Current through all regulations passed and filed through September 16, 2024
(A) In addition to the definitions in rule
5122-24-01
of the Administrative Code, the following definitions apply to this rule:
(1) "Caseload" means the individual cases
open or assigned to each full-time equivalent IHBT staff.
(2) "Continued stay review" means a review of
a child/adolescent's functioning to determine the need for further services to
achieve or maintain service goals and objectives.
(3) "Crisis response" means the immediate
access and availability, as clinically indicated, to the child/adolescent and
family, which may include crisis stabilization services
in accordance with rule
5122-29-10
of the Administrative Code, safety planning, and the alleviation of the
presenting crisis.
(4)
"Family" means any individual or caregiver related by
blood or affinity whose close association with the person is the equivalent of
a family relationship as identified by the person; including kinship and foster
care.
(5) "Home" means any
family living arrangement
including but not limited to biological, kinship,
adoptive, foster home, and non-custodial families
who have made a commitment to the
child/adolescent.
(6) "Out-of-home
placement" means any removal of the child/adolescent from his or her home.
Planned respite, where the child's main residence remains
their home, is not considered out-of-home
placement.
(B) Intensive
home based treatment (IHBT) service is a comprehensive behavioral health
service provided to a child/adolescent with serious emotional disturbance
(SED) and their family, designed to treat mental health conditions that
significantly impair functioning. IHBT may also be utilized for the treatment
of children and adolescents that have co-occurring substance use or
neurodevelopmental needs, when these needs co-occur with a mental health
condition. IHBT is provided for the purpose of preventing out of home placement
or facilitating a successful transition back home. IHBT integrates
trauma-informed and resilience-focused assessment, crisis response,
individual and family psychotherapy, service and resource coordination, and
rehabilitative skill development with the goal of either preventing the out-of
home placement or facilitating a successful transition back to home. These
intensive, time-limited behavioral health services are provided in the
child/adolescent's natural environment with the purpose of stabilizing and
improving
their behavioral health functioning
as documented using the Ohio specific child and
adolescent needs and strengths (CANS) tool.
The purpose of IHBT is to enable a child/adolescent with
SED to function successfully in the least
restrictive, most normative environment. IHBT services are culturally,
ethnically, racially, developmentally and linguistically appropriate, and
respect and build on the strengths of the child/adolescent and family's race,
culture, and ethnicity.
(C)
The following describes the activities and components of IHBT:
(1) IHBT is an intensive service that
consists of multiple in person
contacts per week with the
child/adolescent and family, which includes collateral contacts related to the
behavioral health needs of the child/adolescent as documented in the
individual client record (ICR) as required by Chapter
5122-27 of the Administrative Code. IHBT can be provided
via telehealth in accordance with rule
5122-29-31 of the
Administrative Code.
(2)
IHBT is provided
in the home, school, and community where the child/adolescent lives and
functions;
(3)
The frequency and modality of contacts may fluctuate
based on the assessed needs and unique circumstances of the child, adolescent,
and family;
(4) IHBT is
strength-based and family-driven, with both the child/adolescent and family
regarded as equal partners with the IHBT staff in all aspects of developing the
service plan and service delivery;
(5) Provided by staff
with a caseload that averages over any six month period and per full time
equivalent staff:
(a)
Twelve or less when provided by a team of two,
or
(b)
Six or less
when provided by an individual staff.
(6)
Immediate crisis
response is available twenty-four hours a day seven days a week by the lead
IHBT team member with back-up coverage available from other IHBT team members
or the IHBT team supervisor.
(7) Each
child/adolescent and family receiving IHBT is assessed for risk and safety
issues. A jointly written crisis
and safety plan shall be developed that is provided to the
child/adolescent and family;
(8) Collaboration
is required
to be performed with other child-serving agencies or systems, e.g.,
school, court, developmental disabilities, child welfare, and health
care providers that are providing services to the child/adolescent and family,
as well as family and community supports identified by the child/adolescent and
family;
(9) The service
activities and components are
individually tailored to
meet the needs of the child/adolescent and family. Appointments are made at a
time that is convenient to the child/adolescent and family, including evenings
and weekends if necessary;
(10) The service is
time-limited, with length of stay matched to the presenting
behavioral health needs of the child/adolescent
and the family; and
(11)
The IHBT team will collaboratively develop a plan to
transition with each youth and family. The plan will include a focus on
transition to other services, supports and providers for services and supports
based on the individualized needs of the youth and family.
(D)
Eligibility
for IHBT will be determined by the IHBT team in collaboration with the youth
and family and other cross systems partners by documenting the following
criteria:
(1) Is clinically determined
to meet the "person with serious emotional disturbance" (SED) criteria in rule
5122-24-01
of the Administrative Code and the child or
adolescent;
(a)
Is under twenty-one years of age;
(b)
Has a mental
health need;
(c)
Has an Ohio specific CANS assessment that indicates
marked to severe behavioral/emotional impairment and at least one of the
following:
(i)
Impairment that seriously disrupts life functioning;
or
(ii)
Risk behaviors that are rated as actionable on the
CANS.
