DFCS Online Policies & Procedures

  DFCS Online Policies & Procedures

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Handbook 4: Case Plans and Case Management Services
4-10   Therapeutic Behavioral Services (TBS)

 

Case Plans and Case Management Services
4-10  Therapeutic Behavioral Services (TBS)
Reference Points
Overview
Goals of TBS
Conditions for Referring for TBS
Eligibility Requirements
Medical Necessity Criteria
Service Need Criteria
Situations Not Appropriate for TBS
TBS Referral Process
Direct Services and Goal for Youth and Their Families
Length of Service


Reference Points
Effective Date: 7/1/07
Last Updated: 5/21/07


Overview  

Therapeutic Behavioral Services (TBS) are one-on-one mental health services for youth with serious behavioral challenges. Youth referred for TBS services are experiencing a stressful transition or life crisis and need effective, short-term intervention.  One-on-one therapeutic contact with a behavioral counselor helps the youth maintain the least restrictive level of care by providing the youth with skills to effectively manage the behavior(s) or symptom(s) and achieve short-term treatment goals. 

TBS services are defined by the State Department of Mental Health.

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Goals of TBS  

The goal of Therapeutic Behavioral Services is to:

  • Maintain youth in out-of-home care in the lowest appropriate level of care by resolving target behaviors and achieving short-term treatment goals, or

  • Successfully help the youth transition from a high level of care to a less-restrictive setting.
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Conditions for Referring for TBS  

For a youth to be accepted for TBS services, one of the following four conditions must be met.  The youth:

  • Is currently placed in a group home facility of RCL12 or above and/or a locked treatment facility, or

  • Is being considered by the county for placement in a facility of RCL 12 and/or a locked treatment facility, or

  • Has undergone at least one emergency psychiatric hospitalization related to his/her current presenting disability within the preceding 24 months, or

  • Has previously received therapeutic behavioral services while a member of the certified class.
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Eligibility Requirements  

To be eligible for Therapeutic Behavioral Services, a youth must:

  1. Have full-scope Medi-Cal;
  2. Be between the ages of 4-21;
  3. Meet both medical necessity criteria and service need criteria;
    • The TBS provider usually establishes medical necessity in his/her assessment.
  4. Have target behaviors or symptoms which are not responding to other mental health services alone, which jeopardize current placement, and which can be expected to respond to short-term intensive intervention;
  5. Be currently receiving other mental health service.
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Medical Necessity Criteria  

To meet medical necessity criteria for TBS services, all three of the following must exist:

  1. There is documentation of a primary diagnosis* that meets medical necessity and which is the primary focus of the interventions and treatment to be provided.
  2. There is documentation that, as a result of the diagnosed mental illness, there is significant functional impairment in an important area of life functioning.
  3. There is documentation that the planned intervention is expected to improve the impairment or reduce risk of deterioration.



*Included Diagnoses

The following SM-IV-TR disorders qualify for a primary diagnosis:

  • Pervasive Developmental Disorders, except autistic disorder
  • Attention Deficit and Disruptive Behavior Disorders
  • Feeding and Eating Disorders of Infancy or Early Childhood
  • Elimination Disorders
  • Other Disorders of Infancy, Childhood or Adolescence
  • Schizophrenia and Other Psychotic Disorders
  • Mood Disorders
  • Anxiety Disorders
  • Somatoform Disorders
  • Factitious Disorders
  • Dissociative Disorders
  • Paraphilias
  • Gender Identity Disorders
  • Eating Disorders
  • Impulse-Control Disorders not elsewhere classified
  • Adjustment Disorders
  • Medication-Induced Movement Disorders
  • Personality Disorders (Axis II), except Antisocial Personality Disorder

Excluded Diagnoses

The following DSM-IV-TR disorders do not qualify for a primary diagnosis:

