Philadelphia Community Services for Children and Adolescents

IV. Services That Support Children in Their Own Homes and Comuunities

In the last few years, there has been a shift in the delivery of children's mental health services toward an emphasis on helping families take care of their children at home. Family-Based Mental Health Services, Children's Intensive Case Management, and services available under EPSDT (Early and Periodic Screening, Diagnosis, and Treatment) support families in caring at home for children who have emotional disorders.

A. Children's Intensive Case Management

Intensive Case Management (ICM) is a service that assists children with emotional disorders and their families to obtain access to needed medical, social, educational, and other services. ICM offers families access to staff 24 hours a day/seven days per week for assistance and for crisis.

Intensive case managers assist children and their families in obtaining services described in treatment and service plans. They also assist families in obtaining entitlements.

ICM is available to children on a city-wide basis. Contact the Community Mental Health Center that serves your area for information. View the map of community MH/MR center catchment areas to find the center serving you. Please refer to this partial list of Intensive Case Management resources.

B. Family-Based Mental Health Services

The Family-Based Mental Health Program provides mental health services to children and adolescents with emotional disorders and their families. The family-based program provides a variety of services to families in their home, including traditional therapy services and nontraditional services, such as respite services, transportation, and linkage with other service systems and community resources. The program serves children who are at risk of psychiatric hospitalization or out-of-home placement. This is a short-term program and provides transition to other community-based services.

Families can access the Family-Based Mental Health program through their Community Mental Health Center. Not all Community Mental Health Centers offer this service. Referrals are also taken from psychiatric hospitals and the judicial system. Please refer to this list of Family Based Mental Health Services.

C. Services Available Under EPSDT

Under EPSDT (Early and Periodic Screening, Diagnosis, and Treatment), a more flexible range of services are now available. The term "wraparound" is used to describe these flexible and individualized services designed to meet the specific needs of each child and his or her family. EPSDT provides screening, diagnosis, and treatment for physical or mental health problems. These and other existing services to children in their own home can provide support to children and their families that may prevent hospitalization or residential placement.

Under EPSDT, children who are eligible for Medical Assistance (MA) have access to any treatment considered medically necessary for physical or mental health problems. A psychiatrist or psychologist must evaluate the child as having a diagnosis listed in the Diagnostic and Statistical Manual of Mental Disorders. (Fourth Edition Text-Revised), or DSM-IV-TR, and recommend these services as medically necessary. Families can access these services.

1. A Parent's Guide To Wraparound Services in Philadelphia

This guide provides brief answers to frequently asked questions about wraparound behavioral health services. While much of the information is general, this guide is designed specifically for residents of Philadelphia County.

a. What is "wraparound"?

"Wraparound" services include a blend of Therapeutic Staff Support, Mobile Therapy and consultation from a Behavioral Specialist. The wraparound staff works as a multidisciplinary team to support children and adolescents who require intensive in-home and community-based support for severe behavioral health needs. This process will include the family as an integral part of the treatment planning and implementation, as well as including their respective needs and preferences. More importantly, the role of wraparound services is to "teach" families how to implement the behavioral techniques and strategies so families can address their children's needs without this intensive level of service. Wraparound services should address the whole child by considering all areas of the child's life (home, school, peers, etc.) Visit the Glossary for further definition.

b. How does my child receive wraparound services?

If you think your child could benefit from any behavioral health services, such as outpatient therapy, you should contact an outpatient clinic that provides mental health services to schedule an intake appointment. You may also contact CBH at 1-888-545-2600, for referral to an appropriate mental health provider. As an initial part of treatment, your child must receive a comprehensive biopsychosocial evaluation to determine specific clinical needs that would justify the intensive need for wraparound services.

The evaluation will be done by either a licensed psychologist or psychiatrist. After meeting with you and your child, the psychologist or psychiatrist may diagnose your child with a mental health disorder and make recommendations for psychological services that he or she feels could help your child.

The behavioral health provider will arrange an interagency team meeting to review the recommendations of the evaluations and for the family to understand the clinical needs of the child. A parent or family member must be present at this meeting. You may invite an advocate, friend, or family member to attend this meeting. The purpose of the interagency team meeting is to develop a comprehensive plan for services that identifies the child's and family's strengths and needs. The plan should include both formal treatment services such as therapy, as well as social, community, and recreational services.

An individualized treatment plan will be written, with your input, that will tell you how specific psychological service providers will work with you and your child to improve his or her mental health. You and your child (if age 14 or older) must approve the treatment plan by signing and dating it. You should not sign a treatment plan if it is incomplete, if you do not understand what it means, or if you are in complete disagreement.

The mental health provider agency will send a copy of all the information about your child's need for wraparound services to CBH for review and approval. CBH must review the request for wraparound services within 2 business days of receiving the information. After the services have been approved by CBH, your child should begin receiving services within two weeks.

c. What is a psychological or psychiatric evaluation?

A psychological or psychiatric evaluation is an interview with you and your child to determine if your child has a mental health disorder and, if so, which psychological services would be most helpful to your child. As part of the interview, the evaluation should include a mental status examination of your child, which will help the psychologist or psychiatrist determine the proper diagnosis, if any.

d. What is the difference between a psychologist and a psychiatrist?

