Gary S. Kavit, MD, FACEP represents VACEP on the Governor's Interagency Civil Admissions Advisory Council, formed to address issues related to persons entering Virginia's behavioral health system through CSB crisis services and our hospital emergency departments. As the letter from Commissioner Reinard outlines below, this has been a tremendous challenge but some progress is being made.

The draft guidance document was provided the VACEP Board of Directors who recommended it was much too long to provide practical use.

In his follow up report to our Board, Dr. Kavit stated: "It was not shortened. It actually had a bit more added. There are too many stakeholders involved. Everything is important to somebody. There will be an education phase. In preparation for that I have asked for an algorithm page that could be followed for quick reference be produced. That had mixed reviews."

As additional materials and reports become available from the ICAAC and Dr. Kavit, we will share that with you as well.

  Medical Screening and Assessment Guidance Issued

March 13, 2007

Letter from James S. Reinard, MD

Commissioner, Virginia Department of Mental Health, Mental Retardation, and Substance Abuse Services

Medical screening and assessment of persons who enter Virginia's behavioral health system through community services board crisis services and hospital emergency departments is a complex and difficult task.  Numerous problems have been documented with the medical screening and assessment process, and there is strong consensus across a broad spectrum of stakeholders that a coordinated statewide effort to improve the process is warranted. 

In response to this need, several activities have been undertaken to improve medical screening and assessment of persons with psychiatric disorders in emergency settings. For example, the 2006 General Assembly added language to the 2007-8 Appropriations Act allowing medical screening and assessment services provided during the emergency custody period to be reimbursed through the Department of Medical Assistance Services (see item 300B, Appropriations Act).  Also, Senate Bill 890, which will become effective on July 1, 2007, will allow law officers to transport persons in their custody for medical screening and assessment if required by an admitting physician (see Chapter 7, Acts of Assembly 2007). These changes will facilitate and support effective medical screening and assessment in these situations.  

Effective medical screening and assessment has also been hampered by wide variations in practice among providers statewide.  In an effort to make these practices more uniform, the Department of Mental Health, Mental Retardation and Substance Abuse Services (DMHMRSAS) has collaborated with the Virginia Association of Community Services Boards (VACSB), the Virginia Hospital and Healthcare Association (VHHA), the Virginia College of Emergency Physicians (VACEP) and the Department of Medical Assistance Services (DMAS) to develop consensus guidance materials on medical screening and assessment to be used by all public and private behavioral healthcare providers and emergency departments statewide. 

The consensus Medical Screening and Assessment Guidance developed through this collaborative process is attached.

The above-referenced organizations have agreed to disseminate this Medical Screening and Assessment Guidance to each of their members, and to encourage and support adoption of the Medical Screening and Assessment Guidance through local, regional and state-level collaboration and problem solving among providers and organizations.

Adoption and use of this Medical Screening and Assessment Guidance will be through the same process established for the Regional Utilization Management (RUM) Guidance. The RUM Guidance document and implementation process was disseminated under my signature in a memorandum dated January 10, 2007, and is also attached. Consistent with the process outlined in that memorandum, I am asking that that each region:

• Review this Medical Screening and Assessment Guidance;
• Identify and engage the internal and external stakeholders who will implement the Medical Screening and Assessment Guidance, including service providers and law enforcement officers;
• Implement local and regional strategies to actualize the Medical Screening and Assessment Guidance;
• Maximize awareness and use of the Medical Screening and Assessment Guidance among stakeholders in the region.
• Prepare an interim report in September 2007 for the Department and other partners (i.e., VACSB, VHHA, VACEP, DMAS) describing implementation successes and barriers, as well as recommended solutions to known obstacles, and;
• Incorporate implementation status of the Medical Screening and Assessment Guidance into the 12-month and 24-month reports described in the January 10, 2007, RUM Guidance memorandum.

We will also include this topic for discussion at the regional meetings described in the RUM Guidance memorandum. 

Lastly, I want to express a special thanks to our partner organizations for their contributions to the Medical Screening and Assessment Guidance document. These organizations have each shared a strong commitment to achieving consensus and finding solutions. I appreciate this teamwork and collaboration, and the Medical Screening and Assessment Guidance exemplifies what can be accomplished with that approach.

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