Beth Waldman, JD,. MPH Remedial Services Transition Committee: Meeting Two Attachment: Background Research October 18, 2010

2 Background Research: States Included Arizona Colorado Louisiana Maryland Massachusetts Nebraska Pennsylvania Rhode Island

3 How are services that are similar to remedial services defined in other states? Did not find another state with a service called remedial services. Several states have services that are similar or overlapping with Iowas remedial services Like Iowa, most states dont have a clear definition of the services. Definitions and descriptions follow for: –Arizona –Massachusetts –Nebraska –Pennsylvania –Rhode Island –Louisiana –Maryland

4 Arizona: Rehabilitation Services Include the provision of education, coaching, training, demonstration. Specific services include: –Skills training and development –Psychosocial rehabilitation living skills training –Cognitive rehabilitation –Behavioral health prevention/promotion education –Medication training and support –Psychoeducational service (pre-job training and development)

5 Arizona: Home Care Training Family (Family Support) Involves face-to-face interaction with family members directed toward restoration, enhancement or maintenance of family functioning to increase the familys ability to effectively interact and care for the person in home and community. Activities may include: –Assisting family to adjust to persons disability –Developing skills to effectively interact and//or manage the person –Understanding the causes and treatment of behavioral health issues

6 Arizona: Home Care Training to Home Care Client Services provided by a foster parent to person residing in home Assist and support person in achieving service plan goals Includes supervision and provision of behavioral health support services including personal care, psychosocial rehabilitation, and skills training and development

7 Massachusetts: Childrens Behavioral Health Initiative (CBHI) Services Implemented as a result of litigation (Rosie D) Services include: Intensive Care Coordination, Family Support and Training, In-Home Behavioral Services (including Behavioral Management Therapy and Behavior Management Monitoring), Therapeutic Mentoring Services, In-Home Therapy Services (including Therapeutic Clinical Intervention and Ongoing Therapeutic Training and Support), Mobile Crisis Intervention and Crisis Stabilization

8 Massachusetts: Therapeutic Mentoring Services Structured one-to-one, strength-based support services between a therapeutic mentor ad a youth for the purpose of addressing daily living, social and communication needs. Includes supporting, coaching and training the youth in age-appropriate behaviors, interpersonal communication, functional skill-building, problem solving, conflict resolution, and relating appropriately to other youth, as well as adults, in recreational and social activities.

9 Nebraska: Community Treatment Aide Services Supportive, directive and teaching interventions provided in the childs natural environment designed to improve the childs level of functioning. Services targeted for high risk youth Primary goals is to assist family in accessing appropriate psychosocial support in community Treatment interventions are directed at environmental and/or psychological stressors or other factors complicating recovery Requires a parent or usual care giver to be present during the entire delivery of the service. This is not respite, day care or mentor services.

10 Pennsylvania: Family Based Mental Health Services Available to children at risk for out-of-home placement due to severe emotional or behavioral disorder, or due to severe mental illness Also used as step down for child transitioning home Discrete service provided by a team, comprehensive in scope, incorporating intensive home therapy, casework services, family support services and crisis stabilization. Services include: individual and family therapy; crisis stabilization; ongoing information-gathering in support of active treatment; collaborative development and modification of the treatment plan; clinical intervention to attain identified treatment goals including remediation of childs symptoms (behavioral, affective, cognitive, thought impairments), improvement of family relationships, community integration and other aspects of psychosocial competence and skill development in the home, school or community; support for parents in implementing effective behavior management and parenting approaches; school based consultation and intervention as needed; referral and coordination w/ other agencies.

11 Pennsylvania: Behavioral Health Rehabilitation Services Designed to address the increasingly complex needs of children receiving services in multiple child serving systems (e.g., child welfare, juvenile justice, etc.) Appropriate for children who require intervention at sites where problematic behaviors occur Limited to services provided in the home or community; does not include psychosocial rehabilitative services that occur at provider site (e.g., after school program) Goal is to ameliorate symptoms, medication management, promote psychosocial growth and development and prevention of regression/recidivism by improving the childs level of functioning and ability for self maintenance; coordination of treatment and discharge planning, and increase in age-appropriate interactivity. Specialized services include: mobile therapy, behavioral specialist consultant (doctors or masters level), therapeutic staff support, and summer therapeutic activities program

12 Rhode Island: Home Based Therapeutic Services Specialized, intensive services and treatment provided according to an approved individual treatment plan –Treatment plan must include specific goals and a plan to measure progress Services provided in childs home or other age appropriate community setting. Ongoing parent participation is required to maximize what is learned during treatment. Offered to enable a child to participate in his/her family and community more by helping to improve communication, behavioral, psychosocial and developmental skills

