UM Guidelines

Applies to BlueCare Only.

Clinical Indications for Admission to to Intensive Outpatient Program

• Admission to CIIF is indicated due to ALL of the following:
  • Member is at risk of out of home placement.
  • Current primary DSM-V-TR diagnosis
  • Functional impairment (i.e. lack of age-appropriate decision making, social relationship issues with peers and adults, disruptive behavior, difficulty communicating, etc)
  • Evidence of instability in the home and community setting (i.e. psychosis, danger to self or others, violence in the home/school/work settings, etc)
  • The child or youth’s behaviors have measurably escalated within the past 90 days, showing significant change in school, home, or community functioning
  • The child or youth’s support system is in need of intensive interventions to stabilize care in the home and community
  • Support services are likely to prevent an inpatient admission or long term out of home placement
  • Less intensive outpatient services do not sufficiently meet the child/youth’s and family’s needswith no other crisis or in home services in place

Discharge Criteria

• Continued CIIF is generally needed until 1 or more of the following:
  • CIIF is no longer necessary due to adequate patient stabilization or improvement, as indicated by ALL of the following:
    • Risk status acceptable, as indicated by ALL of the following:
      • Danger to self or others manageable/treatable, as indicated by 1 or more of the following:
        • Absence of thoughts of suicide, homicide, or serious harm to self or to another
        • Thoughts of suicide, homicide, or serious harm to self or to another present but manageable/treatable at available lower level of care
  • Patient and supports understand follow-up treatment and crisis plan.
  • Provider and supports are sufficiently available at lower level of care.
  • Patient, as appropriate, can participate as needed in monitoring at available lower level of care.
  • Functional status acceptable, as indicated by 1 or more of the following:
  • No essential function is significantly impaired.
  • An essential function is impaired, but impairment is manageable/treatable at available lower level of care.
  • Symptom status acceptable, as indicated by ALL of the following:
  • Symptoms stabilized and may be appropriately treated at available lower level of care
  • No current plan for change in treatment or re-evaluation
  • Treatment goals for level of care met
  • CIIF is no longer indicated due to 1 or more of the following:
  • Member deterioration (physical or psychiatric) requires higher level of care
  • Member/guardian no longer consents to treatment and there is no court order for treatment
  • Member has not made progress despite participation and is judged not likely to improve at this level of care.
  • Inadequate participation in treatment by member and/or supports

References

Alternatives to inpatient mental health care for children and young people: Evidence and implications for public health. Retrieved 7/18/17. http://www.healthevidence.org/documents/byid/19286/Shepperd2009_EvidenceSummary_EN.pdf.

Home-Based Multisystemic Therapy as an Alternative to the Hospitalization of Youths in Psychiatric Crisis: Clinical Outcomes.  Henggeler, S.W., Rowland, M.D., Randall, J., Ward, D.M., Cunningham, P.B.,  and Miller, S.L. Volume 38, Issue 11, November 1999.  Retrieved 7/18/17. http://www.sciencedirect.com/science/article/pii/S0890856709666818.

One-Year Follow-up of Multisystemic Therapy as an Alternative to the Hospitalization of Youth is Psychiatric Crisis.  Henggeler, S.W., Rowland, M.D., Halliday-Boykins, C., Sheidow, A.J., Ward, D.M., Randall, J., and Pickrel, S.G.  Volume 42, Issue 5, May 2003.  Retrieved 7/18/17. http://www.sciencedirect.com/science/article/pii/S0890856709609394.