After these immediate questions are answered, if a mental health condition appears to be present, the worker helps the person access needed supports and services. Most of these questions will help gear the types of supports, services, or treatment options that will be provided. The questions will usually not be used to make any kind of a mental health or mental illness diagnosis. Confidentiality and privacy must be maintained and respected.

Once a person has been screened and found to be eligible to receive public funded mental health services, he/she is "enrolled" into the public mental health service system. This means that paperwork is completed and entered into a computer data system so the amount, cost, and effectiveness of services and supports can be followed through computer-generated/tracking information.

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Mental Health Services: Private or Public?

If a person or family has private insurance that can be used to pay for the mental health service or support, the person or family contacts their insurance company for a referral to an approved mental health provider. If the person or family needs public (state and/or locally funded) services, they are to be referred to those services as quickly as possible.

Because of the limited public funds available to pay for mental health services, many people may be referred for other supports and services. Public mental health funds are spent on those persons who have been determined to be most in need of services and supports, that is, the target population groups for mental health funding. To meet the target population criteria, adults and children with mental health conditions must be screened and assessed to have these mental health conditions documented and confirmed by certified mental health professionals. These mental health professionals can include:

• Licensed clinical social workers
• Licensed clinical or school psychologists
• Registered psychiatric nurses
• Psychiatrists or physicians

The vast majority of publicly funded mental health services in Florida are provided by agencies and programs that are contracted with by local (district) mental health program offices. If someone has a mental health condition that is an emergency, that person will be taken to the closest mental health receiving facility.

Most hospital emergency rooms will do an emergency mental health assessment. Some mental health centers employ staff who provide screening services as well.

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Screening: Common Questions
That May Be Asked About Children or Teenagers

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People who are seeking services for children or teenagers may be asked some of the following questions:

• Does the person use alcohol or drugs?
• Are there family members or friends who are using alcohol or drugs?
• Is the child/teenager having problems in school?
• Has he or she injured him/herself or others?
• Are there sleeping problems (too little rest or too much)?
• Is the person withdrawn or depressed?
• Is the person easily excited or overactive?
• Has the person's pet or other animals been physically harmed?
• Is the person sexually active to the point that the activities put the person at risk?
• Is the person hearing voices or having hallucinations?

If "yes" is the answer to any of these questions, the person should be referred for an assessment.

The above questions were adapted from the "Behavioral Health Screening Form," Department of Children and Families, "Recommended Form," 1998.

Many of these same questions will be asked about people who are over 18 years of age, as well!

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Screening: The Global Assessment
of Functioning Scale

Every person in Florida who is screened for a mental health condition is assessed using a formal instrument called a "Global Assessment of Functioning (GAF) Scale." The GAF is used for adult mental health screening, and the "Children's Global Assessment Scale" (CGAS) is used to assess children's and teenagers' mental health conditions. Each of the scales has a 100-point ranking scale that is used by trained mental health professionals. The higher the score on the scale, the better "functioning" the person being assessed has. In other words, if an adult receives a score of 39 and another persons scores 93, the person with the 93 score is considered to function more successfully in communication, judgment, or thinking areas. People conducting the screenings are required to go through rigorous training.

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Referral Activities

Select the topic you want to view:

Referrals: Introduction

Referrals: Staff Responsibilities

Referral Staff

Referral Information to Give to the Person

Training for Conducting Referrals

Referrals: Introduction

The purpose of making referrals is to link the person or family with the appropriate person(s), programs, agencies or groups, in their community, who can provide, purchase, or coordinate needed supports and services in a timely fashion. If it is determined that a person or family does not need immediate mental health services or supports, the worker often refers the person or family to other programs, schools, agencies, or persons who can provide assistance. Accurate and timely referrals must focus on the immediate and long-term needs of the individual or family. Ease of access to requested or needed supports and services is the top priority!

Referrals should begin with an easily accessible point of entry (usually the best place to start is the district mental health program office!). For example:

• Telephone referrals should be available 24 hours per day, through agencies contracted either by the state or district offices.

• District Department of Children and Families offices are often located throughout the community that can provide walk-in assistance and referrals to appropriate agencies or programs. Some communities have co-located programs or a centralized point of contact for management of referrals, where one "common" application for assistance or intake forms may apply to several programs.

