Chapter 3 : Section 7.4

Arranging Treatment in a Behavioral Health Inpatient Facility

Procedures

The process to determine whether to pursue treatment in a behavioral health inpatient facility (formerly called residential treatment center) for a dependent child should begin within the Child and Family Team (CFT) process.

Behavioral Health Inpatient Facility (BHIF) services provide treatment for children and adolescents who:

• demonstrate severe and persistent psychiatric disorders, when less restrictive levels of care do not meet their treatment needs; and

• require services at a psychiatric residential treatment facility under the direction of a psychiatrist.

These services are designed for children and adolescents who:

• have significant deficits in social, behavioral, psychiatric, and psychological functioning (see Practice Guideline for detailed criteria of impairments required for admission)

• require active treatment in a controlled environment with a high degree of psychiatric oversight, 24 hour nursing presence, effective program and treatment availability, and continuous supervision provided by professional behavioral health staff.

• Do not require a higher level of care such as hospitalization.

Admissions to a BHIF are not emergent or urgent and are always prior authorized. The team must confirm:

• less restrictive levels of care do not meet the treatment the child’s needs;

• proper treatment of the recipient’s psychiatric condition requires intensive residential treatment under the direction of a physician;

• the condition does not required stabilization in an acute hospital setting; and

• the services can reasonably be expected to improve the child’s condition or prevent further regression so that the services will no longer be needed.

Behavioral Health Inpatient Facility (BHIF) psychiatric services must involve active treatment through implementation of a professionally developed and supervised individual plan of care. Active treatment must be:

• developed and implemented no later than 14 days after admission; and

• designed to achieve the recipient’s discharge from the Behavioral Health Inpatient Facility (BHIF) at the earliest possible time.

Active treatment at a Behavioral Health Inpatient Facility (BHIF) focuses on specific targeted goals identified by the CFT (and approved by the Health Plan during the prior authorization process); and are designed to enable the child/adolescent to be discharged from the BHIF at the earliest possible time. A lack of available outpatient services is not in and of itself the sole criterion for admission to or discharge from a BHIF.

If the child is dually adjudicated, inform the other agency provider of all notices, motions, hearings or other proceedings related to treatment in a BHIF.

Sign a Release of Information allowing the High Needs Case Manager (HNCM) and/or Residential Coordinator (RC) with the health plan provider to obtain records necessary to support prior authorization. The HNCM or RC will gather and disseminate the higher lever of care packet required to request a BHIF.

Attend all hearings regarding the treatment in a BHIF and provision of services.

If an outpatient assessment, inpatient psychiatric assessment or inpatient psychiatric acute care service recommends treatment in a BHIF, obtain health plan authorization for the service.

Contact the assigned Assistant Attorney General to discuss filing a motion for treatment in a BHIF.

Contact all parties, including the child's attorney, and determine each party's position on the motion for placement in a BHIF. A hearing on the motion is not required if all parties agree with the motion.

Complete the Motion for Placement . The motion must include the following:

• A Statement From The Medical Or Clinical Director/Designee of the Residential Treatment Center (BHIF-RTC), CSO-1364C or the director's designee that the facility's services are appropriate to meet the child's mental health needs.

• Provide the Motion for Placement and all of the following documents to the assigned Assistant Attorney General:

  • A written psychological, psychiatric or medical assessment recommending treatment in a BHIF. The court, on a finding of good cause, may waive the written assessment. If the court does not waive the written assessment, the assessment shall include at least the following:

  • the reason why treatment in a BHIF is in the child's best interests;

  • the reason why treatment in a BHIF is the least restrictive treatment available;

  • the reason why the child's behavioral, psychological, social or mental health needs require treatment in a BHIF; and

  • the estimated length of time that the child will require treatment in a BHIF.

Personally admit or arrange for another DCS representative familiar with the case to admit the child to the BHIF, completing all necessary paper work including authorization for treatment, and providing information on the child’s background, legal status, and reasons for the admission.

Ensure that the BHIF is aware of Department policies and procedures regarding contact between the child, the child’s parents and siblings, family members, other relatives, friends and any former foster parents.

Provide the BHIF with the names and addresses of all parties including the child's attorney and guardian ad- litem.

If the child remains placed in a BHIF for at least 60 days or longer, the court will review the child’s continuing need for treatment in a BHIF every 60 days from the date of the treatment order.

The DCS Specialist will ensure the BHIF submits a written treatment summary to the court at least five days before the review and to all parties including the child’s attorney and guardian ad-litem.

The treatment summary shall include recommendations and all of the following:

• the nature of the treatment provided, including any medications and the child's current diagnosis;

• the child's need for continued treatment in a BHIF, including the estimated length of the services;

• summary of the discharge plan and a projected discharge date;

• the level of care required by the child and the potential caregiver options that are available to the child on discharge; and

• a statement from the medical or clinical director of the BHIF or the director's designee as to whether treatment in a behavioral health inpatient facility are necessary to meet the child's needs and whether the facility that is providing the services to the child is the least restrictive available alternative.

The Child and Family Team meetings should continue throughout the child’s admission to the BHIF and should address issues including, but not limited to:

• Sharing services, activities, and treatment interventions that have and have not worked in the past;

• Integrating CFT practices into aspects of the BHIF programming;

• Aligning the BHIF service plan with the CFT’s service plan.

• When the out of home treatment goals have been met, or significant progress has been made and treatment can continue in the child’s home and community, the focus of the CFT turns to planning for the child’s return to his/her community.

• Ensure discharge planning includes:

  • Identifying the next level of care that is most appropriate for the child’s clinical needs;

  • Ensure medication prescription is available to receiving caregiver;

  • Identification of behaviors that may trigger an escalation in the behaviors successfully addressed in treatment.

  • Identification of new needs identified during treatment;

  • Coordination of supportive and follow-up services need after discharge.

To notify the court of the child's discharge from the behavioral health inpatient facility:

• Obtain or request a copy of the discharge summary including a statement of services being provided to the child and the child's family from the BHIF. Contact the assigned Assistant Attorney General to discuss the child's discharge to a group care facility, an unlicensed provider, or to the parent or guardian, and complete the following:

  • the Motion for Placement; and

  • obtain the parties' position on the motion for change of physical custody.

• Provide the Motion for Placement, Addendum Report and the discharge summary to the assigned Assistant Attorney General.

For Prior Authorization and the Appeal and Denial Process, see Behavioral Health & Substances Abuse Services for Children and Young Adults.

Court Ordered Treatment

When a BHIF admission is ordered by the Court outside of the health plan prior authorization process, contact the CHP SOCC assigned to the field office. The CHP SOCC will:

• Review the child’s history of services;

• Participate in the Child and Family Team meeting and a Clinical Case Review (if appropriate);

• Attend the next court hearing to support the DCS Specialist;

• Support the Specialist in the Appeal of denied services by the health plan (if necessary); and

• Submit for prior authorization to the DCS CHP Behavioral Health CMO.

Documentation

Document all court hearings in Guardian.

Document participation in treatment staffings using Notes

Update the child's physical address and phone number in Guardian.

Document Assistant Attorney General approval of all motions in Notes as an AG Contact.

DCS CHP submits a new Placement Service Request in Guardian for behavioral health placement of the child.

Effective Date: February 13, 2023

Revision History: November 30, 2012, November 17, 2017, February 1, 2021, April 1, 2021, June 25, 2021