homelessness (PATH). The center is run by 2 staff and had 40 members in FY 2004.
Crisis Hotline:
The Crisis Hotline (CHL) project, comprised of 1 full-time staff and coverage provided by staff of the Adult Inpatient Unit, started as an information help line for Desert Storm and from this tumult was recognized a need for a 24-hour telephone "counseling" service to the island community. Under the umbrella of the Volunteers are Important People (VIP), out of the Governor's Office, the Crisis Hotline started its operations at 6:00pm, January 17, 1991. In 1995, the CHL was integrated into the Department of Mental Health and Substance Abuse, Clinical Services Division.
Purpose:
The purpose of the Crisis Hotline is to assist individuals experiencing crisis situations, through staff and volunteers having undergone comprehensive training in crisis intervention, and a strong networking system with other governmental agencies and private organizations.Approximately 320 calls come through the Crisis Hotline every month. The spectrum of crisis calls range from a youngster needing help with his homework to suicide. The most prevalent calls are relationship problems, most of which are compounded by depression.
The Crisis Hotline has as a strong networking system with agencies such as VARO (Victims Advocate Reaching Out), a private, non-profit organization helping abused spouses and/or children; Alee Shelter, a safe refuge for victims of domestic violence; Guam Police Department (GPD); Guam Fire Department (GFD); Civil Defense; Child Protective Services (CPS); Adult Protective Services (APS); and Adult Outpatient Services. DMHSA staff, as a collateral duty, currently provides supportive resources to the hotline.
Co-occurring Substance Abuse and Mental Disorders service:
The Mentally Ill Chemical Abuser (MICA) group commenced October 1, 1999. A chemical dependency treatment specialist facilitates the group with over 10 years experience in their respective fields. A Chemical Dependency Treatment Specialist runs the program from the Drug and Alcohol Branch.
The group focus is on education of substance abuse and mental illness. Components of twelve steps, recovery goals, relapse prevention, stress management, and education on psychotropic medications. Each group member is encouraged to attend self-help groups such as Alcoholics Anonymous and Narcotics Anonymous.
The co-facilitators coordinate with the Consumers’ assigned social workers to eliminate barriers that prevented them from coming to the drug and alcohol group.