(2) Meets one or more of the following
criteria as documented in the ICR:
(a) Is at
risk for out-of-home placement due to
their
behavioral health
conditions;
(b) Has returned within the previous thirty
days from an out-of-home placement or is transitioning back to their home
within thirty days; or
(c) Requires
a high intensity of
behavioral health interventions to safely remain
in or return home.
(E) The
community mental health services or addiction
services provider must demonstrate that the following staff requirements
and qualifications are met:
(1) A minimum of
two full-time equivalent staff provide the service. Services may be provided by
a single person, or team of staff clearly sharing various responsibilities for
the same child/adolescent and family. Each child/adolescent shall have a staff
assigned with lead responsibility.
(2) The
provider must have a documented plan for clinical supervision
of each team member.
(3) The IHBT supervisor shall have primary
responsibility for providing supervision to the IHBT staff twenty-four hours a
day, seven days a week. If the IHBT supervisor is unavailable, then supervision
must be provided by staff qualified according to rule
5122-29-30
of the Administrative Code.
(F) The provider must
demonstrate that each IHBT staff has an individualized training plan based on
an assessment of
their specific training needs. The following
professional training and development criteria must be met:
(1) Each staff receives an assessment of
initial training needs based on the skills and competencies necessary to
provide IHBT service prior to providing IHBT service; and
(2) The agency shall have a written
description of the skills and competencies required to provide IHBT service,
which include, at a minimum, the following:
(a) Family systems;
(b) Risk assessment,
crisis
stabilization, and safety planning;
(c) Parenting skills and supports for
children/adolescents with SED;
(d)
Cultural competency;
(e)
Intersystem collaboration with a focus on schools, courts, and child welfare:
(i) Knowledge of other systems;
(ii) System advocacy; and
(iii) Roles, responsibilities, and mandates
of other child/adolescent-serving entities;
(f) Trauma-informed and resiliency-focused care;
(g) Educational and vocational functioning:
(i) Assessment and intervention strategies
for resolving barriers to successful educational and vocational
functioning;
(ii) Knowledge of
special education laws; and
(iii)
Strategies for developing positive home-school partnerships and
connections;
(h) IHBT
philosophy, including strength-based assessment and treatment planning;
and
(i)
Understanding the complex and interconnected range of
symptoms and needs of children and adolescents, including cooccurring substance
use disorders and developmental disabilities.
(G) The provider's
training plan must include provisions for ongoing training specific to the
identified training needs of the staff as it relates to the population served,
including attention to cultural competency, changing demographics, new
knowledge or research, and other areas identified by the agency.
(H)
The provider must demonstrate that each IHBT supervisor receives training
specific to the clinical and administrative supervision of the
service.
(I)
The provider shall obtain satisfactory fidelity reviews
based on the provider's specific program modality every twelve months by
an individual or organization external to the provider and designated by the Ohio department of mental health and
addiction services (OhioMHAS), utilizing the IHBT individual provider model fidelity
rating tool, version March 1, 2022 or the IHBT teamed-model fidelity rating
tool, Version March 1, 2022
available at
www.medicaid.ohio.gov, or be licensed by an OhioMHAS approved evidence-based
practice (EBP). The provider shall incorporate the results of the
fidelity review into the provider's performance improvement program, if
indicated.
(J) Intensive home
based treatment service shall be supervised by staff who are qualified according to rule
5122-29-30
of the Administrative Code.
(K)
IHBT shall be provided by persons with competency in
the provision of mental health interventions through one of the following
program configurations:
(1)
At least one licensed practitioner and at least one
other licensed practitioner who is authorized to provide services pursuant to
rule
5122-29-30
of the Administrative Code and who are providing an evidence-based practice
approved by OhioMHAS and are working in a program licensed by a national
accreditation body or their delegate. Each practitioner must have their own
caseload of clients.
For those providers who are delivering
functional family therapy (FFT), the services may be delivered by an individual
who is licensed to provide services pursuant to rule
5122-29-30
of the Administrative Code;
(2)
At least two or
more licensed or licensed-eligible practitioners who are eligible to provide
services pursuant to rule
5122-29-30
of the Administrative Code and who are providing an evidence-supported practice
approved by OhioMHAS. Each practitioner must have their own caseload of
clients; or
(3)
At least two practitioners eligible to provide services
pursuant to rule
5122-29-30
of the Administrative Code. One of the practitioners must be licensed and the
other either a qualified behavioral health specialist as defined in rule
5122-29-30
of the Administrative Code or a peer supporter who holds a valid and
unrestricted certification from OhioMHAS issued in accordance with rule
5122-29- 15.1 of the Administrative Code. The peer supporter must be a family
peer supporter or a youth peer supporter in accordance with rule 5122-29- 15.1
of the Administrative Code. Peer supporters will also demonstrate competency
working with children or adolescents with SED and their families. These
practitioners must share a caseload of clients.
(L)
A provider of FFT
who provides the service in accordance with the national evidence based model,
found at
https://www.fftllc.com/about-fft-training/clinical-model.html, does not need to meet requirements of paragraphs (C) and
(E) to (H) of this rule. Any provider of FFT without meeting all other
requirements of this rule will be certified as "IHBT-FFT Only."
