A. FUNCTIONAL FAMILY THERAPY

Definition

Functional Family Therapy (FFT) is a manualized treatment model designed to prevent children and adolescents ages 11-17, from requiring psychiatric hospitalization or residential placement or to support discharge from these out-of-home levels of care.

The FFT model is a home-based service designed to address both symptoms of serious emotional disturbance in the identified child as well as parenting practices and/or other family challenges that affect the child and family’s ability to function.

During the FFT intervention, efforts are made to address areas in addition to child functioning and family relationships that may contribute to the child’s psychosocial adversity. Particular areas include the school environment as well as the family’s involvement with formal and naturalistic supports and services.

It is expected that FFT clinicians will take an active role in working directly with children and their families as well as in managing their care and facilitating health-enhancing connections in the community.

Authorization Process and Time Frame for Service

This level of care requires prior authorization and can only be provided by a treatment provider who is credentialed as an FFT provider and certified by the Department of Children and Families as an FFT provider.

The number of sessions varies according to the individual needs of the child/adolescent and family. However, authorization is typically provided on a monthly basis in bundles of 50 units (15 min/unit) to reflect 3 hrs per week for 4.2 weeks per month.

Authorization of significant additional hours per week may be required in certain instances to respond to the needs of the child and family. In these cases, more frequent review with a care manager will be required. Services typically last up to four months, or beyond with special review.

This level of care may be concurrently authorized with other levels of care such as outpatient, intensive outpatient or extended day treatment based on the individual needs of the child and family. This level of care may not be authorized concurrently with other intensive home-based behavioral health services, including Intensive In-Home Child and Adolescent Psychiatric Services (IICAPS), Multidimensional Family Therapy (MDFT), Multisystemic Therapy (MST), and Family Support Teams (FST).

Level of Care Guidelines

1.1.0 Admission Criteria

1.1.1 Symptoms and functional impairment include all of the following:

1.1.1.1 Diagnosed DSM-IV Axis I or Axis II disorder,

1.1.1.2 Symptoms and impairment must be the result of a primary psychiatric disorder, excluding V-codes; substance abuse disorders may be secondary

1.1.1.3 Functional impairment not solely a result of Pervasive Developmental Disorder or Mental Retardation

1.1.1.4 GAF <60

1.1.2 Presentation consistent with at least one of the following:

1.1.2.1 Recent and/or ongoing marked depression, anxiety, or withdrawal from activities and relationships and peers; or

1.1.2.2 Recent and/or ongoing marked mood lability as evidenced by frequent or abrupt mood changes accompanied by verbal or physical outbursts/aggression and/or destructive behaviors; or

1.1.2.3 Recent and/or ongoing dangerous or destructive behavior as evidenced by episodic impulsivity or physically or sexually aggressive impulses that are moderately endangering to self or others (e.g., impulsive acts while intoxicated, self injurious behavior, running away from home or placement with voluntary return, fire setting, violence toward animals, affiliation with dangerous peer groups).

1.1.3 Children/Adolescents appropriate for FFT services are those for whom:

1.1.3.1 There is a family/caregiver resource that is available and willing and able to participate in this intensive home-based intervention, and

1.1.3.2 Arrangements for supervision at home are adequate to assure a reasonable degree of safety, and

1.1.3.3 There is a crisis plan in place, and

1.1.3.4 The primary presenting problem is not recent and/or ongoing suicidal gestures and/or attempts; or recent and /or ongoing self-injurious behavior that is serious and dangerous; or recent and/or ongoing risk of deliberate attempts to inflict serious injury on another person; or recent and/or ongoing psychotic symptoms or behavior that poses a moderate risk to the safety of the child or others (e.g., hallucination, marked impairment of judgment). (If these symptoms are present, refer child to IICAPS or FST.)

