CBHI Services Kickoff Meeting

CBHI Services Kickoff Meeting
September 9, 2009

CBHI Services Kickoff Meeting September 9, 2009
Welcome Gisela Morales-Barreto CBHI Services Kickoff Meeting September 9, 2009 2

Plan for the Day 9:15 – 9:45 Overview 9:45 – 11:00 In-Home Therapy 11:00 – 11:15 Break 11:15 – 12:30 Therapeutic Mentoring 12:30 – 1:30 Lunch 1:30 – 2:45 In-Home Behavioral Services 2:45 – 3:00 Break 3:00 – 4:20 Panel 4:20 – 4:30 Next Steps CBHI Services Kickoff Meeting September 9, 2009 3

CBHI Overview Mission, Vision, and Values Suzanne Fields Office of Behavioral Health for MassHealth CBHI Services Kickoff Meeting September 9, 2009 4

Children’s Behavioral Health Initiative
Overview and Implementation Update Worcester Crowne Plaza September 9th

CBHI Mission To strengthen, expand and integrate Massachusetts state services into a comprehensive, community-based system of care To ensure that families and their children with significant behavioral, emotional and mental health needs obtain the services necessary for success in home, school and community

CBHI Values Family-Driven, Child-Centered and Youth Guided
Strengths-Based Culturally Responsive Collaborative and Integrated Continuously Improving

CBHI Vision The Children’s Behavioral Health Initiative places the family and child at the center of our service delivery system. Policies, financing, management and delivery of publicly-funded behavioral health services will be integrated to make it easier for families to find and access appropriate services, and to ensure that families feel welcome, respected and receive services that meet their needs, as defined by the family.

Implementation Update
Intensive Care Coordination and Family Support and Training Began serving families on June 30th To date approximately 100 family partners and 158 care coordinators are hired To date approximately 1200 families have been referred and are working with the CSA’s Care planning teams are happening! System of Care meetings are happening! Training vendor selected and orientations have started

Mobile Crisis Intervention Service began June 30th To date approximately 2040 interventions have occurred The key is that the service “mobilizes” to the child and occurs in the home or community location

In-Home Behavioral Services October 1st implementation deadline 34 unique providers across the Commonwealth selected by the Managed Care Entities Therapeutic Mentoring 51 unique providers across the Commonwealth selected by the Managed Care Entities

In-Home Therapy November 1st implementation deadline 55 unique providers across the Commonwealth selected by the Managed Care Entities Crisis Stabilization CMS update

SERVICE DEVELOPMENT PROCESS
Families Stakeholders Providers MCE’s Court Monitor State of MA Plaintiffs National Consultants CMS

How do we get there? There is much that we do know but…..
Today is just the beginning ALL of us need to learn together There is much that we do know but….. there is a lot that we still have to figure out Families and Providers share what they learn Data, data, and did we mention data? For the next 2 + years- refinement will occur

Review of Clinical Hub Concept
Anne Pelletier Parker Massachusetts Behavioral Health Partnership CBHI Services Kickoff Meeting September 9, 2009 15

Clinical Hub: What is it?
CBHI Services Kickoff Meeting September 9, 2009 16

Care Coordination: Clinical Hubs
Intensive Care Coordination (Wraparound) Clinical Assessment inc. CANS SED determination for eligibility Medical Necessity determination Care coordination In-Home Therapy Clinical Assessment inc. CANS Medical necessity determination Care coordination available Outpatient Therapy Clinical Assessment inc. CANS Medical necessity determination Care coordination available CBHI Services Kickoff Meeting September 9, 2009 17

Intensive Care Coordination
(Wraparound) Clinical Assessment inc. CANS SED determination for eligibility Medical Necessity determination Care coordination Additional Services (accessed through core clinical services) Behavior Management Therapy & Monitoring Family Support and Training (Family Partners) Therapeutic Mentoring Families decide on most appropriate initial service independently or in consultation with helping professions such as: primary care, mental health clinicians schools case workers community orgs faith leaders others In-Home Therapy Clinical Assessment inc. CANS Medical necessity determination Care coordination available Outpatient Therapy Clinical Assessment inc. CANS Medical necessity determination Care coordination available Emergency Services Mobile Crisis Intervention Child may have 1,2, or all 3 core services Care coordination provided by most intensive service received. 18

What does it mean to be a “hub”?
Can make referrals for services that require a hub: therapeutic mentoring, in-home behavioral, and family support and training Are responsible for coordinating care and collaborating with other service providers (e.g. convening care planning teams for ICC, making regular phone calls to collaterals, holding meetings with the family and other treatment providers). Need to regularly connect with those “hub dependent” service providers to which you make referrals in order to coordinate care and obtain and provide updates on the youth’s progress Remember when more than one clinical hub service provider is involved with a family, care coordination is provided by the most intensive service CBHI Services Kickoff Meeting September 9, 2009 19

“Hub dependent” What does it mean to be a “hub dependent” service? Referrals must come from one of the three clinical core hubs: outpatient, in-home therapy, intensive care coordination Service will not be authorized as a “stand-alone” service; it requires a hub There must be a goal identified on an existing individual care plan (ICP) for youth in ICC or a treatment plan for youth in IHT or outpatient that the service is required or needed to address CBHI Services Kickoff Meeting September 9, 2009 20

Care Integration Natural Supports Faith-Based Support
Community Services & Supports DDS Services & Supports Primary Care DCF Services & Supports DYS Services DMH Services Individual Child & Family Individual Child & Family MassHealth BH Clinicians Emergency Services Care Coordination Early Intervention Services (DPH) Probation & Courts Substance Abuse Services (DPH) SPED Services (DESE) Early Education (DEEC) 21

In-Home Therapy (IHT) Overview Performance Specifications Medical Necessity Criteria on MCE website Anne Pelletier-Parker Massachusetts Behavioral Health Partnership CBHI Services Kickoff Meeting September 9, 2009 22

In-Home Therapy Services
In Home Therapy Services is a structured, consistent, strength-based therapeutic relationship between a licensed clinician and the youth and family for the purpose of treating the youth’s behavioral health needs. Services are delivered by one or more members of a team consisting of professional and paraprofessional staff, offering a combination of medically necessary: In-Home Therapy & Therapeutic Training and Support. CBHI Services Kickoff Meeting September 9, 2009 23 23

Enhance and improve the family’s capacity to improve the youth’s functioning in the home and community. Prevent the need for the youth’s admission to an inpatient hospital, psychiatric residential treatment facility or other treatment setting. CBHI Services Kickoff Meeting September 9, 2009 24 24

The In-Home Therapy Services provider:
operates from 8 a.m. to 8 p.m seven days per week, 365 days per year; has 24-hour urgent response 365 days a year; responds to all referrals telephonically within one business day; responds to referrals during daytime operating hours by offering a face-to-face encounter within 24 hours. engages in assertive outreach regarding engaging in the service engages and supports the ESP/Mobile Crisis Intervention team in an emergency. CBHI Services Kickoff Meeting September 9, 2009 25 25

