Mental Health Services for Children and Adolescents

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Service Delivery System Vision and Values

The service delivery system for public mental health services for children is based on the following vision and values:Family Guide: Children's Mental Health Services

Vision

  • Emotional wellness for youth, families, and communities in Texas.

Mission

  • To provide quality family-focused, community-based mental health services and supports to children and their families.

Values

  • Services and supports for children and their families will be individualized based on family-identified strengths, needs, preferred services and supports, and outcomes.
  • Services and supports will be flexible and will fit the children and families.
  • Children and families will have access to an array of mental health treatment services and supports provided through local mental health authority provider networks, as well as access to informal and natural supports preferred by the children and families.
  • Families will be included as full partners in all aspects of the treatment of their own children. Families will be included at state and local levels of planning, policy development, service delivery, and evaluation.
  • There will be an increasing commitment to the development of a service delivery system that is sensitive and responsive to cultural diversity.

Children’s Mental Health Service Criteria

DSHS Children’s Mental Health serves children ages 3 through 17 with a diagnosis of mental illness (excluding a single diagnosis of substance abuse, mental retardation, autism or pervasive development disorder) who exhibit serious emotional, behavioral or mental disorders and who:

  1. Have a serious functional impairment; or
  2. Are at risk of disruption of a preferred living or child care environment due to psychiatric symptoms; or
  3. Are enrolled in a school system’s special education program because of serious emotional disturbance.

The Family Guide: Children's Mental Health Services (PDF) was created to help families navigate the Children’s Mental Health System under the Department of State Health Services in Texas.

Services Provided to Children & Adolescents

Screenings

A process where a staff person from the local mental health authority/community mental health center talks to you and your child, either face-to-face or over the phone, to gather information to find out if there is a need for a detailed mental health assessment. If you are not the parent, but the legally authorized representative, the staff person will talk with you.

Assessment

There are several steps to completing an assessment. The first part is to determine whether or not your child is eligible for services from the local mental health authority. In order to be eligible, your child must meet the definition of "priority population." To be in the priority population, your child must be between the ages of 3 through 17 with a diagnosis of mental illness who exhibit serious emotional, behavioral or mental disorders and who:

  • Have a serious functional impairment
  • Are at risk of disruption of a preferred living or child care environment due to psychiatric symptoms: or
  • Are enrolled in a school system's special education program because of a serious emotional disturbance.

A licensed professional will meet with you and your child face-to-face to ask you questions about your child's mental health, emotional and behavioral issues, their relationships at home and with friends, their health, their development, their schoolwork and other information needed to complete the assessment.

Crisis Services

A child/adolescent seeking crisis services must meet the definition of a crisis cited in the Community Standards Rule:

Crisis: A situation in which because of a mental health condition; the child/adolescent presents an immediate danger to self or others; or the child/adolescent’s mental or physical health is at risk of serious deterioration; or a child/adolescent believes that he/she presents an immediate danger to self or others; or that his/her mental or physical health is at risk of serious deterioration.

Crisis hotline

A telephone service available 24 hours a day, seven days a week that you can call to get information, support and referrals to help you and your child when your child is experiencing a psychiatric crisis.

Crisis Intervention Services

Interventions provided in response to a crisis to reduce symptoms of severe and persistent mental illness or emotional disturbance and to prevent admission of a child/adolescent to a more restrictive environment. Shall be provided in accordance with 25 Texas Administrative Code (TAC), Chapter 419, Subchapter L, MH Rehabilitative Services.

Psychiatric Diagnostic Interview Examination

A face-to-face interview by a licensed professional practicing within the scope of their license with the child/adolescent and family to evaluate the child/adolescent’s psychiatric diagnosis and treatment needs provided. This service must be provided and documented as described in the most current version of 25 TAC, Chapter 412, Subchapter G, MH Community Services Standards.

Pharmacological Management

A service provided to a child/adolescent by a physician or other prescribing professional to the consumer to determine symptom remission and the medication regimen needed.

Safety Monitoring

An ongoing observation of a child/adolescent to ensure the child/adolescent’s safety. An appropriate staff person must be continuously present in the child/adolescent’s immediate vicinity. Provide ongoing monitoring of the child/adolescent’s mental and physical status, and ensure rapid response to indications of a need for assistance or intervention. Safety monitoring includes maintaining continuous visual contact with frequent face-to-face contacts as needed.