13 Maryland: Therapeutic Behavioral Services Therapeutic Behavioral Services (TBS): for children with mental illness or developmental disabilities and maladaptive behaviors –Service provided at home and in community –Includes initial assessment, development of a behavior plan, and ongoing individual one to one aide –Designed to support children who are at risk for higher level of care without the intervention TBS is not: –Not available during hospitalization, residential treatment center or group home if one to one staffing already provided –respite care or for provision of assistance with ADLs

14 Maryland: Psychiatric Rehabilitation Program Service: Psychiatric Rehabilitation Program Service: –Community-based mental health services provided to children with mental illness in therapeutic after school programs or one to one in their home or community –Designed to promote positive peer interaction, effective communication, self-help skills and completion of age appropriate ADLs –Must have a diagnosis of a mental illness

15 Louisiana: Mental Health Rehabilitation Services Intensive outpatient services for adults with serious mental illness and youth with emotional/behavioral disorders. Medically Necessary Behavioral Health Services that are recovery and rehabilitative in nature, provided in community, home or school to assist individuals in remaining in the community Goal of Services: –Stabilize acute symptoms –Assist with coping of symptoms –Minimize aspects that make it difficult to live independently –Are recovery and rehabilitation focused Types of services may include: –Supportive and group counseling –Clinical and Medication management –Individual and parent/family intervention –Individual and group psychosocial skills training –Behavior intervention plan development –Service integration

16 Who uses services similar to remedial services in other states? Many limitations on who can receive services is included in the definitions –Many states limit service to children –Some states target to high-risk youth (Nebraska, PA) States also utilize admissions criteria to determine who may receive specific services

17 Massachusetts: Admissions Criteria for Therapeutic Mentoring Services Must meet all of the following requirements: –Have completed a comprehensive BH assessment which includes the CANS that indicates childs clinical condition warrants service –Child requires education, support, coaching & guidance in age- appropriate behaviors, interpersonal communication, problem- solving and conflict resolution, and relating appropriately to others to address daily living, social and communication needs and to support the youth in a home, foster home or community setting OR, requires support in transitioning back to the community from a congregate care setting –Outpatient services alone are not sufficient to meet these service needs –Required consent is obtained –Child is engaged in outpatient services and the provider believes this service can facilitate attainment of a goal/objective within treatment plan

18 How are services similar to remedial services authorized in other states? States require: –review of services by a clinician; similar to a LPHA (all) –development of a comprehensive treatment plan, that includes specific goals (MA, MD, NE, PA, RI) –states and their vendors review service authorizations, either providing prior approval or using retrospective review Many states authorize service based on entire treatment plan; not individually Referring providers responsible for providing service providers with specific need for the referral and goal trying to meet with the service (MA)

19 Who provides services similar to remedial services in other states? In most states, the services are provided through an agency or organization, not an individual provider, who hire specific paraprofessional staff to provide the services. –Some states utilize teams to provide comprehensive set of services to individual, including remedial-like services and a team member will provide these services (MA, PA) –Includes ongoing clinical oversight of the service and tie-back to the treatment plan (RI, MD) Examples include: –CMHCs –Outpatient hospitals –CHCs –Clinics –Private agencies credentialed by the state/vendor

20 Massachusetts: Provider Requirements Service must be operated by provider with demonstrated infrastructure to support and ensure: –Quality Management/Assurance –Utilization Management –Electronic Data Collection/IT –Clinical and Psychiatric Expertise –Cultural and Linguistic Competence Providers develop and maintain policies specific to the therapeutic mentoring services and ensure staff training

21 Massachusetts: Staffing Therapeutic Mentors must meet minimum qualifications: –21 years of age or older –Educational experience: Bachelors degree in human service field & 1 year experience working with children/adolescent/transition aged youth; or Associates degree in human service field & 1 year experience working with the target population; or High-school diploma or GED and & 2 years experience working with children/adolescent/transition aged youth; –Comprehensive Training Upon employment Annually –Receive weekly individualized supervision by clinician –Agency has senior licensed clinician available for same day consult

22 Colorado: Credentialing Requirements Typically states with managed behavioral health care carve outs dont specify credentialing by provider type, but provide Contractors with general requirements. In Colorado, the Contractor must: –have written policies for selection and retention of providers –not discriminate against particular providers that serve high-risk populations –verify that providers meet licensing and certification requirement –demonstrate to the state that are credentialed –exclude anyone excluded from participation in federal health care programs –comply with NCQA standards for initial credentialing and re- credentialing –include policies and procedures for detection and reporting of incidents of questionable practice.