The primary difference between a licensed psychologist and a licensed psychiatrist is that a psychiatrist is a medical doctor who is able to prescribe medication when necessary. Both a psychologist and a psychiatrist are qualified to make mental health diagnoses and recommendations for services.

e. What is an Interagency Team Meeting?

An interagency team meeting is a meeting that involves a representative of every system that affects the child's life. The purpose of the meeting is for all of the people who have a relationship with the child to discuss and plan interventions that are most appropriate for that child. The child's family is the most important participant on the interagency team. An interagency team meeting is not considered "valid" if a parent or guardian is not present. Other team members may include mental health staff, school personnel, and any other adults who you think play an important role in the child's life. Parents and guardians are encouraged to have a parent advocate attend the meeting if desired and to suggest any other participants. Interagency team meetings must occur at least every four months to evaluate the appropriateness of wraparound services.

f. How are wraparound services funded?

Medical Assistance provides the funding for wraparound services. If your child does not have Medical Assistance, your first step is to go to your local Medical Assistance office and apply for coverage for your child.

Community Behavioral Health (CBH) is the behavioral health organization that receives and reviews all requests for wraparound services in Philadelphia on behalf of the state Department of Public Welfare. All services must be approved by CBH before they can be authorized for funding. CBH has 2 business days from the receipt of a request to respond to the request. Once services have started, there should be no delay or break in services because of funding.

You are not responsible for obtaining funding for your child's wraparound services. It is the responsibility of the mental health provider agency to communicate with CBH in order to obtain funding.

g. What is a Behavior Specialist Consultant (BSC)?

A behavior specialist is a person who works with the child, the family, and the school, if necessary, with your permission, to develop a plan for re-shaping the child's behavior. The behavior specialist observes the child's behavior in the child's own setting. The behavior specialist identifies the child's strengths and develops a treatment plan with you that addresses the child's behavioral needs, while building on the child's strengths. All behavior specialists are at least Master's level professionals who have a background and expertise in working with children with behavioral health issues.

h. What is Mobile Therapy?

A mobile therapist is a person who provides therapy to children in their own home. They help children and families cope with issues such as loss, developmental delays or disabilities, anger management, parenting, and behavior modification. Every effort should be made to match families with the most appropriate therapist available.

i. What is a Therapeutic Staff Support (TSS)?

Therapeutic staff support may be provided in the home, school, or other community settings. The role of the TSS is to implement the clinical interventions that described in the child's treatment plan to help make positive changes in behavior. The TSS should also provide encouragement to the child as well as feedback about how the child's behavior affects others. All TSS staff should have a Bachelor's degree in a human service field and have prior experience working with children.

j. What is a therapeutic staff support aide (TSS aide)?

A therapeutic staff support aide (TSS aide) provides services very similar to those provided by a TSS. Like a TSS, TSS aides work one-to-one with a child in the setting where the child is having behavioral difficulties and implement interventions described in the child's treatment plan. The primary difference between a TSS and TSS aide is the staff qualifications. TSS aides are required to have a high school diploma and prior experience working with children.

k. Will my child need any further psychological assessment?

Yes. Medical Assistance requires that a child be re-evaluated every four months to assess their progress and the medical necessity for continuing services. At that time, another psychological or psychiatric evaluation needs to be done and another interagency team meeting must be held.

l. What if I have a question about my child's services?

The behavioral health provider agency should provide you with the name of someone to contact at the agency if you have a problem or question. CBH requires that every child have a lead clinician responsible for overseeing the child's care. The agency should also give you information about what to do if there is an emergency. If you have difficulty contacting your provider agency or you need further assistance, you should contact CBH Member Services or any of the organizations listed in the "Resources to Assist You" section at the end of this chapter.

m. What if my child shows no improvement?

Wraparound services are just one type of mental health service available to help your child. If you feel the wraparound services are not helping your child, you should speak to your child's wraparound staff as well as the behavioral health provider agency. Ideally, an interagency team meeting should be held to discuss your child's current needs and response to wraparound services. A plan for alternative services or adjustments in current services can be made during the interagency team meeting.

n. How long will my child need behavioral health services?

The length of service will depend on the severity of the problem and the response of the child to services. Some children only need help getting through a particularly difficult period, while others will require a longer period of time to learn new ways of coping and behaving. If your child shows significant progress and the symptoms have been alleviated, service can be gradually reduced and discontinued. Generally, service will last at least four months.

2. Summary of Important Points

a. The basic steps involved in receiving wraparound services:

Understand that this is an intensive level of care, so less intrusive levels of care such as outpatient therapy may be used first.
Make sure your child has Medical Assistance insurance coverage.
Get your child a psychological assessment.
Participate in an interagency team meeting
Review your child's treatment plan

b. Documents you and your child (if age 14 or older) will be asked to sign:

Interagency team meeting summary.
Treatment plan.
MA97 billing form.

c. Information you need to be sure you understand:

Which specific services your child will receive and where.
How the treatment plan is designed to help your child.
Whom to contact at the provider agency if you have a problem.
What to do and/or whom to contact if there is an emergency.

3. Resources to Assist You

If you have a problem with accessing services, how services are delivered, understanding the services, or other problems related to wraparound services, contact any of the organizations listed for wraparound assistance.

For additional information on accessing these services, contact your Community Mental Health Center.