Crisis Transportation

Transporting child/adolescents receiving crisis services or crisis follow-up and relapse prevention services from one location to another. Transportation is provided in accordance with state laws and regulations by law enforcement personnel, or, when appropriate, by ambulance or qualified staff.

Crisis Flexible Benefits

Non-clinical supports that reduce the crisis situation, reduce symptomatology, and enhance the ability of the child/adolescent to remain in the home. Examples in children’s/adolescent’s mental health services include home safety modifications, child care to allow the family to participate in treatment activities, and transportation assistance.

Respite Services

Services provided for temporary, short-term, periodic relief for primary caregivers. Program-based respite services are provided at temporary residential placement outside the child/adolescent’s usual living situation. Community-based respite services are provided by respite staff at the child/adolescent’s usual living situation. Respite includes both planned respite and crisis respite to assist in resolving a crisis situation.

Extended Observation

Up to 48 hour emergency and crisis stabilization service that provides emergency stabilization in a secure and protected, clinically staffed (including medical and nursing professionals), psychiatrically supervised treatment environment with immediate access to urgent or emergent medical evaluation and treatment.

Children’s Crisis Residential Services

Twenty-four hour, usually short-term residential services provided to a child/adolescent demonstrating a psychiatric crisis that cannot be stabilized in a less restrictive setting. This service may use crisis beds in a residential treatment center or crisis respite beds.

Crisis Stabilization Unit

Short term residential treatment designed to reduce acute symptoms of mental illness provided in a secure and protected clinically staffed, psychiatrically supervised treatment environment that is licensed under and complies with a crisis stabilization unit licensed under Chapter 577 of the Texas Health and Safety Code and Title 25, TAC, Part 1, Chapter 411, Subchapter M, Standards of Care and Treatment in Crisis Stabilization Units.

Family Partner

Experienced parents or primary caregivers of a child/adolescent with a serious emotional disturbance. Family partners are active members of the intensive case management/wraparound team process providing peer mentoring and support to the primary caregivers; introducing the family to the treatment process; modeling self-advocacy skills; providing information, referral and non-clinical skills training; assisting in the identification of natural/non-traditional and community support systems; and documenting the provision of all family partner services, including both face-to-face and non face-to-face activities.

Engagement Activity

Face-to-face activities with the child/adolescent or collaterals (in accordance with confidentiality requirements) in order to develop treatment alliance and rapport with the child/adolescent or collaterals and includes activities such as motivational interviewing, providing an explanation of services recommended, education on service value, education on adherence to the recommended care and its importance in recovery, and short term planned activities designed to develop a therapeutic alliance and strengthen rapport. This service shall not be provided in a group.

Inpatient Hospitalization Services

Hospital services staffed with medical and nursing professionals who provide 24-hour professional monitoring, supervision, and assistance in an environment designed to provide safety and security during acute psychiatric crisis. Staff provides intensive interventions designed to relieve acute psychiatric symptomatology and restore child/adolescent's ability to function in a less restrictive setting. The hospital must be contracting with or operated by Contractor.

Inpatient Services (Psychiatric)

Inpatient psychiatric hospital bed days - Room and Board.

Crisis Follow-up and Relapse Prevention

Supported services provided to children/adolescents who are not in imminent danger of harm to self or others but require additional assistance to avoid reoccurrence of the crisis event. The service is provided to ameliorate the situation that gave rise to the crisis event, ensure stability, and prevent future crisis events. This service includes ongoing assessment to determine crisis status and needs, provides time-limited (up to 30 days) brief, solution-focused interventions to children/adolescents and families and focuses on providing guidance and developing problem-solving techniques to enable the child/adolescent to adapt and cope with the situation and stressors that prompted the crisis event.

Core Services

Psychiatric Diagnostic Interview Examination (as described above)

Pharmacological Management

Skills Training and Development Services

Training provided to a child/adolescent and the primary caregiver or Legally Authorized Representative (LAR) that addresses the serious emotional disturbance and symptom-related problems that interfere with the child/adolescent’s functioning, provides opportunities for the child/adolescent to acquire and improve skills needed to function as appropriately and independently as possible in the community, and facilitates the child/adolescent’s community integration and increases his or her community tenure. This service includes treatment planning to facilitate resiliency. Must be provided in accordance with 25 TAC, Chapter 419, Subchapter L, MH Rehabilitative Services.

Medication Training and Support

Instruction and guidance based on curricula promulgated by DSHS. The curricula include the Patient/Family Education Program Guidelines as referenced in TAC and other materials that have been formally reviewed and approved by DSHS. Must be provided in accordance with 25 TAC, Chapter 419, Subchapter L, MH Rehabilitative Services.

