The DHS Fast Track process aims to ensure patients with severe mental illness are placed at a mental health shelter on the same day they are discharged.
Background: DHS shelter intake and placement is a multiweek process and many patients with SMI leave shelter before they are placed at an appropriate mental health shelter. Same-day placement at a mental health shelter can help prevent patients' return to street homelessness.
Fast Track processes only apply to new or inactive DHS clients (clients who do not have a DHS assignment). Active DHS clients do not need to undergo the Fast Track process as they can be discharged directly to their assigned shelter, safe haven or stabilization bed.
Patients who are already engaged in their mental health care and don't need services from a mobile mental health program - e.g. day-of-discharge accompaniment, on-site treatment adherence support - can be discharged to the shelter intake center for same-day placement at a mental health shelter.
To refer a patient for same-day placement at a mental health shelter:
Step 1: Follow the Institutional Referral process (as for all patients).
Step 2: Submit Request for Reasonable Accommodation for expedited intake and shelter placement.
Step 3: Discharge patient to single adult shelter intake center. See discharge recommendations.
Patients who need treatment adherence support require additional care coordination prior to discharge. Steps 1 to 3 are prerequisite to step 4 and required for successful Fast Track placement.
Step 1: Enroll client in a mobile mental health program that provides day-of-discharge accompaniment
Enroll client in a mobile health program (such as SPACT, SOS, IMT, CHW, CTI, peer navigation or other that meets their needs in the community), and ideally agrees to:
Engage and enroll patient while still hospitalized
Suggest a shelter that would best meet client needs and permit program access to shelter
Meet client at the hospital on the day-of-discharge to accompany through shelter Intake and then assigned shelter (half day)
Engage with the shelter social service staff to begin coordination of care
Step 2: Follow the institutional referral process (as for all patients)
Complete and submit the DHS Institutional Referral Form (fillable PDF, complete in Adobe Reader) with required medical documents.
Step 3: Submit Request for Reasonable Accommodation for expedited intake and shelter placement
Submit Request for Reasonable Accommodation for expedited intake and shelter placement.
DHS staff are not permitted to deviate from regular protocols for intake and shelter placement without an approved reasonable accommodation request. If assistance is needed, contact the Health Services Office.
Step 4: One business day before discharge, coordinate accompaniment and same-day mental health shelter placement
Reach out to DHS in the morning one business day before discharge (Monday - Thursday, excluding holidays) with a request to “Set up fast-track for [CARES ID]” (CARES ID is included in the Institutional Referral approval to discharge to shelter email.)
Copy mobile health program (ACT, SOS, etc) on the email to support coordination and accompaniment.
After receiving this email, DHS will look for a bed in shelter location and type agreed upon during the Institutional Referral process, and reserve.
DHS will notify the hospital and mobile health provider, shelter intake and security leadership, and target shelter of the confirmed plan.
Step 4: On the day of discharge, discharge patient to mobile mental health program staff member who will accompany patient to shelter intake
Hospitals should:
Discharge patients as early as possible to the shelter intake center. This is to ensure that patients have sufficient time to travel to the intake center, complete the full intake process and check into their shelter before 5:00 PM, when social service staff are still on-site.
Inform patients in advance that the intake process will take several hours; encourage patience with the process.
The mobile mental health program staff providing accompaniment should:
Pick up the client from the hospital.
Complete the DHS Authorization for Mobile Health Program Accompaniment through Shelter Intake and Placement Form.
Upon arrival to the intake center, present the authorization form to Intake Access Control (Security) along with organization ID in order to obtain approval to remain with the client during intake.
Remain with and support clients through the intake interview.
After intake, accompanying the client to the shelter to claim the bed.
Try to meet with the social service staff at the assigned shelter to establish communication and care coordination plans.
Inform DHS Health Services Office when the client has checked into their assigned shelter.