In Home Therapy Services may be provided in any setting where the youth is naturally located, including, but not limited to, the home (including foster homes and therapeutic foster homes), schools, child care centers, respite settings, other community settings. CBHI Services Kickoff Meeting September 9, 2009 26 26

Intake In-Home Therapy Services provider participates in discharge planning at the referring provider location; makes every effort to meet at the time of referral or as soon as possible if the referral is initiated by the MCI Team as a diversion from out of home placement or psychiatric hospitalization; will visit the youth and family in any safe setting within 24 hours of referral from an inpatient unit, CBAT, Crisis Stabilization or Mobile Crisis Team; completes an initial, or updates an existing, risk management/safety plan during intake. CBHI Services Kickoff Meeting September 9, 2009 27 27

Initial Assessment The In-Home Therapy Services provider completes an initial assessment within 24 hours of meeting with the youth and family. Assessment includes: main need /focal problem, contributing factors to the main need from multiple life domains, matching interventions with an emphasis on youth/family interactions and skill building. The In-Home Therapy Services provider completes the age appropriate CANS-MA version within 48 hours of the initial contact. CBHI Services Kickoff Meeting September 9, 2009 28 28

Treatment Planning & Documentation
The In-Home Therapy Services provider, in consultation with the youth, the parent(s)/guardian(s)/caregiver(s), IHT supervisors, other involved treaters, and the IHT multidisciplinary team, completes an evidence-based/best-practice guided treatment plan, including a risk management/safety plan, within seven (7) calendar days of first contact. All parties involved, including the youth, sign the treatment/care plan. The In-Home Therapy Treatment Plan: is solution-focused; clearly defines interventions; includes measurable outcomes; assists the youth and family members in their environment to help the youth to achieve and maintain stabilization; is synchronized with other provider’s existing plans. CBHI Services Kickoff Meeting September 9, 2009 29 29

identify and utilize community resources
The In-Home Therapy team works with the entire family, or a subset of the family, to implement focused interventions and behavioral techniques to: build skills to strengthen the family, advance therapeutic goals and improve ineffective patterns of interaction enhance problem-solving, limit-setting, risk management/ safety planning, and communication identify and utilize community resources develop and maintain natural supports for the youth and parent/caregiver in order to promote sustainability of treatment gains CBHI Services Kickoff Meeting September 9, 2009 30 30

risk management/safety planning effective patterns of interaction
Intensive Family Therapy may include working with the entire family, or a subset of the family, to implement focused, structural, strategic, or behavioral techniques, or evidence-based interventions to enhance problem-solving limit-setting communication risk management/safety planning effective patterns of interaction CBHI Services Kickoff Meeting September 9, 2009 31 31

Therapeutic Training & Support
TT & S is provided by a qualified paraprofessional working under the supervision of a clinician to support implementation of the licensed clinician’s treatment plan to assist the youth and family in achieving the goals of that plan. The paraprofessional assists the clinician in implementing the therapeutic objectives of the treatment plan designed to address the youth’s mental health, behavioral and emotional needs. Teaches the youth to understand, direct, interpret, manage, and control feelings and emotional responses to situations and to assist the family to address the youth’s emotional and mental health needs. CBHI Services Kickoff Meeting September 9, 2009 32 32

Identification of community resources
Development of natural supports for youth and parent/ caregiver(s) Support and sustain achievement of the youth’s treatment plan goals and objectives CBHI Services Kickoff Meeting September 9, 2009 33 33

Staffing The In-Home Therapy Services team employs a multidisciplinary model, with both professionals trained in working with youth and their families, and paraprofessional staff capable of providing family members with therapeutic support for behavioral health needs. Staff are knowledgeable about: available community mental health and substance use disorder services within their natural service area, the levels of care, relevant laws and regulations, Systems of Care philosophy and Wraparound planning process, medical, legal, emergency, and community services available to the youth and family. CBHI Services Kickoff Meeting September 9, 2009 34 34

Staff Supervision & Consultation
The In-Home Therapy Services provider ensures that a licensed, master’s level, senior clinician provides supervision commensurate with licensure level and consistent with credentialing criteria to professional and paraprofessional staff on a weekly basis. A board-certified or board-eligible child psychiatrist or a child-trained Psychiatric Nurse Mental Health Clinical Specialist is available during normal business hours within one (1) hour for consultation related to treatment planning, medication concerns, and crisis intervention. A senior-level, licensed clinician trained in working with youth is available to the staff and the supervisor 24 hours a day, seven days a week for consultation as needed. CBHI Services Kickoff Meeting September 9, 2009 35 35

Discharge Planning and Documentation
A discharge planning meeting is scheduled whenever the authorized decision maker decides that services are no longer desired, or the family, determines that the youth has met his/her goals and no longer needs the service, or the youth no longer meets the medical necessity criteria for In-Home Therapy. Discharge plan includes, at minimum: identification of the youth’s needs according to life domains, a list of services that are in place post-discharge and providers arranged to deliver each service, a list of prescribed medications, dosages, and possible side effects, treatment recommendations consistent with the service plan of any involved state agency. CBHI Services Kickoff Meeting September 9, 2009 36 36

Eligibility All MassHealth benefit plans CBHI Services Kickoff Meeting September 9, 2009 37

FST enhanced and expanded to IHT
For MassHealth, FST is being enhanced, expanded, and renamed In-Home Therapy MassHealth will no longer purchase FST beginning 11/1/2009 FST will remain a viable service for the non-MassHealth population depending on specific insurer CBHI Services Kickoff Meeting September 9, 2009 38

IHT vs. FST: Similarities
Home and Community Based Service Comprehensive home based assessment and CANS Risk Management/Safety Planning Treatment Planning and Monitoring of Goals 24/7 Availability Care/Case Management – collaboration with all services and supports Psychiatric Consultation to staff Linkage with MCI and CSA teams Behavioral Management/Parent Skills Training CBHI Services Kickoff Meeting September 9, 2009 39

IHT vs. FST: Differences
Ongoing Treatment Knowledge of Wraparound and System of Care 8 – 8, 365 Days Hub for TM and IHBS Professional and paraprofessional team supervised by licensed, master’s level clinician FST Stabilization Not required 9 – 5, M thru F Not hub for other services Master’s level and BA level team CBHI Services Kickoff Meeting September 9, 2009 40

IHT Authorization Parameters
15 minute units 360 units in 90 days (13 weeks) MCE specific document at end of day CBHI Services Kickoff Meeting September 9, 2009 41

Worcester, Massachusetts September 9, 2009 Rick Shepler, Ph.D., PCC-S Center for Innovative Practices a part of the Institute for the Study and Prevention of Violence Kent State University All materials copyrighted 2009, Richard Shepler, Ph.D

