Service Description and Criteria for Participation

EPSDT MediCal Mental Health Services

Comprehensive Rehabilitative Mental Health Services Program for Emotionally Disturbed Children

1. Comprehensive Treatment Program Components
2. Treatment Program Goals
3. Criteria for Participation in Mental Health Treatment Program
4. Referral and Assessment Process
5. Needs and Services Plan
6. Coordination with Tapestry's Foster Care Programs
7. Interagency Coordination and Involvement

I. Comprehensive Treatment Program Components

Tapestry Family Services provides a comprehensive program of Rehabilitative Mental Health Services for seriously emotionally disturbed children ages eight through twelve years of age. The program includes a range of services to assist children in gaining the social and functional skills necessary for appropriate development and social integration. The program involves a variety of services for children and their families, including foster families. The components of this program include:

• A Therapeutic After-School and Summer Activities Program for emotionally disturbed children. During the summer, this program is operated as an Intensive Day Treatment Program. These programs take place Monday through Thursday. Special activities associated with these programs are held at the Methodist Church, in the community and in nearby communities on Fridays and Sundays.
• Individual Rehabilitative Mental Health Services. In accordance with the goals of each child's Needs and Services Plan, Tapestry staff provide Individual Rehabilitative Mental Health Services in the community. These services are provided outside of the hours of the After-School and Summer Activities Programs.
• Individual, Group and Family Therapy (including Foster Family therapy) and individual Rehabilitative services for children who are participating in Tapestry's other service components.
• Therapeutic Behavioral Services for children who need these services and who are participating in Tapestry's other service components. These services are provided at the After School Program, in the community, in the schools and in the homes of the children.
• Case Management/Brokerage services for children involved in the comprehensive treatment program. These services include interagency and intra-agency consultation, communication, coordination, and referral and the monitoring of service delivery.

Tapestry's Mental Health Treatment Program is designed to provide an integrated environment where therapy and behavioral interventions are coordinated to support the child's success in placement. This integrated approach requires that child's individual therapy, therapy with the family and/or foster family, individual and group rehabilitative services and Therapeutic Behavioral Services be provided by Tapestry's clinical team. (Exceptions to this policy will be made when the child and/or his/her family has a well-established, successful therapeutic relationship with another provider.)

Within the scope of Tapestry's Comprehensive Mental Health Services Program, Tapestry can provide individual therapy to siblings of children who are enrolled in the program even if the sibling is not participating in the full program. However, Tapestry does not provide individual or family therapy for children or families who are not a part of the larger, comprehensive program.

II. Treatment Program Goals

The goals of Tapestry's comprehensive Mental Health Treatment Program are:

• To utilize a broad range of therapeutic interventions which will lead to a remission of maladaptive behaviors.
• To help the children develop impulse control, emotional self-awareness and affect tolerance/management.
• To help the children improve and/or learn effective social skills, communication skills and the capacity to participate in positive relationships with peers and caregivers.
• To help children learn behaviors and skills needed to make appropriate academic progress.
• To maintain children in the least restrictive and most "normal" setting possible.
• To prevent unnecessary higher levels of placement.
• To return children to their community and offer a lower level of placement after necessary institutional settings.
• In response to the child's healing and reduction/remission of maladaptive behavior, to gradually reduce the level of treatment and intervention and move the child toward a less intensive level of care.

III. Criteria for Participation in Mental Health Treatment Program

To be eligible for participation in this program, children must meet the guidelines for Full-Cost MediCal. Full-cost MediCal children who are living with their birth parents, adoptive parents, guardians, or who are in foster care with the County or with any local foster family agency are eligible to participate in Tapestry's Mental Health Treatment Program.

The eligibility criterion for participation in Tapestry's comprehensive Rehabilitative Mental Health Treatment Program includes a requirement that there is an indication that:

• the child has a substantial impairment in at least two areas of life functioning (e.g. self care, school functioning, family relationships, and/or the ability to function in the community), OR:
• there is a probability of significant deterioration in an important area of life functioning, OR:
• there is a probability that the child will not progress developmentally as individually appropriate.

