| Infrastructure Infrastructure
refers to structural components that are necessary to build a delivery system for
children’s mental health and substance abuse services at the state, local and
community level. Components of the system are financing mechanisms, policies and
regulations, training and technical assistance, information and communication technology,
processes for needs assessment and strategic planning, and research and evaluation.
Integrated Care Coordination Units (ICCUs)
These units are located in five of the six Behavioral Health Regions in the State and
are joint collaborations between each region and the Department of Health and Human
Services. The ICCUs are designed to integrate care for children in the child
welfare/juvenile justice system and is intended to effectively manage the care of children
and families with multiple and complex needs at the local level. The youth served through
this project are high-need wards of the state who are in Agency-Based Foster Care
(therapeutic foster care) and higher levels of care. Funding is through a case rate based
on 95% of the historic cost of serving these youth. This project utilizes an integrated
care coordination collaborative that includes Protection and Safety Workers (child welfare
and juvenile justice system) and Professional Partners (mental health and substance abuse
service system) who work in conjunction with family support organizations in each Region
to provide advocacy for families served in the program).
Top of Page
Medicaid Definitions
Transportation
Transportation Services are those services that ensure that members without
transportation get to medically necessary mental health and substance abuse appointments.
Customer Assistance Program (CAP) Managed Care Only Service
The Customer Assistance Program provides short term, solution-focused therapy aimed at
assisting those who have personal problems that interfere with their daily living and well
being. CAP is an early intervention approach to dealing with those problems before they
become unmanageable. CAP is intended to provide assistance to individuals who do not have
a DSM IV diagnosis or who will not need ongoing assistance. CAP services require
registration, but not pre-certification.
Outpatient Mental Health and Substance Abuse Services
Outpatient Mental Health and Substance Abuse services are behavioral health services
rendered in an office/clinic environment, a member’s home or other locations
appropriate to the provision of service for psychotherapy or medication management.
Services focus on the restoration, enhancement and/or maintenance of a member’s level
of functioning and the alleviation of symptoms, which interfere with functioning in at
least one major life area (e.g. familial, social, educational, employment). The goals,
frequency and length of treatment will vary according to the needs of the individual or
family being served and the response to treatment. Outpatient services may be provided in
an individual, family or group format.
Intensive Outpatient (Managed Care Only Service)
Intensive outpatient is a level of care between day treatment and traditional
outpatient. Service may be delivered in a group format within a facility or as an
individualized format within a member’s own home. This level of care is intended to
prevent admissions to higher levels of care or to serve as aftercare for members who are
transitioning from higher levels. Intensive outpatient can be 6 -12 hours of individual,
family and group therapy per week.
Community Treatment Aide (CTA)
Community Treatment Aide services are supportive, directive and teaching services
provided in the home, school or other community location to assist the member in improving
their capacity for living in the least restrictive environment. These services are
typically delivered by a para-professional. They are to be prescribed and supervised by
the supervising practitioner and included as part of the master treatment plan.
Day Treatment
Day treatment provides a coordinated set of individualized therapeutic services to
persons who may be able to function in a normal school, work, and/or home environment, but
are in need of therapeutic supports. Day Treatment is a community-based level of care. It
is a comprehensive, multidisciplinary approach to treatment for members who do not require
or meet the guidelines for higher levels of care, but require more intensive and
comprehensive services that can be provided at the outpatient level.
Partial Hospitalization ( Managed Care Only Service)
Partial hospitalization is a nonresidential treatment program that may or may not be
hospital-based. The program provides diagnostic and treatment services on a level of
intensity similar to an inpatient program, but on less that a 24-hour basis. These
services include therapeutic milieu, nursing, psychiatric evaluation, medication
management, group, individual and family therapy. The environment at this level of
treatment is highly structured and there should be a staff-to-patient ration sufficient to
ensure necessary therapeutic services, professional monitoring, control and protection.
Partial hospital treatment may be appropriate when a member does not require the more
restrictive and intensive environment of a 24-hour inpatient or residential setting, but
does need up to eight hours of clinical services each day. Partial hospitalization can be
used both as a transitional level of care (i.e., step-down from inpatient or residential
treatment) as well as a stand-alone level of care to stabilize a deteriorating condition
and avert hospitalization or residential treatment. This level of care is not appropriate
for youth living in subacute levels of care (RTC, ETGH, TGH or TFC).
Treatment Foster Care
Treatment Foster Care is a level of care provided to children and adolescents who
require a higher level of care than is found in traditional foster care. The member is
placed in the safe, secure and nurturing environment of a private home with licensed
foster parents who have received specialized training in the care of children and
adolescents with emotional or substance abuse disorders. Treatment foster parents provide
care for one child and perform behavioral interventions and life skills training in
addition to assuring that the child receives needed mental health and substance abuse
services, medical care and education. This level of care is transitional, and typically
considered for children and adolescents who have been recently discharged, or who are
being diverted from higher levels of care. Family therapy is included in the per diem to
prepare for reunification or alternative placement.
Treatment Group Home
Treatment Group Homes provides 24-hour mental health and/or substance abuse services in
a licensed, non-secure facility. They are designed for children and/or adolescents with
significant functional impairment, but some capability to engage in community-based
activities. Treatment group homes offer a less restrictive treatment environment that
residential treatment, but are more restrictive that treatment foster care. Typically,
treatment services include 24 hours per week of individual, group and family counseling,
vocational training, recreational therapy and skill building. Members may also be involved
in community-based activities such as school, work or recreation.