All materials copyrighted 2009,
In-Home Therapy Either a Master’s level clinician or a team approach Intensive family therapy in the home or other community/natural setting to: Enhance problem-solving, limit-setting communication Build skills to strengthen the family Identify and utilize community resources Develop and maintain natural supports Risk management/safety planning All materials copyrighted 2009, Richard Shepler, Ph.D

In-Home Therapy, con’t Includes: Assessment (comprehensive home-based, inclusive of CANS) Development of a youth- and family-centered treatment plan Intensive Family Therapy Coaching Skills training Referral and linkage Identification of community resources and development of natural supports Available to MassHealth enrolled youth All materials copyrighted 2009, Richard Shepler, Ph.D

In-Home Therapy (IHT): Pivotal service in a comprehensive system of care IHT expands the continuum of care to increase the availability of the less restrictive service options for youth at-risk of out-of-home placement due to issues related to his or her mental health Pivotal: most intensive community-based option prior to more restrictive placement options All materials copyrighted 2009, Richard Shepler, Ph.D 45

Continuum of Service Intensity
A continuum of intensity based on mental health needs of the youth Opens up range of youth to be served All materials copyrighted 2009, Richard Shepler, Ph.D

Typical Youth/Family Served
Youth with serious emotional challenges with functional impairments Youth at-risk of placement or have significant safety issues Youth with multiple system involvement System has not engaged youth and family effectively All materials copyrighted 2009, Richard Shepler, Ph.D

Typical Youth Served Multiple risk factors Few protective factors Skill set deficits: e.g. problem solving; communication; emotional regulation Youth who need additional supports, active facilitation, and accommodations for success (school, home, community) All materials copyrighted 2009, Richard Shepler, Ph.D

Parents and Families High in stressors – Low in resources and supports High family conflict Current parenting skill set unsuccessful in dealing with youth's mental health needs Trust issues with the “system” Difficulty with service access (work, transportation, poverty) All materials copyrighted 2009, Richard Shepler, Ph.D

IHT Benefits: Youth and Families
Reduced out of home placements Mental health stabilization Family Stability Reduced involvement in Juvenile Justice System Increased school success Positive outcome and cost benefit to the family and other child-serving systems All materials copyrighted 2009, Richard Shepler, Ph.D 50

IHT Benefits: Other Systems
IHT actively assesses and manages risk and safety concerns Cost savings to other systems Increases positive outcomes for other child-serving systems (school success; decreased arrest rates, decreased abuse and neglect, etc.) All materials copyrighted 2009, Richard Shepler, Ph.D 51

Differences Between IHT & Traditional Services
Services delivered in the home and community 24/7 availability & response by IHT team Frequency & duration matches need Flexible Scheduling Lead role in service coordination Smaller caseloads Comprehensive mix of services Outpatient Clinic-based No 24/7 availability by team One hour weekly appointments Appointments during office hours Limited opportunities for collaboration Large Caseloads >30 Therapy only All materials copyrighted 2009, Richard Shepler, Ph.D

IHT: Key Components Access and availability Eco-systemic assessment and intervention Intensity of service matches family need Active risk management and safety planning Active intervention monitoring Active support to family Respectful and culturally mindful engagement Cross-system collaboration and advocacy Supervisor availability and team consultation All materials copyrighted 2009, Richard Shepler, Ph.D

IHT: Service of Access Service delivered where the youth lives and functions: home, school, and community at times that are convenient to the family Access to information Family dynamics and interactional patterns Recovery environments Access to people Family School Court Community Informal supports Access for interventions: implemented where behaviors occur All materials copyrighted 2009, Richard Shepler, Ph.D

Ecosystemic Assessment and Intervention
Behavioral health interventions that impact the youth in context of his or her functional environments Home School Peers Community All materials copyrighted 2009, Richard Shepler, Ph.D

Intensity of Service Matches Family Need
Based on youth and family need and functional impairment Caseload size should reflect program intensity: The greater the need the greater intensity the smaller the caseload All materials copyrighted 2009, Richard Shepler, Ph.D

Active Risk Management & Safety Planning
Active risk management; safety assessment, planning and monitoring Family is involved and informed 24/7 on call: The In-Home Therapy Services provider has 24 hour urgent response accessible by phone to the youth and family, 365 days a year. Immediate crisis response from In-Home Therapists with face to face response as needed Important that the response is from the IIHS provider/team. Not as big a burden to the staff as it may seem. Most programs have rotating on-call on the weekend All materials copyrighted 2009, Richard Shepler, Ph.D 57

Active Intervention Monitoring
IHT actively monitors interventions Treatment persistence All materials copyrighted 2009, Richard Shepler, Ph.D

Active Supports Resource poor and resource drained families Pile up of stressors and life circumstances Need active system support until we can re-build informal supports All materials copyrighted 2009, Richard Shepler, Ph.D

Respectful and Culturally Mindful Engagement
Appreciative perspective: Families are doing the best they can do, at any given time, given their current capacities and abilities, and life circumstances. Strengths and Culture Discovery (VanDenBerg): IHT providers strive to understand and appreciate the family’s values, culture, strengths, and life realities. Validation and Valuing: The youth and family are validated for their courage, efforts, and persistence, knowing that progress is sometimes very difficult, and that “hanging in there” is sometimes all that is possible at any given point in a family’s life. (Resiliency Ohio, 2008) All materials copyrighted 2009, Richard Shepler, Ph.D

Partnering with Youth & Families
The whole is greater than the sum of its parts. Working together accomplishes more than working apart We need to pool our resources and expertise Mutual Expertise: Youth and families are experts on their lives and you are an expert in your field. Engage parents and young adults in transition as co-consultants Parents are experts on their families; we are experts on our service. Need both sets of expertise working in concert to be most successful. All materials copyrighted 2009, Richard Shepler, Ph.D 61

IHT Lessons Learned: Engagement
Mutual assessment process: youth and families are assessing us as we are assessing them Misinterpreting a family’s self protection as resistance Public testimony versus private testimony All materials copyrighted 2009, Richard Shepler, Ph.D

Cross-system Collaboration and Advocacy
Pro-active cross-system collaboration and service coordination Skillful advocacy efforts are promoted to assist with accommodations and system navigation - while respecting other child-serving system’s mandates All materials copyrighted 2009, Richard Shepler, Ph.D

Supervisory Support, Availability and Team Consultation
Access and availability for IHT staff when needed Pro-active consultation and strong clinical support Supervisor should have a designated responsibility to the team All materials copyrighted 2009, Richard Shepler, Ph.D