  • Autistic Disorders
  • Learning Disorders
  • Motor Skill Disorders
  • Communication Disorders
  • Tic Disorders
  • Delirium, Dementia and Amnestic and Other Cognitive Disorders
  • Mental Disorders Due to a General Medical Condition
  • Substance-Related Disorders
  • Sexual Dysfunctions
  • Sleep Disorders
  • Other conditions that may be a focus of clinical attention, except Medication-Induced Movement Disorders
  • Mental Retardation (Axis II)
  • Antisocial Personality Disorders (Axis II)
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Service Need Criteria  

The youth's need for services is assessed by the mental health provider.  To be assessed as needing TBS services:

  • The youth must be receiving other specialty mental health services and

  • In the clinical judgment of the mental health provider:
    • Without the addition of short-term support of TBS, the youth will need placement in a higher level of residential care, including acute care, because of a change in behaviors or symptoms which jeopardize continued placement in the current facility in which the youth is placed, or
    • The additional support of TBS is needed to assist the youth in transitioning to a lower level residential placement.
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Situations Not Appropriate for TBS  

Therapeutic based services are not approved:

  • When the need is solely:
    • For the convenience of the caregiver
    • To provide supervision
    • To ensure the youth's physical safety or the safety of others, e.g. suicide watch
    • To address conditions that are not part of the youth's mental health condition

  • When the youth can sustain non-impulsive self-directed behavior, handle himself/herself appropriately in social situations with peers and able to appropriately handle transitions during the day.

  • When the youth will never be able to sustain non-impulsive self-directed behavior and engage in appropriate community activities without full-time supervision.

  • When the youth is an inpatient of a hospital, psychiatric health facility, nursing facility, IMD or crisis residential program.
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TBS Referral Process  

To refer a youth for TBS services, the social worker:

 

Step
Task
Who
1.

Calls the Mental Health Department (MHD) Quality Improvement Program:

  • Robert Rocco, Tel: 408-793-5807
Social Worker
2. Discuss the referral. Social Worker and MHD staff
3. Provides social worker with the name of a provider who has a TBS opening. MHD Staff
4. Calls the provider and requests a TBS referral form. Social Worker
5. Faxes the form to the social worker. TBS Provider
6.
  • Completes the referral form.
  • Faxes the referral form back to the provider.
Social Worker
7.
  • Creates an Initial Screening request for TBS.

  • Faxes the Initial Screening request to the MHD Quality Improvement Program.
TBS Provider
8.

Reviews the Initial Screening request.

Approves or denies the request.

MHD Quality Improvement Program staff
9.
  • Informs the social worker of the MHD's decision to approve or deny the request.

If approved:

  • Invites the social worker to meetings with the youth/family service staff.
  • Updates the social worker as to the youth's progress with services.
TBS Provider
10.
  • Participates in meetings scheduled by the TBS provider.
  • Reviews updated information from the TBS provider.
Social Worker
 
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Direct Services and Goals for Youth and Their Families  

Services

  • On-site behavioral counseling
  • One-on-one behavioral counseling
  • Family sessions
  • Behavioral analysis assessments
  • Development of behavioral or incentive plans



Goals

  • Parents and Families Learn Behavioral Strategies
    • Behavioral language skills
    • Positive reinforcement systems
    • Structure, consistency, and rules
    • Tracking and monitoring behaviors
    • Maintaining effective parenting skills

  • Elimination of Violent Behavior
    • Harm to self, others, property
 
  • Reduction of Inappropriate Behavior
    • Tantrums
    • Non compliance
    • Rude or obscene language, actions
 
  • Increase in Appropriate Behavior
    • Immediate pleasant compliance
    • Polite, kind language
    • Increased school attendance, grades
 
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Length of Service  

The length of time that TBS services are provided varies depending upon the needs of the youth.  The average length of service is five months.

Services are reauthorized by the Mental Health Department after the first 30 days and, then, after each 60 day period.  The TBS service providers submit the reauthorization requests to the MHD.

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