A. MULTIDIMENTIONAL FAMILY THERAPY

Definition

Multidimensional Family Therapy (MDFT) is a Family-focused, ecologically oriented evidence-based model shown effective in treatment of children/adolescents between the ages of 11 – 17.5 with substance abuse and/or dependence issues, or children/adolescents with substance abuse/dependence issues and co-morbid psychiatric issues. MDFT is designed to reduce the influence of factors that place a child/ adolescent at risk for substance abuse while strengthening the presence of protective factors, such as supporting a positive parent-child relationship.

MDFT was developed at the University of Miami and targets several facets in a child/adolescent’s life in order to alleviate the presenting problems of drug abuse and co-morbid psychiatric issues. The approach combines clinical intervention with case management type activity and assumes change to be multi-determined. MDFT will work with parents and youth to facilitate compliance with any prescribed medications and psychiatric medication.

Interventions are multidimensional and include the child/adolescent and/or the parent, family members, and representatives from systems external to the family (e.g., education, juvenile justice, peers, social services). It is expected that interventions are inclusive of all family and environmental influences that affect the individual child or adolescent’s success within treatment.

Authorization Process and Time Frame for Service

This level of care requires pre-authorization and can only be provided by a treatment provider who is authorized and credentialed through the University of Miami, MDFT credentialing process and certified by DCF to provide this service. In addition, on-going participation in the MDFT consultation and training from the state based MDFT certification center is required for all MDFT providers. The number of sessions will be dictated by the needs of the adolescent and family, but is not to be less than three contacts (2 hours/contact) per week, or 101 units (15 minutes per unit) per month (4.2 weeks). Typically, services can last from four to six months. Drug screens are conducted on a routine basis by therapist or case-manager, but results are not shared externally.

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 Diagnosable DSM IV Axis I or Axis II disorder,

1.1.1.2 Symptoms and impairment must be the result of a primary substance abuse disorder, or the child/adolescent must be at risk of substance abuse with co-occurring Oppositional Defiant Disorder or Conduct Disorder. Other psychiatric issues can be present but secondary,

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

1.1.1.4 GAF <55, and

1.1.1.5 IQ > 65

1.1.2 Presentation consistent with substance abuse or risk of substance abuse and at least one of the following:

1.1.2.1 Recent and /or ongoing emotional and/or behavioral problems that are severe and potentially dangerous; or

1.1.2.2 Recent and/or ongoing involvement with legal system (status offenses, impulsive acts, running away from home) or

1.1.2.3 Recent and/or ongoing behaviors that pose a moderate risk to the safety of the child or others (e.g., depression marked impairment of judgment); or

1.1.2.4 Withdrawal from activities and relationships with peers and family member

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

1.1.3.1 A family resource is available to participate in the treatment program, and

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

1.1.3.3 A crisis plan has been developed.

1.1.4 Children/Adolescents for whom MDFT is not an appropriate or medically indicated service are those children/adolescents who currently demonstrate any of the following:

1.1.4.1 Child/Adolescent is actively suicidal (ideation and plan); or

1.1.4.2 Child/Adolescent currently exhibits a psychotic disorder (or features); or

1.1.4.3 Primary presenting problem is an eating disorder; or

1.1.4.4 Child/Adolescent engages in fire setting activity; or

1.1.4.5 The child’s problems in functioning are not primarily a function of current abusive and neglectful home environment (refer to Family Preservation); or

1.1.4.6 The family ‘s primarily need is for respite, social support and/or social welfare service

1.1.5 Intensity of Service Need

1.1.5.1 The child/adolescent has been admitted to, or is at risk of being admitted to a residential treatment program, or detention facility; or

1.1.5.2 The child/adolescent has had frequent (i.e., four times within a 6 month period) visits to a emergency room setting due to disruptive behavior; or

1.1.5.3 The child/adolescent is in out of home care and requires intensive in-home or community based treatment to achieve the reintegration plan.

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

1.1.5.4 The child’s successful reintegration or maintenance in the community is dependent upon an integrated and coordinated treatment approach that involves family members, school, peers, other systems as primary intervention specialists, and

1.1.5.5 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:

1.1.5.5.1 Recent attempts to engage the child/adolescent 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

1.1.5.5.2 The above problems occur in 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 MDFT as evidenced by:

1.2.1.1 The child /adolescent ‘s symptoms or behaviors persist at a level of severity documented at the most recent start for 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/adolescent 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 hrs 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 (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).

1.2.3 If child/adolescent does not meet criterion E.2.1, 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 home-based treatment and continued home based treatment in current setting is determined 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 is necessary to enable the patient to be discharged to a less intensive level of care; 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, clinical and non clinical support, day treatment or intensive outpatient treatment etc). Authorization may be extended for up to 10 days. 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.