E. INTENSIVE IN HOME CHILDREN AND ADOLESCENT PSYCHIATRIC SERVICES
Definition
Intensive In-Home Child and Adolescent Psychiatric Services (IICAPS) is a manualized treatment model designed to prevent children and adolescents from psychiatric hospitalization or institutionalization or to support discharge from inpatient levels of care. While children with psychiatric symptoms are the focus of intervention, the model address and intervenes with the domains that impact the child most directly: family, school, community resources and service systems.
IICAPS is an intensive, home-based service designed to address specific psychiatric disorders in the identified child, while remediating problematic parenting practices and/or addressing other family challenges that effect the child and family’s ability to function. Efforts are also made within the service to improve the child’s educational programming and to ameliorate any environmental factors that may contribute to the child’s psychosocial adversity. IICAPS teams are expected to spend a minimum of five hours per week working directly with children and their families and managing their care. Children receiving IICAPS services are likely to be recipients of concurrent services from other mental health providers. These providers are expected to work in collaboration with the IICAPS team during the IICAPS intervention. Their involvement with the child and family often extends beyond the IICAPS Episode of Care.
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 certified by the Department of Children and Families as an IICAPS provider.
Authorization is typically provided on a monthly basis in bundles of eighty-eight (88) units per authorization. Services may last up to six months or beyond with special review.
Level of Care Guidelines
5.1.1 Symptoms and functional impairment include all of the following:
5.1.1.1 Diagnosed DSM Axis I or Axis II disorder,
5.1.1.2 Symptoms and impairment must be the result of a primary psychiatric disorder, excluding V-codes; substance abuse disorders may be secondary.
5.1.1.3 Functional impairment not solely a result of Pervasive Developmental Disorder or Mental Retardation, and
5.1.1.4 GAF <55
5.1.2 Presentation consistent with at least one of the following:
5.1.2.1 Recent and/or ongoing suicidal gestures and/or attempts; or
5.1.2.2 Recent and /or ongoing self-mutilation that is severe and dangerous; or
5.1.2.3 Recent and/or ongoing risk of deliberate attempts to inflict serious injury on another person; or
5.1.2.4 Recent and/or ongoing dangerous or destructive behavior as evidenced by indication of episodic impulsivity or physically or sexually aggressive impulses that are moderately endangering to self or others (e.g., impulsive acts while intoxicated, self mutilation, running away from home or placement with voluntary return, fire setting, violence toward animals, affiliation with dangerous peer groups); or
5.1.2.5 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); or
5.1.2.6 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 marked depression, anxiety, or withdrawal from activities and relationships and peers
5.1.3 Children appropriate for IICAPS services are those for whom:
5.1.3.1 There is a family resource that is available, willing and able to participate in this intensive home-based intervention
5.1.3.2 Arrangements for supervision at home are adequate to assure a reasonable degree of safety
5.1.3.3 It is possible to willingly enter into a reliable contract for safety (applicable only when a developmentally appropriate expectation)
5.1.4 Intensity of Service Need
5.1.4.1 The child’s successful reintegration or maintenance in the community is dependent upon an integrated and coordinated treatment approach that involves family members as primary intervention specialists
5.1.4.2 The child has been admitted to, or is at risk of being admitted to a psychiatric inpatient unit or is being discharged from a residential treatment center and demonstrated the above admission criteria prior to placement.
5.1.4.3 The child is either in out of home care and requires intensive in-home care as part of the individual care plan or is at high risk for out of home care.
E. 1.4.4. 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:
E.1.4.4.1. Recent attempts to engage the child and/or family in 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
E.1.4.4.2. 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).
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 the 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.
5.2.1 Patient has met admission criteria within the past thirty (30) days for IICAPS as evidenced by:
5.2.1.1 The child or youth’s symptoms or behaviors persist at a level of severity documented at the start of this episode of care; or
5.2.1.2 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
5.2.2 Evidence of active treatment and care management as evidenced by:
5.2.2.1 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
5.2.2.2 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
5.2.2.3 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).
E.3.2.4 Children receiving IICAPS services can receive concurrent treatment from other mental health providers including but not limited to out-patient, extended day, and partial hospital services if deemed appropriate in the treatment plan.
5.2.3 If child/adolescent does not meet criterion E.3.1, continued treatment may still be authorized under any of the following circumstances:
5.2.3.1 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
5.2.3.2 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 rather than to a more restrictive setting; or
5.2.3.3 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 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).