1.1.4 Intensity of Service Need

1.1.4.1 The child’s successful maintenance in the community is dependent upon an integrated and coordinated treatment approach that involves family members as primary intervention specialists; or

1.1.4.2 The child is in out-of-home care and requires intensive home-based care to achieve the reintegration plan

In addition to either of the above criteria, the following criteria must be met:

1.1.4.3 The above symptoms cannot be contained, attenuated, evaluated and treated in a lower level of community based care as evidenced by one of the following:

1.1.4.3.1 Recent attempts to engage the child and/or family in outpatient therapy have been unsuccessful due to transportation issues and/or other family constraints that interfere with ability to keep appointments on a consistent basis; or

1.1.4.3.2 The above problems occur in the context of a regular and significant outpatient therapeutic relationship despite efforts to augment such treatment (e.g., medication consultation or increased outpatient therapy visits or addition of family/parent therapy, psychological assessment, group therapy, etc.).

1.2.0 Continued Care Criteria

1.2.1 Child/adolescent has met admission criteria for the previously approved level of FFT as evidenced by

1.2.1.1 The child/adolescent’s symptoms or behaviors persist at a level of severity documented at the start of this episode of care; or

1.2.1.2 The child/adolescent’s symptoms or behaviors persist at a level of severity adequate to meet admission criteria; or

1.2.1.3 The child or youth has manifested new symptoms or maladaptive behaviors that meet admission criteria and the treatment plan has been revised to incorporate new goals; or

1.2.1.4 The child/adolescent’s symptoms have increased sufficiently over the past 24 hours to warrant immediate increase of number of hours provided weekly to the family, and

1.2.2 Evidence of active treatment and care management as evidenced by:

1.2.2.1 A care plan with evaluation and treatment objectives appropriate for this level of care has been established, treatment objectives are related to readiness for discharge and progress toward objectives is being monitored weekly; and

1.2.2.2 Child and family (caregiver) participation in treatment is consistent with care plan, or active efforts to engage the patient and/or family are in process. Type, frequency and intensity of services are consistent with treatment plan; and

1.2.2.3 Vigorous efforts are being made to affect a timely transition to outpatient care, when such care is consistent with the treatment plan (e.g., meeting with caseworker, convening aftercare planning meetings with aftercare providers, identifying resources and referring for aftercare or care coordination, scheduling initial aftercare appointments).

1.2.2.4 Children receiving FFT services can receive concurrent treatment from other mental health providers including, but not limited to, outpatient, extended day, and partial hospital services if deemed appropriate in the treatment plan.

1.2.3 If child/adolescent does not meet criterion , continued treatment may still be authorized under any of the following circumstances:

1.2.3.1 Child/adolescent has clear behaviorally defined treatment objectives that can reasonably be achieved through continued home based treatment and such treatment is necessary in order for the discharge plan to be successful and there is no less intensive level of care in which the objectives can be safely accomplished; or

1.2.3.2 Child/adolescent can achieve certain treatment objectives in the current level of care and achievement of those objectives will enable the patient to be discharged directly to a less intensive community-based level of care rather than to a more restrictive setting; or

1.2.3.3 Child/adolescent is scheduled for discharge, but the community-based aftercare plan is missing critical components. The components have been vigorously pursued but are not available (including, but not limited to, such resources as placement options, psychiatrist or therapist appointments, therapeutic mentoring, etc). Authorization may be extended based on the individual clinical needs of the child/adolescent. Child/adolescent should be referred to Intensive Care Management. (Intensive Care Manager will work with Managed Service System if child is DCF involved or directly with local providers or Community Collaboratives to address aftercare needs).

Note: Making of Level of Care Decisions

In any case in which a request for services does not satisfy the above criteria, the ASO reviewer must then apply the document Guidelines for Making of Level of Care Decisions and in these cases the child/adolescent shall be granted the level of care requested when:

1) Those mitigating factors are identified and

2) Not doing so would otherwise limit the child/adolescent ability to be successfully maintained in the community or is needed in order to succeed in meeting child/adolescent treatment goals.