Enhanced Treatment Group Home (Managed Care Only Service)
Enhanced Treatment Group Homes proved 24-hour mental health and/or substance abuse
services in a licensed non-secure facility. Enhanced Treatment Group Homes are designed
for youth who are eligible for Medicaid Manage Care Mental Health/Substance Abuse
Services. Youth have significant functional impairments but some capacity to engage in
community-based activities. Youth typically have impairments due to emotional disorders
and primary or co-morbid clinically significant impairments from one of the disruptive
behavior disorders of childhood and adolescence. Enhanced Treatment Group Homes offer a
less restrictive treatment environment then residential treatment and provides an enhanced
array of treatment interventions and treatment modalities. Typically, treatment services
include 21 hours per week of individual group and family counseling, intensive cognitive
behavioral interventions, vocational training, recreational therapy and skill building.
Members need to be involved in community-based activities such as school, training or work
experience and recreation.
Residential Treatment
This level of care provides 24 hour behavioral treatment in a licensed, highly
structured residential program for child/adolescents who do not require an inpatient
setting and will benefit from a short-term, structured residential setting. This
supervised short-term treatment model serves as an alternative to inpatient
hospitalization. In this facility-based program, children/adolescents receive services in
a safe, structure setting, with continuous 24-hour observation and supervision. The
program addresses the identified problem through 42 hours per week of crisis
stabilization, initial and continuing bio-psychosocial assessment, care management,
medication management, therapy and mobilization of family support and community resources
in the context of a comprehensive multidisciplinary treatment plan.
23-Hour Crisis Observation, Evaluation, Holding and Stabilization
This level of care provides up to 23 hours of care in a secure and protected
environment. The program is medically staffed, psychiatrically supervised and includes
continuous nursing services. The primary objective of this level of care is for prompt
evaluation and/or stabilization of individuals presenting with acute symptoms or distress.
Before or at admission, a comprehensive assessment is conducted and a treatment plan
developed. The treatment plan should place emphasis on crisis intervention services
necessary to stabilize and restore the individual to a level of functioning that does not
require hospitalization. Duration of services at this level of care may not exceed 23
hours and 59 minutes, by which time stabilization and/or a determination of the
appropriate level of care will be made, and facilitation of appropriate treatment and
support linkages will be coordinated by the treatment team.
Acute Inpatient
Acute inpatient treatment represents the most intensive level of care.
Multidisciplinary assessments and multi-modal interventions are provided in a 24-hour
secure and protected setting which is a medically staffed and psychiatrically supervised
treatment environment. Twenty-four hour skilled nursing care, daily medical care, and a
structured treatment milieu are required. The goal of acute inpatient is to stabilize
acute psychiatric and substance abuse conditions.
Best Practice
Clinical intervention that has been consistently shown in research studies to assist
consumers in achieving their desired goals of health and wellness.
Promising Practice
Many of these are in the early stages of research and may be individualized practices
selected by the family.
Professional Partner Program
Utilizes the wraparound approach to coordinate services and supports to children and
their families and to ensure they have voice, ownership, and access.
System of Care
A comprehensive spectrum of mental health and other necessary services which are
organized into a coordinated network to meet the multiple and changing needs of children
and their families.
Top of Page
Family Centered Care Definitions
Compassionate
Every effort to communicate with consumers, colleagues and families embodies compassion
and is distinguished by good manners. The hopes of the individual and family are
cherished, nurtured and held dear.
Individualized
People are unique; their problems are as well. Simple logic dictates that the best
solution to their problems are those that are uniquely tailored to them.
Family/Person Driven
Families are the experts on what they need. This process produces a new level of
individual and family input and eventually, investment in plans intended to alleviate
distress and respond to troubling circumstances.
Strengths Based
A thorough discovery of individual and family strengths, cultures, preferences, and
values is where this process starts. Meetings begin with a description of the strengths,
culture and values of the individual/family.
Strategies intended to meet unmet needs focus on how individual and family strengths
can best help get each identified task completed. Strengths, cultures, preferences and
values drive the selection and design of the strategies.
Culturally Competent
We set out to learn each individual’s and family’s unique culture. These are
among the cornerstone strengths and assets on which the plan is based
Team Developed and Supported
The people who are involved with the family – both formally and informally –
come together in a Family Team. This team, which changes as it’s developed, forms a
circle of support around the person in need.
Outcome Focused
Accountability is encouraged because planned outcomes are defined in advance and
monitored throughout the process. Outcome statements identify specifically what is to be
produced by the plan.
Needs Driven
Unmet needs, when met, become the bridges between the desired outcomes and the current
reality. Needs statements are specific and positively framed. Needs are not
service-oriented responses intended to assist the individual/family to meet their desired
outcomes.
Flexible
The integrity of the individual and family is the concern, not the integrity of the
program. We don’t try to shove square pegs into round holes. Unique supports and
resources are developed to best fit a particular person or family and meet their needs.
Unconditional
Plans are supposed to work, to produce desired outcomes. If the plan does not work,
change the plan. Do Not Give Up
Normalized
Plans are created that feel so familiar and comfortable to their intended beneficiaries
that they claim them as their own. People have access to the activities that typify daily
life for children and adults of the same age, stage and culture.
Community Based
We should help people remain in their neighborhoods and communities and still get their
unmet needs met.
Top of Page
Documents in  PDF format require the use of Adobe Acrobat Reader which
can be dowloaded for free from Adobe Systems,
Inc. |