Each district Department of Children and Families office may, however, have different policies concerning referral activities. Response time for referrals will depend upon their urgency!

Mental health staff at the district mental health program offices refer people to specific programs or services to meet their immediate needs for food, shelter, or housing. If someone is a danger to themselves or others, district mental health program office staff usually contact a local mental health provider who may be able to send a "mobile crisis team" that can assist in an emergency or crisis situation.

If the situation is determined to be an immediate emergency because of someone's mental health status, police or the sheriff's office staff are usually called to assist with the emergency. Some situations may be handled immediately, or some people may be taken to a psychiatric hospital for an emergency mental health screening or placed under arrest and taken to jail if the person is determined to have broken the law.

More information on emergency procedures is available about the Baker Act process, Chapter 394 at www.leg.state.fl.us/statutes for emergency psychiatric situations.

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Referrals: Staff Responsibilities

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The person making the referral has the following responsibilities:

• Receiving requests for assistance or information. Staff responding to the request are to be personal and respond appropriately when receiving referrals.

• Recording the information by obtaining and recording information. This information may include:
  1. The date the request was received;

  2. The nature of the request or inquiry, including the scope of the person's/family's needs;

  3. Whether the family or individual had a role in making the request or inquiry or gave permission for the request or inquiry (Strict laws govern personal confidentiality!)

• Determining the urgency or intensity of the mental health needs of the person or family to make appropriate referrals and expedite the review and access of supports and services in the case of any emergency or crisis.

• Obtaining permission from the person or legal representative to make referrals to mental health service providers, people or places in the community, and other programs or agencies.

• Making referrals and provide assistance in securing contacts that match the requested needs.

• Taking necessary follow-up action in crises or emergency situations with:
  1. People and families for whom supports and services are sought

  2. Any other persons assigned to provide expedited reviews, evaluations assessments, or referrals

  3. Agency staff to schedule and arrange for an interview to complete or review the application and begin person- and family-centered planning in responding to the personal or family needs for assistance

  4. Whenever possible, when referrals are made, following up to determine whether the person or family was able to contact the referral sources.

• Documenting the referral made in response to each request, the reasons for referral, follow-up activities, contact that were made, and the outcome(s) of referrals.

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Referral Staff

Each district Department of Children and Families office has staff or contracted providers who are responsible for conducting referrals. The designated person or agency may use volunteers if they meet the requirements of confidentiality and have been trained to deal with referral and emergency situations.

Some district offices may have developed specific "protocols" or requirements on how information gathering and assessment activities will be done. The flow of activities from information to referrals can be merged when staff or volunteers are co-located at sites or when the same people provide both functions.

The more informed staff and volunteers are about their community and available resources, the better and more efficient they are at making appropriate referrals. Such ease and efficiency of referrals depend upon accurate knowledge about community resources.

It is important that local service providers develop and share resource information and combine resource materials whenever possible. Many local United Way agencies or Information and Referral agencies maintain lists that are available at no or little cost. This information can also be provided in pamphlets, brochures, or Internet sites.

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Referral Information to Give to the Person and Family

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Specific information about programs or services can speed the time people must take to complete and provide information. As referrals are made, give the person this information:

• Names of programs and people to contact with addresses, telephone numbers, and e-mail addresses

• Hours of operation

• Range of supports and services available

• Staff names and contacts, if known

• Basic information about the screening and referral process and supporting materials that may be needed to make an application for service

• Major eligibility requirements and how these requirements may vary based on needs, age, income, or other eligibility requirements, if any

• Cost, if any, of any supports and services and availability of financial assistance

• Safety guidelines in case outreach workers need to come to a person's or family's home

• Access to public or other transportation

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Training for Conducting Referrals

Training for conducting referrals must be included specific knowledge, skills, and abilities necessary to determine the urgency and scope of needs referrals should be made to the right people and places. Training in these areas are recommended:

• Knowledge of confidentiality and express and informed consent laws and requirements

• Knowledge of diagnostic prerequisites for mental health services

• Knowledge of the range of supports and services available in the local community

• Knowledge of culturally competent supports and services

• Skills in basic interviewing

• Abilities to make decisions about when to take different actions including different levels of assistance for diverse needs and circumstances