Phases of Home-based Intervention
Engagement and Assessment Engagement (youth, family, & collaborative partners) Risk Management and Safety Planning Assessment Treatment Individual and family treatments and supports Skill Building, Skill Consolidation, and Generalization Enhancement of Positive Support Network Linkages, Closure, & Follow-up Discharge In Ohio the average LOS for Intensive Home-Based Treatment is 4.5 months 3 main phases of work: 1st phase (2 to 4 weeks) is focused on positive engagement; stabilization of presenting crises and safety needs; and thorough assessment; establish collaborative relationships with other system providers 2nd phase: (middle 6 to 8 weeks) Treatment: individual and family therapy; skill building & generalization 3rd phase (2 to 4 weeks) Enhancement of Positive Support Network: Build supports comprised mainly of informal supports (family, faith, and friends). Ritual closing celebrating successes. All materials copyrighted 2009, Richard Shepler, Ph.D 65

Multidimensional Assessment
Diagnoses: youth who meet the criteria for Mental Health Disorder and related symptom manifestation Developmental Functioning: (cognitive, emotional, & behavioral maturity) Contextual Functioning: Individual functioning in relevant life domains, including risk and protective factors, and risk and recovery environments Safety Risks: Self and other harm, personal, family, and community safety All materials copyrighted 2009, Richard Shepler, Ph.D 66

Comprehensive Array of Services: IHT Core Services
Risk management and safety planning Skill building Individual & Family Interventions Cross-System Interventions and Service Coordination Resource and support building activities All materials copyrighted 2009, Richard Shepler, Ph.D

Organizational Framework
Need framework for organizing the myriad of information obtained in the home environment A family need hierarchy is utilized to assist in assessing and prioritizing the youth’s and family needs Strategies and interventions are matched to the most salient need, progressing to more complex needs once the primary needs are met All materials copyrighted 2009, Richard Shepler, Ph.D

FAMILY NEED HIERARCHY R. Shepler (1991;1999)
All materials copyrighted 2009, Richard Shepler, Ph.D 69

Basic Needs, Safety, and Stabilization
Are there material needs that are unmet? (Food; Shelter) Are there current safety and/or symptom concerns that need stabilization? Are there significant risk factors that are barriers to recovery? All materials copyrighted 2009, Richard Shepler, Ph.D 70

Basic Needs and Safety (con.)
Assist with basic needs: Active Case Management and Advocacy Establish basic safety: Risk management; safety planning; symptom stabilization Risk reduction: Reduce risk factors and environmental stressors. All materials copyrighted 2009, Richard Shepler, Ph.D

Basic Skills Does the youth and family know how to do what you are asking them to do? What skills does the youth need to be successful? All materials copyrighted 2009, Richard Shepler, Ph.D 72

Skill Set Development Emotional regulation skills (CBT; DBT; ART; etc) Communication skills: individual and family Conflict management skills: Negotiation, compromise, problem solving skills: conflict resolution; mediation Self knowledge: Triggers; symptom management Personal safety skills All materials copyrighted 2009, Richard Shepler, Ph.D

Ecosystemic Functioning
What family or system dynamics are barriers to the youth and family’s success? How well does the youth function in key life domains/ (home, school, peers, community) Goal: Improve functioning in major life contexts (family, school, community, social, vocational, etc) All materials copyrighted 2009, Richard Shepler, Ph.D 74

Family Context: Set Stage for Change
Create family recovery environment Decrease family conflicts Rebuild bonds and relationships Increase positive family communication Increase supervision and monitoring Must change family environment, as well as , individual skills for lasting change. All materials copyrighted 2009, Richard Shepler, Ph.D 75

Community Context: Building Connections
Educate community professionals (schools, juvenile court, children services, etc) on the impacts of mental health challenges Facilitate reasonable expectations Facilitate accommodations Facilitate connections and opportunities Traditionally poor connections in the community All materials copyrighted 2009, Richard Shepler, Ph.D 76

Recovery and Resiliency
What resources and supports are necessary for ongoing growth and development? Empowered parents Supports: informal and formal; for youth and family Positive peers and activities Mentors Pro-social activities Positive connections (School; community) Opportunities to give back Services: Wraparound process: ICC Possible step-down services: therapeutic mentoring Medications; Psychiatrist All materials copyrighted 2009, Richard Shepler, Ph.D 77

IHT Discharge When to discharge: Presenting mental health symptoms no longer causing functional impairments Child no longer at-risk of placement Safety issues are stabilized Treatment gains have reached a plateau Family voice and choice Youth needs higher level of care for safety Treatment plan goals have been met All materials copyrighted 2009, Richard Shepler, Ph.D

Lessons Learned: IHT Discharge
Common Issues: Difficult for family to let go of valued service Pressures from community to remain involved No viable step-down options Family crises at termination or as services wind down There is still lots of work to do Keep in mind: Medicaid pays for episodes of treatment IHT is based on medical necessity and therefore is typically time limited All materials copyrighted 2009, Richard Shepler, Ph.D

Common Concerns and Challenges
Bugs Contagion Animals Weapons Neighborhoods Distractions: phones; TV; visitors Getting comfortable so you can do the work Need to adopt standard safety precautions Process with the participants what are their common concerns and how to deal with them All materials copyrighted 2009, Richard Shepler, Ph.D 80

Lessons Learned: Managing Challenges
Remember you are a guest in family’s home You are in control of the mental health service. The family is in control of their home. Be respectful of the family’s values and culture Do not demand or challenge. Make simple request if needed. Relate to the family how the challenging situation affects you and what would be helpful. All materials copyrighted 2009, Richard Shepler, Ph.D

Lessons Learned from the Field
Engagement is key Confidentiality in the field Reporting obligations Where to do sessions Transporting All materials copyrighted 2009, Richard Shepler, Ph.D

Lessons Learned: Administrative Supervision
Don’t let administrative supervision (productivity and paperwork) take time away for clinical supervision and case consultation time Managing caseloads and LOS Protecting electronic information Client communications via internet Texting Traveling with information Managing ethical situations All materials copyrighted 2009, Richard Shepler, Ph.D

Lessons Learned: Implementation
Build policies that support the worker: Dedicated supervisor Cell phones Flex-time policies Flex funds when possible Adjusted productivity expectations Policies and trainings that support worker safety , ethics, and burnout Ongoing coaching and training Supervisor with previous in-home experience is critical All materials copyrighted 2009, Richard Shepler, Ph.D

Lessons Learned: Implementation
Clearly identify the target population and where your service fits into the overall continuum of care in your community What stakeholders need to be on board…who are the champions and what do they expect Significant community wide education about the program Be careful of the overpromise Identifying and maintaining key referral sources Plan and budget for turnover All materials copyrighted 2009, Richard Shepler, Ph.D

The Critical Equation NIRN
Effective intervention practices and programs + Effective implementation practices = Good outcomes for children and their families The usability of a program has little to do with the weight of the evidence regarding program outcomes Evidence on effectiveness helps us select what we want implement Evidence on outcomes does not help us implement the program No other combination of factors reliably produces desired outcomes for children, families, and caregivers All materials copyrighted 2009, Richard Shepler, Ph.D 86

