UM Guidelines

Clinical Indications for Admission to Intensive Outpatient Program

• Admission to CCFT[A] is judged appropriate as indicated by the presence of ALL of the following (1)(2)(3):
  • Member demonstrates symptoms consistent with a covered DSM-IV or DSM-5 diagnosis
  • Member’s symptoms are serious enough to jeopardize the community placement but not severe enough to require a more intensive level of care (4)
  • The member and family voluntarily consent to treatment with these services
  • Traditional outpatient services do not sufficiently meet the member’s and family’s needs
  • Member’s support system is temporarily too unstable or weak to manage member’s behaviors without extra supports

References

1. Sebelius, K, Hyde, PS, Vecchio, P, Randolph, F, Blau, G.  The comprehensive community mental health services for children and their families program: Evaluation findings –annual report to congress. Center for Mental Health Services, Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services 2010:1-35.  retrieved from  http://store.samhsa.gov/product/Comprehensive-Community-Mental-Health-Services-for-Children-and-Their-Families-Program-Evaluation-Findings/All-New-Products/PEP12-CMHI2010.
2. Mann,C, Hyde, PS. Joint CMCS and SASMHSA Informational bulletin regarding coverage of behavioral health services for children, youth, and young adults with significant mental health conditions May, 2013: 1-11. Substance Abuse and Mental Health Services Administration and Centers for Medicare and Medicaid Services.
3. Medicaid reimbursement for wraparound care coordination for children and youth with complex behavioral health needs: Policy statement and recommendations to the centers for medicare and medicaid services (CMS) from the national wraparound initiative September, 2011:1-4. National Wraparound Initiative, retrieved from www.nwi.pdx.edu.
4. Lamb, CE. Alternatives to admission for children and adolescents: providing intensive mental healthcare services at home and in communities: what works? Current Opinion in Psychiatry 2009;22(4):345-50.
5. Walker, JS, Bruns, EJ. Building on practice-based evidence: Using expert perspectives to define the wraparound process.  Psychiatric Services, 57:1579-1585.

Footnotes

[A] Comprehensive Child and Family Treatment (CCFT) services are high-intensity, goal-specific services designed to provide stabilization and deter the imminent risk of out of home placement, including state custody or higher levels of care. CCFT services concentrate on child/family/guardian behaviors and interactions with the goal of reaching an appropriate point of stabilization so the individual can be transitioned to a less intensive outpatient service.  CCFT services can be provided in home, community, or office-based settings using a frequency appropriate for the intensity and imminent risk presented by the clinical situation, but typically at least 3 sessions a week.  CCFT services are available 24 hours a day, 7 days a week. CCFT services can include therapeutic and/or skills training interventions that support improved functioning of the child/youth and the family unit so the imminent crises are averted. Services are designed to utilize and foster individual and family strengths and utilization of community supports, both formal and informal. This intensive care coordination component of CCFT is designed to initially “wrap” families with supports but ultimately to help families independently navigate systems to meet their formal and informal needs. CCFT services are delivered through a team approach to children with high risk behaviors and family instability.