September Newsletter: Joint Commission Behavioral Healthcare Update

All behavioral health programs accredited under the Behavioral Health Standards manual are required to conduct a nutritional screening as part of the initial assessment process. Although this standard has been around for quite awhile, many behavioral health organizations still struggle with meeting this requirement. Nutritional screening is one of the top five most non-compliant standards for behavioral health programs. For surveys during the first half of 2010, almost 20% of all behavioral health organizations received a Requirement for Improvement related to their nutritional screening process.

What exactly do the Behavioral Health standards require for a nutrition screening?

The current 2010 standard for nutritional screening (PC.2.110) has been revised in the new 2011 Care, Treatment and Services chapter. It is now CTS.02.01.11. The new standard does not differ significantly from the current one but it is more clearly worded and also offers examples of what might trigger a nutritional assessment.

The key requirements of CTS.02.01.11 are as follows:

You must do a nutritional screening on all clients.
Based on the screening, you must identify those clients needing a nutritional assessment.
For those clients identified as needing a nutritional assessment, you must either conduct that assessment within your organization or refer the client elsewhere for that nutritional assessment.
If you conduct the nutritional assessment within your organization, the assessment must identify clients who are at moderate or high nutritional risk.

What is the most effective way to screen everyone and identify those needing further assessment?

In order to identify those clients who need to be referred for a full nutritional assessment, you must have criteria or "triggers" in your screening that will identify this group. This has always been the most challenging aspect of this standard.

Clear and Stringent Criteria

One approach that many behavioral health organizations take is to utilize fairly stringent criteria in their nutritional screening. Then, if a client meets any of the criteria, that triggers a need for further assessment. Examples of such criteria include the following:

Unintentional weight loss or gain greater than 10 lbs. in a month
Chronic chewing, swallowing or digestion problems
Poor nutrition intake greater than two weeks
Uncontrolled diabetes
Nausea/vomiting for more than 72 hours
Eating disorder (anorexia, bulimia) or significantly restricting food
Non-compliance with a prescribed diet

Using a Self Rating Tool

Another approach is to have clients complete a self rating to score their nutritional health. There is a checklist titled "Determine Your Nutritional Health" (developed by The Nutritional Screening Initiative) which scores the individual's level of nutritional risk based on their nutritional habits. Several behavioral health organizations have adapted the scoring tool such that a score of 6 or higher indicates a need for further nutritional assessment. To view this checklist, click on Determine Your Nutritional Health Checklist.

Once a need for further nutritional assessment has been identified, what is our responsibility?

When the nutrition screening identifies a need for further nutritional assessment or treatment, the organization needs to determine the appropriate next step for that individual client. Options can include:

Referring the client to their primary care practitioner for further evaluation
Helping the client find a PCP if they don't already have one
Referring the client to a nutritionist for a nutritional assessment
Providing nutrition education to the client as part of the behavioral health program
Helping the client link up to community resources providing nutrition education and evaluation.

Remember, if follow-up on the identified nutritional need is a significant clinical issue, it should be included in the treatment plan and updated at treatment plan reviews. Joint Commission surveyors frequently review nutritional screenings as part of their tracers and check to see if appropriate follow-up has occurred for clients with identified nutritional needs.