Contact Information Rick Shepler, Ph.D., PCC-S All materials copyrighted 2009, Richard Shepler, Ph.D 87

BREAK! CBHI Services Kickoff Meeting September 9, 2009 88 88

Therapeutic Mentoring (TM)
Overview Performance Specifications Medical Necessity Criteria on MCE websites Lauren Falls Network Health CBHI Services Kickoff Meeting September 9, 2009 89

Therapeutic Mentoring offers structured, one-to-one, strength-based support services between a therapeutic mentor and a youth for the purpose of addressing daily living, social, and communication needs. Services are provided to youth (under the age of 21) in any setting where the youth resides, such as the home and in other community settings such as school, child care centers, respite settings, and other culturally and linguistically appropriate community settings. CBHI Services Kickoff Meeting September 9, 2009 90 90

Therapeutic Mentoring Services are designed to:
support age-appropriate social functioning ameliorate deficits in the youth’s age appropriate social functioning Therapeutic Mentoring services include supporting, coaching, and training the youth in: age-appropriate behaviors, interpersonal communication, problem-solving and conflict resolution, relating appropriately to other children and adolescents, as well as adults, in recreational and social activities CBHI Services Kickoff Meeting September 9, 2009 91 91

Goal Directed Therapeutic Mentoring interventions are designed to address one or more goals on a youth’s existing Outpatient or In-home Therapy treatment plan (for youth not in ICC), or on an existing ICP (for youth in ICC). Progress toward meeting the identified goal(s) must be documented and reported regularly to the youth’s current treater(s). CBHI Services Kickoff Meeting September 9, 2009 92 92

Purposeful The Therapeutic Mentoring provider engages the youth in community activities that meet one or more of the following purposes: Provision of anticipatory guidance Teaching of alternative strategies Role playing Behavioral rehearsal Skill acquisition in the community Practicing skills in the community Exposure to social situations in which age-appropriate skills can be practiced Enhancing conflict resolution skills Developing communication skills CBHI Services Kickoff Meeting September 9, 2009 93 93

Activity Based Activity Based Interventions
Activities of daily living Social activities Artistic or creative activities Athletic activities Educational or vocational activities Activity Based Interventions CBHI Services Kickoff Meeting September 9, 2009 94 94

Staffing Requirements
Minimum qualifications for Therapeutic Mentors include: 21 years of age or older; and Bachelor’s degree in a human service field from an accredited university and one (1) year experience working with children/adolescents/transition age youth; Associate’s degree in a human services field from an accredited school and one (1) year of experience working with the target population; or High school diploma or GED and a minimum of two (2) years of experience working withchildren/adolescents /transition age youth CBHI Services Kickoff Meeting September 9, 2009 95 95

The Therapeutic Mentoring provider ensures that all Therapeutic Mentoring staff receive weekly individual supervision by a licensed clinician with specialized training in child/adolescent issues, child-serving agencies, mental health, family-centered treatment, strength-based interventions, and Wraparound planning process consistent with Systems of Care philosophy. The Therapeutic Mentoring provider ensures that a senior licensed clinician is available for consultation within one (1) hour to Therapeutic Mentoring staff during all hours that Therapeutic Mentoring staff provide services to youth, including evenings and weekends. CBHI Services Kickoff Meeting September 9, 2009 96 96

Service, Community, and Collateral Linkages
For youth in ICC Therapeutic Mentor participates as a member of the CPT and clearly outlines the goals of the Therapeutic Mentoring Service in the ICP. For youth not in ICC Therapeutic Mentor works closely with the family, and any behavioral health existing/referring provider(s) to implement the goals and objectives identified by the referring provider. 97

The Therapeutic Mentor supports, coaches and trains the youth in order to support linkages to community resources and services that will sustain the youth’s optimal functioning in the community. YMCAs Treatment Providers Tutoring Other New Resources Job-Training Health and Wellness Programs After-School Programs Faith Communities Town Recreational Programs Boys and Girls Clubs Youth CBHI Services Kickoff Meeting September 9, 2009 98 98

Process Specifications Treatment Planning and Documentation
The referring provider is responsible for communicating the reasons for referral, and for identifying goals for Therapeutic Mentoring. The Therapeutic Mentor: contacts the family to initiate services within three (3) business days of receipt of the referral; has at least one contact per week with the youth’s ICC, In-Home Therapy Services, or outpatient provider to provide updates on progress toward goals on the identified treatment plan or ICP; ensures that all services are provided in a professional manner, ensuring privacy, safety, and respecting the youth and family’s dignity and right to choice; documents each contact in a progress report in the service record for the youth and shares this information with treatment team or CPT for youth in ICC; CBHI Services Kickoff Meeting September 9, 2009 99 99

Process Specifications Treatment Planning and Documentation (cont) The Therapeutic Mentor: must coordinate with the referring behavioral provider or ICC and attend all treatment team or CPT meetings that occur while they are providing Therapeutic Mentoring Services; For youth in ICC, gives input to the CPT in order to clearly outline the goals of the service in the ICP and provide updates on the child/adolescent’s progress; develops and identifies for the referring provider or CPT an anticipated schedule for meeting with the youth and a timeline for goal completion; determines the appropriate number of hours per week/month for Therapeutic Mentoring services based on the needs of the youth as identified in the Treatment Plan or ICP. CBHI Services Kickoff Meeting September 9, 2009 100 100

Process Specifications Discharge Planning and Documentation
A discharge-planning meeting is initiated when the adult adolescent/ emancipated child, parent/caregiver and current treater or CPT for youth in ICC, determine that the youth has met his/her goals and no longer needs or meets the criteria for Therapeutic Mentoring Services. The Therapeutic Mentor provider, in cooperation with the treatment team or CPT for youth in ICC, writes a discharge plan that includes reasons for discharge and documentation of ongoing strategies, supports, and resources to assist the youth and family in maintaining gains. The plan is given to the youth and/or parent/guardian/caregiver and, with consent, the existing behavioral health provider(s) within five (5) business days of the last date of service. If unplanned termination of services occurs, the provider makes every effort to obtain the youth’s participation in the services and to provide assistance for appropriate follow-up plans. As a hub dependent service, the provider contacts the hub provider. Such activity is documented in the staff’s record for the youth. CBHI Services Kickoff Meeting September 9, 2009 101 101

Eligibility Only: MassHealth Standard MassHealth CommonHealth CBHI Services Kickoff Meeting September 9, 2009 102

CSP CSP services still available for youth under 21 TM and CSP have distinct but similar medical necessity criteria Expected that one youth will not need both services at same time CBHI Services Kickoff Meeting September 9, 2009 103