IV. Referral and Assessment Process

Social workers, Mental Health case managers, schools and other community organizations can make referrals of children to Tapestry's Mental Health Treatment Program. Referrals are accepted for children ages 7 ½ years through 11 ½ years (generally, we do not start new children after they turn 12 years of age). To refer a child, simply complete the Tapestry Family Services Referral for Services Form and fax it to Tapestry Family Services (463-3318). If you would like to discuss a potential referral prior to completing the form, call Tapestry Family Services at 463-3300.

Referrals to Tapestry's comprehensive Mental Health Services Program are assessed for eligibility and appropriateness by the Tapestry Family Services Treatment Team Coordinator. The comprehensive assessment process includes the determination of an initial 5-Axis DSM IV diagnosis, if applicable and if the child has not been previously diagnosed. Children are accepted into the Mental Health Services Program when the assessment indicates that the child meets the criteria for the program, and that the child will be likely to benefit from the services that Tapestry provides.

The assessment process involves interviews with the child, family members, case manager and other service providers, and the gathering of history and background information regarding the child. The intake information is reviewed by the Treatment Team Coordinator to determine medical necessity, EPSDT eligibility, and whether the program can provide the services necessary to meet the child's needs.

The child's engagement in and commitment to the program is key to his/her success in the program. If it is determined that the child meets the criteria for and could benefit from the program, the last step in the assessment process involves bringing the child to the program for a visit and a discussion with the child regarding their interest in participating in the program. If the child expresses a desire to participate in the program and is accepted for treatment, the Treatment Team Coordinator prepares a Treatment Authorization Request (TAR) and begins the process of developing the child's individual Needs and Services Plan.

V. Needs and Services Plan

Once the child begins his/her involvement in the program, the Tapestry Treatment Coordinator will work with the child, the child's parent/caregiver, the referring agency and other service providers to develop an individual Needs and Services Plan for the child. This plan will be developed during the first 30 days of the child's participation in Tapestry's Mental Health Services program and will be reviewed and updated every six months. A Needs and Services Plan is a comprehensive plan of care which includes the DSM Diagnosis, identified behavioral and emotional issues, long and short term goals and objectives, the identification of specific treatment interventions and services to address the conditions identified in the assessment, prognosis, time frames, and the identification of the services to be provided the child and his/her family.

Case managers are invited to have input into the Needs and Services Plan and will be provided a copy of the plan when it has been finalized, and at any point that the plan is modified.

VI. Coordination with Tapestry's Foster Care Programs

In addition to the comprehensive Rehabilitative Mental Health Treatment Program for children, Tapestry Family Services serves as a certified Foster Family Agency with two levels of foster care:

• A regular FFA Treatment Foster Care Program through which children and foster parents are provided with social worker and other supports.
• The Intensive Treatment Foster Care Program through which eligible children and their foster families are provided with an intensive level of service, including extended training, respite and in-home support services. To be placed in Intensive Treatment Foster Care, a child must be referred through the Mendocino County System of Care Interagency Case Management Team (IACMT).

To be placed with Tapestry's Foster Family Agency, children must also meet the criteria for and be enrolled in Tapestry's comprehensive Rehabilitative Mental Health Treatment Program. For these children, the foster family is an integral part of Tapestry's treatment team, and the services provided through the foster care placement are integrated with those provided through the Mental Health Treatment Program.

VII. Interagency Coordination and Involvement

Tapestry Family Services encourages the involvement of the child's DSS and/or Mental Health case manager in the assessment process, the development of the child's Needs and Services Plan, in the monitoring of the child's progress, and in the ongoing assessment of the effectiveness of the interventions. Case managers are asked to participate in the assessment process and in the development of the Needs and Services plan through meetings with Tapestry's Treatment Team Coordinator. Once a child is enrolled in the program, Tapestry hosts a monthly case conference for each child. The case conference includes Tapestry staff, the child's parents, guardians and/or foster parents, the DSS and/or Mental Health case manager, and other service providers as appropriate. Case managers are encouraged to attend these case conferences, but if they are unable to attend, the Treatment Team Coordinator will follow-up with a telephone call to gather input and share information.

It is Tapestry's intent to support the agency's case management process whenever possible. Tapestry Family Services provides the case manager with a copy of the Needs and Services Plan, progress reports for the Court (as requested), copies of any Incident Reports and copies of any reports of Suspected Child Abuse that are filed with DSS.