Therapeutic Group Home: Level II

Definition

A Level II Therapeutic Group Home (TGH) is a small, four- to- six bed, DCF or DMR licensed program located in a neighborhood setting with intensive staffing level and services offered within the context of a 24/7 home-like milieu. It is a highly structured treatment program that creates a physically, emotionally and psychologically safe environment for children and adolescents with complex behavioral health needs who need additional support and clinical intervention to succeed in either a family environment or in an independent living situation. A Level II TGH is designed to serve as a step-down from inpatient level of care, or as a step-down from or alternative to residential level of care. Education is provided off site through the local education authority. Community based activities (recreational, vocational, social development) serve as a focus for clinical and rehabilitative intervention. As such, the Level II TGH is designed to develop and promote optimal functioning within the context of a normative environment utilizing highly specific individualized treatment. A Level II TGH is not to be used solely for the purpose of housing/care/custody or as an alternative to incarceration.

Authorization Process and Time Frame for Services:

This level of care requires prior authorization. Referral for admission to this level of care requires the approval of a DCF Area Office Director and the approval of the DCF Bureau of Behavioral Health, Medicine and Education and authorization by the ASO. Each child/adolescent considered for this level of care must have had a Comprehensive Global Assessment (CGA) or DCF approved equivalent and any additional diagnostic service (i.e., face to face interview, psychological testing, medication evaluation, family interview) necessary to develop a complete clinical and psychosocial profile of the child/adolescent’s service needs. The CGA will support the development of a treatment plan that will identify any individual service needs that require clinical and rehabilitative intervention within the group home. This level of care is authorized and reviewed in intervals appropriate to the treatment needs of the child/adolescent and the specific focus of the intervention.

Level of Care Guidelines

Admission Criteria

Symptoms and Functional Impairment include:

Diagnosable DSM-IV Axis I or Axis II Disorder and

Symptoms are primarily the result of a psychiatric disorder, excluding V-codes. Mental Retardation and Substance Abuse may be co-occurring, and

Symptoms and impairment are the result of Pervasive Developmental Disorder or Mental Retardation and

GAF < 60

and

Child /Adolescent requires 24 hour structured therapeutic milieu due to chronic (greater than 6 month) presentation of at least one of the following behaviors:

Past history of suicidal and/or homicidal thoughts and/or impulses with significant current ideation without intent or conscious plan; or

Frequent and severe verbal or physical aggression directed toward self and others that interferes with development of successful interpersonal relationships; or

Episodic impulsivity and/or physically or sexually aggressive impulses that are moderately endangering to self or others (e.g.,status offenses, AWOL, self injurious behavior, fire setting, violence toward animals) or

Recurrent psychotic symptoms/behavior that pose a significant risk to the safety of the child/adolescent or others, or markedly impaired functioning in one or more domains

And one of the following conditions:

Moderate to severe functional problems in school/vocational setting or other community setting (e.g., school suspension, involvement with the law) due to inability to accept age appropriate direction or supervision from caretakers or

Chronic medical condition that requires assistance to achieve compliance with prescribed medical regimen (e.g., diabetes treatment, asthma treatment) or

Demonstrated inability to form trusting relationships with caregivers (including regular and specialized foster care) that prohibit success in a family setting or

Demonstrated inability to tolerate a large congregate care setting (e.g., larger than six beds)

Intensity of Service Need

The child or adolescent is can not be treated in a family setting with a combination of outpatient and intensive ambulatory services due to demonstrated low tolerance for family environment or marked intolerance for adult authority as evidenced by one of the following:

Two or more failures in home or foster home settings with intensive community based services and supports due to disruptive behavior that has placed child, caregivers or other members of the household at risk for injury to person or property or

Qualitative impairment in social interaction, lack of social/emotional reciprocity, failure to develop peer relations appropriate to developmental level and/or a profound mistrust of others due to previous trauma or pervasive developmental disorder and

Child/Adolescent requires specialized and intensive clinical and rehabilitative intervention provided by trained staff to achieve optimal control over emotions and to exhibit behavior appropriate to age and community expectations or

Child/Adolescent is vulnerable to crisis and may require access to on site 24 hour emergency evaluation and crisis intervention and

Child/Adolescent is able to attend off site educational placement

Continued Care Criteria

Severity of Illness

Symptoms and impairment must be the result of a psychiatric or substance abuse disorder, excluding V-codes, and

Clinical or treatment circumstances consistent with one of the following:

Child/Adolescent has exhibited behavior consistent with admission criteria within the past 60 days or

Child/Adolescent has been hospitalized for symptoms that preclude a lower level of care within the past 30 days or

Child/Adolescent has manifested new symptoms or maladaptive behaviors that meet admission criteria and the treatment plan has been revised to incorporate new goals, and

There is evidence of active treatment and care management as evidenced by:

A care plan has been established with treatment objectives appropriate for this level of care. Treatment objectives are related to improved behavioral and social/emotional functioning, and are tied to the child’s long-range permanency plan (e.g., return to home, discharge to foster care, independent living, or alternative treatment setting within the adult system). Progress toward objectives is being monitored at a level appropriate to child’s permanency needs and

Child’s participation in treatment is consistent with care plan or active efforts to engage child are in process. Type, frequency and intensity of services are consistent with treatment plan and

Vigorous efforts are being made to affect a timely discharge to the next level of care (e.g., lower level group home, transitional living program, independent living, foster family, biological family) including, but not limited to case conferences and appointments with aftercare providers, clinical interventions with future caregivers, educational/vocational planning as indicated.

If the child/adolescent does not meet above criteria, continued stay may still be authorized under the following circumstances:

Child/Adolescent has clear, behaviorally defined treatment objectives that can reasonably be achieved within 30 days and are determined necessary in order for the discharge plan to be successful, and there is no less restrictive environment in which the objectives can be safely accomplished; or

Child/Adolescent can achieve certain treatment objectives in the current level of care and achievement of those objectives will enable the child/adolescent to be discharged to a less restrictive community-based setting; or

Child/Adolescent is expected to transfer to a less restrictive community-based setting within 30 days of discharge and continued stay at this level of care, rather than an interim placement can avoid disrupting care. Continued stays for this purpose may be as long as 30 days; or

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 therapist appointments, therapeutic mentoring, etc.) Referral to the child’s DCF Area Office for review by the Managed Service System is indicated or

Child/Adolescent has been approved for long term placement in the Therapeutic Group Home as part of the DCF Permanency Plan which has been approved by the DCF Area Office and DCF Bureau Chief for Behavioral Health, Medicine and Education.

Note: Making Level of Care Decisions

In any case in which a request for services does not satisfy the above criteria, the ASO reviewer must them apply the document Guidelines for Making 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 to be successfully maintained in the community or is needed in order to succeed in meeting child/adolescent treatment goals