TM Authorization Parameters
15 minute units 208 units in 90 days (13 weeks) MCE specific document at end of day CBHI Services Kickoff Meeting September 9, 2009 104

THERAPEUTIC MENTORING SERVICES
Teaching Skills to Navigate in the World Marci White, MSW NC Mentor September 2009

Therapeutic Mentoring Services – First Things First
Youth must be receiving Outpatient services, In-Home Therapy or ICC Youth’s clinical condition requires the service to improve age-appropriate functioning or to ameliorate deficits in youth’s functioning 106 CBHI Services Kickoff Meeting September 9, 2009

Therapeutic Mentoring: It has an “Assignment”
The service is needed to achieve specific goal(s) in the youth’s individual care plan (ICP) or treatment plan, including: Address daily living, social and communication needs Help the youth navigate social contexts, learn new skills and make functional progress Support, coach and train age-appropriate behaviors, interpersonal communication, problem-solving and conflict resolution, relating appropriately to others in recreational and social activities 107 CBHI Services Kickoff Meeting September 9, 2009

“Assignment” (cont’d)
Teach skills through “structured, one-to-one support services” (across life domains and settings) in order for youth to remain at home, prevent out-of-home placement, or to transition “home” Assist youth to communicate his/her needs to the Care Plan Team (CPT)/treatment team; contribute the “voice of the youth” in the youth’s absence 108 CBHI Services Kickoff Meeting September 9, 2009

Therapeutic Mentoring Services – What It’s NOT
It is NOT observation or management during sport/physical activity, school, after-school activities, or recreation. It is NOT a teacher’s aide. It is NOT for parental respite. The Therapeutic Mentor does NOT directly provide social, educational, artistic, athletic, recreational or vocational services. It is NOT a stand-alone service; it is part of the treatment plan developed by the youth’s clinical hub service (OP,IHT, ICC). 109 CBHI Services Kickoff Meeting September 9, 2009

Therapeutic Mentoring – When?
For youth whose clinical condition and ability to manage stressors and feelings enable them to use supports and learn new skills for improved functioning in the community Youth do not require significant or intensive behavior interventions or management in order to receive this service The youth needs to be able to learn new skills by practicing and coaching and being supported through one-to-one activities with another person. If the youth requires significant behavior interventions or management, other more intensive services are likely to more appropriate, e.g., In-Home Therapy or In-Home Behavioral Services 110 CBHI Services Kickoff Meeting September 9, 2009

What Does the Therapeutic Mentor Do? (One-to-one)
Teach alternative strategies Provide anticipatory guidance Role plays Behavior rehearsals Teach, enhance and practice conflict resolution skills, problem-solving skills, and social skills in “everyday” social situations Mentor would use 1:1 services and interventions to teach the youth skills and alternative strategies so he/she can go “out” in the community and practice them. The Mentor would supervise, guide, coach and discuss the youth’s use of the strategies and skills in the community. 111 CBHI Services Kickoff Meeting September 9, 2009

What Else Does the Therapeutic Mentor Do?
Supervise youth’s practices of new and enhanced skills and engage the youth in discussions about effective strategies for handling “everyday” social situations Help ensure the youth’s success in navigating various social contexts; give feedback; coach and support use of effective strategies 112 CBHI Services Kickoff Meeting September 9, 2009

In What Kinds of Settings and Situations?
Social activities Recreational and athletic activities Artistic or creative activities Educational or vocational activities Activities of daily living In the youth’s home and in the community The Mentor would use these kinds of activities as opportunities for the youth to practice the skills and strategies they had been working on one-to-one. It’s not the Mentor’s role to utilize significant behavior interventions with the youth in the community to address behavior problems. The expectation is that the youth is able to manage significant behaviors with limited coaching, guidance and support. 113 CBHI Services Kickoff Meeting September 9, 2009

Therapeutic Mentoring – Linkages and Connections
Participate on treatment/care plan team and inform other treatment providers of progress on assigned goal(s) Assist the youth in communicating needs to the treatment/care plan team; provide the youth’s “voice” with the team in the youth’s absence Support, coach and train the youth in connecting with existing and new treatment providers Support, coach and train the youth in connecting with community resources and services that help sustain the youth’s optimal functioning in the community (natural supports) 114 CBHI Services Kickoff Meeting September 9, 2009

Assess Progress Toward Goals
Describe the purpose of the contact and the goal being addressed Describe the interventions, skill-building activities used with the youth; assess effectiveness of the intervention and describe youth’s level of mastery of the skill Describe skill components or additional skills for which the youth still needs more practice 115 CBHI Services Kickoff Meeting September 9, 2009

What does the Therapeutic Mentor need in order to start?
The “picture” of the youth and how he “works,” including: The skills and strategies the youth needs to address the daily living, social and communication needs outlined in his/her plan Youth’s strengths and interests (or protective factors) identified in the treatment plan Additional protective factors the youth needs. Which ones would most likely help improve the youth’s functioning and address treatment goals? Examples of Protective Factors to look for and use to build on with skills or to try and add to the youth’s life with Therapeutic Mentoring Family -has the child lived at home most of his/her life? -parents employed? -do the parents have a high school diploma? -are there extended family members involved with the family? -is the child connected to someone in the extended family? Child Competencies -what are the child’s reasoning and problem solving skills? -is the child a good reader? -what are the child’s interests or hobbies? -what does he like to do? -what does she think she’s “good at”? Child Social Skills -does the child get along with other children? -with adults? -does the child have a good sense of humor? -is the child “likable”? -are the child’s friends “positive”? Extra-Familial Social Support -is there support for the child at school? -is there support for the child at a church? -does the child have a good relationship with an adult outside of the family? Outlooks and Attitudes -is the child independent minded (especially girls)? -does the child have positive expectations (hopes and dreams) for the future? -does the child believe he/she has come control over what happens in the future? 116 CBHI Services Kickoff Meeting September 9, 2009

Remember…. The Therapeutic Mentor carries out “assignments” from the treatment plan or care plan The Therapeutic Mentor’s role is to help the youth learn skills to accommodate and function in the world, rather than to focus on getting the “world” to accommodate to the youth (other treatment services have that role) 117 CBHI Services Kickoff Meeting September 9, 2009

“Begin with the End in Mind”
It is NOT a “forever” service Acquisition and demonstration of skills needed to function more effectively in the community is the goal Transition from reliance on Therapeutic Mentor to use of existing, natural supports in everyday situations If behaviors or needs require ongoing or long-term support, other services may be more appropriate (or the goals needs to be re-evaluated and adjusted) 118 CBHI Services Kickoff Meeting September 9, 2009

A Relationship With a Purpose and a Goal
“Kids can walk around trouble, if there is some place to walk to, and someone to walk with.” Tito, ex-gang member 119 CBHI Services Kickoff Meeting September 9, 2009