Routine Case Management

Primarily site-based services that assist a child/adolescent, or caregiver in gaining and coordinating access to necessary care and services appropriate to the child/adolescent's needs. Routine case management activities must be provided in accordance with 25 TAC, Part 1, Chapter 412, Subchapter I, MH Case Management Services. Contractor shall not subcontract for the delivery of these services.

Parent Support Group

Routinely scheduled support and informational meetings for the child/adolescent’s primary caregiver(s).

Engagement Activity

Medication Training and Support

Instruction and guidance based on curricula promulgated by DSHS. The curricula include the Patient/Family Education Program Guidelines as referenced in TAC and other materials that have been formally reviewed and approved by DSHS. Must be provided in accordance with 25 TAC, Chapter 419, Subchapter L, MH Rehabilitative Services.

Skills Training and Development

Training provided in a group format to a child/adolescent and/or the primary caregiver or LAR that addresses the serious emotional disturbance and symptom-related problems that interfere with the child/adolescent’s functioning, provides opportunities for the child/adolescent to acquire and improve skills needed to function as appropriately and independently as possible in the community, and facilitates the child/adolescent’s community integration and increases his or her community tenure. This service includes treatment planning to facilitate resiliency. Must be provided in accordance with 25 TAC, Chapter 419, Subchapter L, MH Rehabilitative Services.

Family Training

Training provided to the child/adolescent’s primary caregivers to assist the caregivers in coping and managing with the child/adolescent’s emotional disturbance. This includes instruction on basic parenting skills and other forms of guidance that cannot be considered rehabilitative skills training. Concurrent rehabilitative training should be identified as a separate encounter with the appropriate rehabilitative service code.

Family Partner

Experienced parents or primary caregivers of a child/adolescent with a serious emotional disturbance. Family partners are active members of the intensive case management/wraparound team process providing peer mentoring and support to the primary caregivers; introducing the family to the treatment process; modeling self-advocacy skills; providing information, referral and non-clinical skills training; assisting in the identification of natural/non-traditional and community support systems; and documenting the provision of all family partner services, including both face-to-face and non face-to-face activities.

Counseling

Child/adolescent, family, and group therapy focused on the reduction or elimination of a child/adolescent’s symptoms of emotional disturbance and increasing the child/adolescent’s ability to perform activities of daily living. Counseling shall be provided by a Licensed Practitioner of the Healing Arts (LPHA), practicing within the scope of their license or by a child/adolescent with a master’s degree in a human services field pursuing licensure under the direct supervision of a LPHA. This service includes treatment planning to enhance recovery and resiliency.

Intensive Case Management

Activities to assist a child/adolescent and their caregiver gain and coordinate access to necessary care and services appropriate to the child/adolescent’s needs. Wraparound planning is used to develop the case management plan. Intensive case management activities shall be provided in accordance with 25 TAC, Part 1, Chapter 412, Subchapter I, MH Case Management Services. Contractor shall not subcontract for the delivery of these services.

Flexible Funds

Funds utilized for non-clinical supports that augment the service plan to reduce symptomatology and maintain quality of life and family integration. Non-clinical supports must be:

  • Included as strategies in the child/adolescent’s Case Management Plan;
  • Based on the preference of the child/adolescent and family and focus on the outcomes they choose;
  • Monitored for effectiveness by the Case Manager and adjusted based on effectiveness;
  • Available through GR funding; and 
  • Not readily available through other sources (e.g., other agencies, volunteers).

Flexible community supports include but are not limited to: transportation services, educational training, (e.g. computer skills, budgeting, etc.) temporary child care, job development and placement activities, and independent living support.

Family Training

Training provided to the child/adolescent’s primary caregivers to assist the caregivers in coping and managing with the child/adolescent’s emotional disturbance. This includes instruction on basic parenting skills and other forms of guidance that cannot be considered rehabilitative skills training. Concurrent rehabilitative training should be identified as a separate encounter with the appropriate rehabilitative service code.

Family Case Management

Activities to assist the child/adolescent’s family members in accessing and coordinating necessary care and services appropriate to the family members’ needs. The need for Family Case Management must be documented in the child/adolescent’s Case Management Plan.

Resources and Additional Information

DSHS MHSA Resources

Other Resources

Contact

Michael Hastie, Program Lead

Child & Adolescent Services

512/458-7111 ext. 3186

michael.hastie@dshs.state.tx.us

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Last updated August 28, 2013