Mental Health Services
Service Standard
Mental Health Services Service Standard print version
Subcategories | Service Units |
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Mental Health Services – Individual | Per visit |
Mental Health Services - Group | Per visit |
Mental Health Services – Psychiatric Evaluation | Per visit |
Mental Health Services – Psychiatric Follow-up | Per visit |
Health Resources and Services Administration (HRSA) Description:
Mental Health (MH) Services are the provision of outpatient psychological and psychiatric screening, assessment, diagnosis, treatment, and counseling services offered to clients living with HIV. Services are based on a treatment plan, conducted in an outpatient group or individual session, and provided by a mental health professional licensed or authorized with the state to render such services. Such professionals typically include psychiatrists, advanced practice nurses, psychologists, licensed professional counselors, and licensed clinical social workers.
Limitations:
Mental Health Services are allowable only for people living with HIV who are eligible for HRSA Ryan White HIV/AIDS Program (RWHAP) services.
Services must be provided by mental health practitioners licensed to practice in the State of Texas.
Services:
Allowable services include outpatient mental health therapy and counseling, and may consist of:
- Mental health assessment
- Treatment planning
- Treatment provision
- Individual psychotherapy
- Conjoint psychotherapy
- Group psychotherapy
- Psychiatric medication assessment, prescription, and monitoring
- Psychotropic medication management
- Drop-in psychotherapy groups
- Emergency/crisis intervention
All mental health interventions must be based on proven clinical methods and provided in accordance with legal, licensing, and ethical standards. Client confidentiality is of critical importance and must be maintained unless otherwise indicated based on federal, state, and local laws and guidelines. All programs must comply with the Health Insurance Portability and Accountability Act (HIPAA) standards for privacy practices and protected health information (PHI).
Mental health services such as assessments or psychotherapy that are provided via electronic means are considered to be telemedicine rather than telehealth and must be provided in accordance with the State of Texas mental health provider practice requirements: Texas Occupations Code, Title 3 Health Professions, and chapter 111.
When psychiatry is provided via electronic means it is considered telemedicine and the provider must follow guidelines for telemedicine as noted in Texas Medical Board (TMB) guidelines for providing telemedicine: Texas Administrative Code, Texas Medical Board, Rules, Title 22, Part 9, Chapter 174, RULE §174.1 to §174.12.
Universal Standards:
Service providers for Mental Health Services must follow HRSA/DSHS Universal Standards 1-46 and 92-97.
Service Standards and Measures:
The following standards and measures are guides to improving healthcare outcomes for people living with HIV throughout the State of Texas within the Ryan White Part B and State Services Program.
Standard | Measure |
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Client Orientation: Orientation is provided to all new clients to introduce them to program services, ensure their understanding of available treatment, and empower them in accessing services. Orientation includes written or verbal information provided to the client on the following:
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Mental Health Assessment: All clients referred to the program will receive a mental health assessment by licensed mental health professionals. A mental health assessment should be completed no later than the third counseling session and should include, at a minimum, the following:
Clients should be assessed for care coordination needs and referrals made to case management programs as indicated. If pressing mental health needs result in the assessment not being finalized by the third session, then this should be documented in the client’s primary record. |
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Treatment Plan and Services: All client files should contain a detailed treatment plan and documentation of services provided. A treatment plan must be completed within 30 days of the mental health assessment and should be developed in conjunction with the client. The treatment plan should include:
Treatment should include counseling regarding the following, as clinically appropriate:
The treatment plan must be signed by the mental health professional; electronic signatures are acceptable. Treatment plans should be reviewed and modified midway through the number of determined sessions, or more frequently as clinically indicated. Services must be provided according to the individual's treatment plan and documented in the client's primary record. Progress notes should be completed according to the agency’s standardized format for each session and include:
In urgent, non-life-threatening circumstances, an appointment will be made within 1 business day. If an agency cannot provide the needed services, the agency will offer to refer the client to another organization that can provide the services and must make this referral within 1 business day. |
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Psychiatric Referral: Clients should be evaluated to determine if there is a need for psychiatric intervention. Providers should refer eligible clients to psychiatric services. |
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Psychotropic Medication Management: Psychotropic medication management services should be available for all clients either directly or through referral. A Doctor of Pharmacy (PharmD) can provide psychotropic medication management services. Mental health professionals should discuss any concerns about prescribed medication with the client (side effects, dosage, interactions with HIV medications, etc.). Mental health professionals should also encourage the client to discuss concerns about prescribed medications with their HIV-prescribing clinician so that medications can be managed effectively. Mental health providers with prescriptive authority will follow all regulations required for prescribing psychoactive medications, as outlined by the Texas Administrative Code, Title 25, Part1, Chapter 415, Subchapter A, Rule 415.10. |
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Coordination of Care: Care should be coordinated across the mental health team. The client should be involved in all decision-making, including whether to initiate or defer treatments. The full care team should be involved in educating the client, providing support, and monitoring mental health treatment adherence. Problem-solving strategies or referrals can be used for clients who need to improve adherence (e.g., behavioral contracts). Medical care providers, psychiatric care providers, and/or pharmacists should be consulted as appropriate regarding medication management, interactions, and treatment adherence. |
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Referrals: As needed, mental health providers should refer clients to a full range of medical/mental health services, including:
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Discharge Planning: Discharge planning should be done with each client when treatment goals are met or when the client has discontinued therapy, either by initiating closure or as evidenced by non-attendance of scheduled appointments. Documentation for discharge planning will include, as applicable:
Note: Staff should not inactivate clients in Take Charge Texas (TCT) at the time of case closure or discharge, unless the case is being closed due to a deceased client |
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References
Division of Metropolitan HIV/AIDS Programs, HIV/AIDS Bureau (HAB). Ryan White HIV/AIDS Program (RWHAP) National Monitoring Standards for RWHAP Part A Recipients. Health Resources and Services Administration, June 2022.
Division of State HIV/AIDS Programs, HIV/AIDS Bureau (HAB). Ryan White HIV/AIDS Program (RWHAP) National Monitoring Standards for RWHAP Part B Recipients. Health Resources and Services Administration, June 2022.
Forstein, Marshall, et al. Guideline Watch for the Practice Guideline for the Treatment of Patients with HIV/AIDS. American Psychiatric Association, 2006.
Mcdaniel, J. Stephen, et al. Practice Guideline for the Treatment of Patients with HIV/AIDS. American Psychiatric Association, November 2000.
New York State Department of Health. Delivery of Care. Mental Health Standards of Care, New York State Department of Health AIDS Institute, June 2013. Accessed 10 Jan. 2023.
Ryan White HIV/AIDS Program. Policy Notice 16-02: Eligible Individuals & Allowable Uses of Funds. Health Resources & Services Administration, October 2018.
Texas Department of State Health Services HIV/STD Program. Interim Guidance for the Use of Telemedicine, Teledentistry, and Telehealth for HIV Core and Support Services. Texas Department of State Health Services. Accessed January 12, 2023.
Texas Department of State Health Services HIV/STD Program. Interim Guidance for the Use of Telemedicine, Teledentistry, and Telehealth for HIV Core and Support Services - Users Guide and FAQs. Texas Department of State Health Services. Accessed 12 Jan. 2023.
U.S. Department of Health and Human Services, Health Resources and Services Administration. Guide for HIV/AIDS Clinical Care. 2014 Edition ed., Rockville, MD, U.S. Department of Health and Human Services, 2014.