Therapeutic vs Social Relationship Relationship
Structured and goal oriented Focus on needs of youth Confidentiality mandated May or may not choose staff Spontaneous Focus on mutual benefit Confidentiality is by trust only Choose your friends 120 CBHI Services Kickoff Meeting September 9, 2009

Here’s some ideas for getting started! Really listen and seek to understand Be honest Learn to apologize and forgive Show respect for the youth Make and keep promises Have a positive attitude Be kind Advocate Seek to understand the youth’s world Be consistent Keep your cool Use humor Maintain empathy Develop concrete goals 121 CBHI Services Kickoff Meeting September 9, 2009

Structure for Teaching Skills
Directed and Intentional Observable Outcomes Evaluation and Feedback Provide Corrections Positive Reinforcers 122 CBHI Services Kickoff Meeting September 9, 2009

Elements of Respectful Teaching
Give your full attention Identify teachable moments Act as a good model Treat people with respect Use appropriate body language Talk about the activity Confirm that learning is taking place 123 CBHI Services Kickoff Meeting September 9, 2009

Model the Skill People learn from watching other people; be a good model When modeling a skill, refer to its components – name them. Look for and create opportunities to model the skill with the youth (teachable moments). Another youth, as well as the Therapeutic Mentor, can model skills. 124 CBHI Services Kickoff Meeting September 9, 2009

Establish the Need for the Skill
Talk about reasons for learning the skill Give examples of benefits for the skill Give examples of consequences for not knowing or using the skill 125 CBHI Services Kickoff Meeting September 9, 2009

Negative behavior > Teach positive
Cursing, vulgar language Being loud, boisterous Sarcasm, whining, begging Ignoring, defying rules/instructions Easily drawn off task by disruptive behaviors of others Taking without asking Hoarding stuff Criticizing others, name-calling, teasing Avoiding eye contact Use words appropriate for the setting Use a voice level appropriate to the setting Use an appropriate tone of voice for the setting Teach how to and the benefit of following instructions Ignore others’ behaviors Ask permission to borrow, touch property of others Sharing Positive statements to others/compliments Make good eye contact 126 CBHI Services Kickoff Meeting September 9, 2009

Examples of Skills Youth Need and Can be Taught
Social Skills Listening Following instructions Asking for help Cooperating Apologizing/expressing regrets Problem-Solving Skills Identifying the problem Identifying options Concentrating/Attention Negotiation Skills Evaluating outcomes Daily Living Skills Time management Use of community resources Job-seeking skills Leisure skills/activities Personal hygiene Conflict Resolution Skills Identifying differences Respecting differences Disagreement skills Identifying anger triggers 127 CBHI Services Kickoff Meeting September 9, 2009

Skills, Skills, Skills….. Behavior Management Skills Identifying and expressing feelings Communication skills Empathy skills Handling group pressure Dealing with fear Avoiding trouble Self-management Skills Dealing with fear Emotional regulation Stress management Identifying healthy options for dealing with symptoms Positive self-talk Relaxation techniques Expressing emotions positively 128 CBHI Services Kickoff Meeting September 9, 2009

Describe the Behavior Components of the Skill
Skills are made up of component behaviors “Following Instructions” is a skill; “Looking at the person” giving instructions is a component of that skill Define individual steps and components of a skill Use behavioral terms that are observable when describing skill components 129 CBHI Services Kickoff Meeting September 9, 2009

Basic Skill: Following Instructions
(+) Looks at the person Thinks about what is being said Acknowledges the request; asks for more information, if needed Does the task immediately Checks back after completing the task (-) Looks away or rolls eyes Ignores instructions Delays beginning task Does not check back after completing the task 130 CBHI Services Kickoff Meeting September 9, 2009

Giving Effective Instructions 3 Essential Elements
Effective instructions are statements, not questions or suggestions. Unless you really are giving a choice, don’t frame it as a question. Effective instructions are brief. One or two steps at a time is enough. Effective instructions are clear, they state exactly what is expected. 131 CBHI Services Kickoff Meeting September 9, 2009

Instructions That Often Don’t Work
Questions Buried Chain Repeated Vague Distant “Let’s” 132 CBHI Services Kickoff Meeting September 9, 2009

Behavior Rehearsals and Role Plays
A way to practice a new skill before youth tries to use it on their own Role Play process: Assign a specific role to the youth Give guidance and feedback, including corrections Role Play is “complete” when there are no more corrections Use positive reinforcers Discuss youth’s reaction to doing the role play 133 CBHI Services Kickoff Meeting September 9, 2009

Practicing the Skill Helps youth transfer learning to other settings Helps reinforce the skill as they begin using it. Lots of creative ways to practice – activities, worksheets, art, diaries, charts, etc. 134 CBHI Services Kickoff Meeting September 9, 2009

Prompting Look for an appropriate teachable moment Use natural prompts Allow for time between prompts Use only brief vocal prompts Vary your tone of voice as appropriate Record required prompts 135 CBHI Services Kickoff Meeting September 9, 2009

Independent Use of the Skill is the Objective
We want youth to use the skills on their own Using the skills will improve their functioning Families and friends become an active part of the process Other people can help them learn and use the skills Reinforcing skills in “everyday” situations helps youth learn skills 136 CBHI Services Kickoff Meeting September 9, 2009

Continuation Keep on keeping on….using those skills (what the Therapeutic Mentor can do to help): Summarize the skill components Relate the skill to the youth’s treatment goals Praise the youth’s use of the skill whenever you see it Note the need/rationale for the skill Acknowledge the challenges and stress the gains Continue to model the skill Remind youth to use the skill when needed Ask the youth to tell you about using the skill since you last met 137 CBHI Services Kickoff Meeting September 9, 2009

References Interpersonal Social Skills: Instructions for Teaching Social Skills to Consumers (NC Mentor, Raleigh, NC, part of The Mentor Network), Presented by Marci White, MSW, NC Mentor Raleigh, NC Portions of this material adapted from the series of Ready-to-Use Social Skills and Activities for Pre-K, Grades 1-3, Grades 4-6, Grades 7-12, and Violence Prevention Skills, edited by Ruth Weltmann Begun 138 CBHI Services Kickoff Meeting September 9, 2009

Lunch! Back at 1:30pm CBHI Services Kickoff Meeting September 9, 2009 139

In-Home Behavioral Services (IHBS)
Overview Performance Specifications Medical Necessity Criteria on MCE websites Briana Duffy Beacon Health Strategies for Neighborhood Health Plan Fallon Community Health Plan CBHI Services Kickoff Meeting September 9, 2009 140

Components of IHBS In-Home Behavioral Services are delivered by one or more members of a team consisting of professional and paraprofessional staff trained in principles of behavior management, offering a combination of medically necessary Behavior Management Therapy & Behavior Management Monitoring. Services are provided in the youth’s home and community. CBHI Services Kickoff Meeting September 9, 2009 141 141

