UM Guidelines

Clinical Indications for Admission to Intensive Outpatient Program

• Admission to Continuous Treatment Team (CTT) [A] [B] [C]  is judged appropriate as indicated by ALL of the following:
  • Symptoms are consistent with a covered primary DSM-5 or DSM-IV-TR diagnosis with 1 or more of the following:
    • Current DSM-5 severity level specified as moderate or severe
    • Current DSM-IV-TR Global Assessment of Functioning (GAF) score of 50 or under
  • Patient presents with two or more  of the following criteria:
    • Required 1 or more of the following:
      • Has required periodic psychiatric hospitalization or residential treatment including at least one episode within the last 6 months
      • At risk of hospitalization in an acute psychiatric setting or a residential treatment setting
    • A major, time-limited weakening of the member’s support system and clear weakening of member’s ability to function independently or within the current support system
    • Has difficulty effectively utilizing lower level case management supports and traditional office-based outpatient services or requires more assertive and frequent non-office based services to meet clinical needs
  • Absence of ALL of the following exclusions:
    • Behavioral and/or psychiatric symptoms that require a more intensive level of care
    • Can be safely maintained and effectively treated with less intensive services.
    • Symptoms are the result of a non-covered condition
    • The member or the parent/guardian/custodian does not voluntarily consent to treatment and there is no court order requiring such treatment

References

1. Chappell, E. Case Management:  Tennessee Department of Mental Health in collaboration with the Bureau of Tenncare March 27, 2012.  Retrieved from http://www.tn.gov/mental/omd/omd_docs/FINALAdult_MHCM.pdf.
2. Clark, C., Rich, A.R. Outcomes of homeless adults with mental illness in a housing program and in case management only. Psychiatric Services 2003; 54(1), 78-83.
3. Congressional Research Service (CRS). CRS report for congress: Medicaid targeted case management (TCM) benefits. March 27, 2008. Retrieved from http://www.tn.gov/mental/omd/omd_docs/FINALAdult_MHCM.pdf.
4. Kolbasovsky, A., Reich, L., Meyerkopf, N. Reducing six‐month inpatient psychiatric recidivism and costs through case management. Case Management Journals 2010; 11(1), 2‐10.
5. Mueser, K.T., Bond,G.R., Drake,R.E., Resnick,S.G. Models of community care for severe mental illness: A review of research on case management. Schizophrenia Bulletin 1998; 24(1), 37‐74.
6. Sherman, P.S., Ryan, C.S. Intensity and duration of intensive case management services. Psychiatric Services 1998; 49(12), 1585‐1590.
7. Ziguras, S.J., Stuart, G.W. A meta-analysis of the effectiveness of mental health case management over 20 years. Psychiatric Services 2000; 51(11), 1410‐1421.

Footnotes

[A] Continuous Treatment Teams (CTT) are coordinated multidisciplinary teams that provide a range of intensive, integrated mental health case management, treatment, and rehabilitation services to adults and children/adolescents at risk of higher levels of care or removal from home due to behavioral health concerns.  CTTs are designed to provide intensive treatment for adult members with Severe and Persistent Mental Illness (SPMI) and children/adolescents with Serious Emotional Disturbance (SED) in the context of their family constellations. Services can include: Crisis intervention and stabilization (available 24 hours a day 7 days a week); Counseling; Skill building; Therapeutic intervention; Advocacy with the education system and other public serving systems; Medication management; School-based services; and Consultation for peer support or family support services.

[B] CTT services are flexible, multi-purpose, in-home/community clinical support for priority members (i.e., SPMI), and the children with severe behavioral and emotional disturbances along with their parents/caregivers/guardians. The purpose of these interventions is to strengthen the member and the member’s family when appropriate, in order to provide stability and preservation in the community setting. These services are flexible both as to where and when they are provided based on member and family needs.

[C] CTTs require the provision of an array of services delivered to the individual and his/her family by a community-based, mobile, multidisciplinary team of professionals and paraprofessionals. Services are designed to meet the unique needs of each member based on cultural values and individual/family strengths, and be maximally flexible in supporting the individual and his/her parents/guardians/caregivers at the time of day when the services are most needed and when the family may be most receptive to therapeutic intervention and skills training.