Behavior Management Therapy Behavior Management Therapy Includes: a functional behavioral assessment, development of a highly specific behavior plan; supervision and coordination of interventions; training other interveners to address specific behavioral objectives or performance goals. The behavior management therapist develops specific behavioral objectives and interventions that are designed to diminish, extinguish, or improve specific behaviors related to the youth’s behavioral health condition(s) and which are incorporated into the behavior plan and the risk management/safety plan. CBHI Services Kickoff Meeting September 9, 2009 142 142

Behavior Management Monitoring
This service includes: implementation of the behavior plan, monitoring the youth’s behavior, reinforcing implementation of the behavior plan by the parent(s)/guardian(s)/caregiver(s), and reporting to the behavior management therapist on implementation and progress toward behavioral objectives or performance goals. As a hub dependent service, the Behavior plan is designed to achieve a goal(s) identified in the youth’s ICC Individual Care Plan (ICP) or the treatment goals of the non-ICC hub. CBHI Services Kickoff Meeting September 9, 2009 143 143

Behavior Management Therapy Activities
Behavioral Health assessment that includes the age appropriate version of the MA Child Adolescent Needs and Strengths (CANS) tool Documented observations of the youth in the home and community Structured interviews with the youth, family, and any identified collaterals about his/her behavior(s) Completion of a written functional behavioral assessment Development of a focused behavior plan that identifies specific behavioral and measurable objectives or performance goals and interventions that are designed to diminish, extinguish, or improve specific behaviors related to a youth’s mental health condition(s). CBHI Services Kickoff Meeting September 9, 2009 144 144

Behavior Management Therapy Activities cont.
Development of specific behavioral objectives and interventions that are incorporated into the youth’s risk management/safety plan Modeling for the parent/guardian/caregiver on how to implement strategies identified in the behavior management plan Working closely with the behavior management monitor to ensure the behavior management and risk management/safety plans are implemented as developed, and to make any necessary adjustments to the plan. CBHI Services Kickoff Meeting September 9, 2009 145 145

Behavior Management Monitoring Activities
Monitoring the youth’s progress on implementation of the goals of the behavior plan developed by the behavior management therapist Providing coaching, support, and guidance to the parent/guardian/caregiver in implementing the plan Working closely with the behavior management therapist to ensure the behavior management and risk management/ safety plans are implemented as developed, and reporting to the behavior management therapist if the youth is not achieving the goals and objectives set forth in the behavior management plan to permit modification of the plan as necessary. CBHI Services Kickoff Meeting September 9, 2009 146 146

Minimum Staff Qualifications for Behavior Management Therapist
Master’s level (or above) clinician Additional hours of coursework and training in conducting functional behavioral assessments and selecting, implementing, and evaluating intervention strategies. Two (2) years relevant experience providing direct services to youth and families who require behavior management to address mental health needs. Supervised experience conducting behavioral assessments and designing, implementing and monitoring behavior analysis programs for individuals. CBHI Services Kickoff Meeting September 9, 2009 147 147

Minimum Staff Qualifications for Behavior Management Monitor
A bachelor’s degree in a human services field from an accredited university and one (1) year of direct relevant experience working with youth and families who require behavior management to address mental health needs, OR An associate’s degree and a minimum of two (2) years of relevant direct service experience working with youth and families who require behavior management to address mental health needs. CBHI Services Kickoff Meeting September 9, 2009 148 148

Additional requirements from last week’s alert
Behavior Management Therapist Board Certified Behavior Analyst (BCBA) Requirements at Behavior Management Monitors One year of direct ABA/Behavior Therapy experience, under supervision of a BCBA, working with youth and families who require behavior management to address mental health needs. CBHI Services Kickoff Meeting September 9, 2009 149

The In-Home Behavioral Services provider ensures that a licensed, senior clinician (master’s level or above), provides adequate supervision to professional and paraprofessional staff on a weekly basis. CBHI Services Kickoff Meeting September 9, 2009 150 150

Service, Community, and Collateral Linkages
The In-Home Behavioral Services provider works collaboratively with ICC, In-Home Therapy Services, or other existing provider(s), and delivers services in accordance with the youth’s plan of care, and participates in all care planning meetings and processes. The behavior management therapist completes a written functional behavioral assessment and develops a highly specific behavior plan with clearly defined interventions and measurable goals and outcomes within seven (7) days of the first meeting with the family. In-Home Behavioral Services staff have contacts as needed but at least one (1) per week with the youth’s ICC care coordinator to provide updates on progress on the identified ICP goal(s). CBHI Services Kickoff Meeting September 9, 2009 151 151

Discharge Planning and Documentation
A discharge planning meeting is scheduled whenever the authorized decision maker decides that services are no longer desired, or for youth in ICC the CPT along with the family, determines that the youth has met his/her goals and no longer needs the service, or the youth no longer meets the medical necessity criteria for In-Home Behavioral Services. The reasons for discharge and all behavior management treatment and discharge plans are clearly documented in the record. The In-Home Behavioral Services staff develops an up-to-date copy of the behavior management plan, which is given to the parent/guardian/ caregiver on the last date of service, and to all current /referring provider(s) and/or to the ICC care coordinator and CPT within seven (7) calendar days of the last date of service. CBHI Services Kickoff Meeting September 9, 2009 152 152

Discharge Planning and Documentation cont.
If an unplanned termination of services occurs, the provider makes every effort to contact the parent/guardian/caregiver to obtain their participation in In-Home Behavioral Services and to provide assistance for appropriate follow-up plans . As a hub dependent service, the provider will make every effort to contact the hub provider. Such activity is documented in the record. CBHI Services Kickoff Meeting September 9, 2009 153 153

Eligibility Only: MassHealth Standard MassHealth CommonHealth CBHI Services Kickoff Meeting September 9, 2009 154

IHBS Authorization Parameters
15 minute units 120 units in 30 days MCE specific document at end of day CBHI Services Kickoff Meeting September 9, 2009 155

Placeholder for Mark’s slides
CBHI Services Kickoff Meeting September 9, 2009 156 156

BREAK! CBHI Services Kickoff Meeting September 9, 2009 157 157

Panel Discussion Members Speakers for each service MassHealth MCEs Moderator John H. Straus, M.D. Massachusetts Behavioral Health Partnership CBHI Services Kickoff Meeting September 9, 2009 158

Next Steps Andrea Gewirtz Massachusetts Behavioral Health Partnership Documents available at table outside: MCE specific authorization processes CBHI authorization parameters CBHI Service Definitions CBHI Services Kickoff Meeting September 9, 2009 159

Next Steps (Continued)
MCE network management teams Regionally-based provider meetings Send any questions to: mailbox CBHI Services Kickoff Meeting September 9, 2009 160

Adjournment CBHI Services Kickoff Meeting September 9, 2009 161

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