Definitions and Basic Terms

 

3.1.1. Behavioral Health Screening

Behavioral screening instruments are designed to be a relatively brief process to obtain information and to “triage” the need for 1) further evaluation or 2) an immediate intervention.[1] A screening does not provide a psychiatric diagnosis and should not be used to develop a long-term plan or disposition. 
 
Grisso and Underwood (2004) described behavioral health screening of youth involved with the juvenile justice system in the following manner:
 
“Screening typically is intended not to provide an accurate psychiatric diagnosis, but rather to distinguish a set of exceptionally troubled youth for whom some special and relatively immediate response is necessary. Examples of responses to “red flags” in juvenile justice screening might include closer monitoring by staff, assignment of a staff member to briefly inquire further about the youth’s current feelings, placement on suicide watch, scheduling for a diagnostic interview and consultation with a mental health professional, or, in some cases, immediate transfer to an inpatient psychiatric facility. Identifying the need for further evaluation, however, is a more frequent purpose of screening”.[2]
 
In selecting an appropriate behavioral health screening instrument for use in juvenile justice settings, the following factors should be considered:
 
Is the instrument scientifically valid and reliable (evidence-based)?
Does the instrument correlate reasonably well to more sophisticated assessment/evaluation/diagnostic tools?
Does the instrument have an ability to prioritize the need for more extensive and expensive assessment or intervention?
Is the instrument relatively brief and easy to administer?
Does the instrument require clinical staff to manage, administer or interpret?
Does the instrument require minimal staff training?
Is the instrument relatively inexpensive to use on an ongoing basis?
Is the instrument designed in way to enable data/information to be collected to inform policy and resource decisions?
Is the instrument accepted “across” systems and enable a common language to be established between the juvenile justice, child welfare, and mental health systems? 
 
[1] Grisso, T. (2005).  Why we need mental health screening and assessment in juvenile justice programs.  In T. Grisso, G. Vincent, D. Seagraves (eds.), Mental health screening and assessment in juvenile justice (pp.3-21). New York: Guilford Press.
[2] Grisso, T. & Underwood, L.A. (2004)  Screening and Assessing Mental Health and Substance Use Disorders Among Youth and in the Juvenile Justice System:  A Resource Guide for Practitioners. US Department of Justice, Office of Justice Programs, office of Juvenile Justice and Delinquency Prevention, pg. 2.

Some examples of behavioral health screening instruments that are used in probation intake or detention include: 
 
Massachusetts Youth Screening Instrument: Second Version (MAYSI~2: Grisso & Barum, 2006): a 52-question self-report screening instrument that measures symptoms on seven scales pertaining to emotional, behavioral, or psychological disturbance, including suicide ideation.  This tool has been examined in more than 50 research studies, and it possibly the only tool with national norms.
 
Suicide Ideation Questionnaire (SIQ; Reynolds 1988): a 25-item self-report screening instrument used to assess suicidal ideation in adolescents.  It can be administered individually or in a group setting. 

Global Appraisal of Individual Needs-Short Screener (GAINS-SS; Dennis, Scott, Funk, & Foss, 2005): a 20-item behavioral health screening tool designed to identify adolescents in need of more detailed assessment for substance use of mental disorder.   Many studies have been conducted to demonstrate that this tool accurately identifies drug and alcohol problems.
 
Voice-Diagnostic Interview Schedule for Children (Voice-Disc; Wasserman, McReynolds, Fisher, & Lucas, 2005): a self-report computerized tool based on the DSM-IV that produces computer assisted diagnoses.  This instrument can take up to 1 hour to complete, yet it is often classified as a screen because a follow-up assessment is recommended to confirm any diagnosis.[3] 
 
[3] Vincent, G. (2012).  Juvenile Justice Resource Series. Screening and Assessment in the Juvenile Justice Systems:  Identifying Mental Health Needs and Risk of Offending. Technical Assistance Partnership for Child and Family Mental Health, Substance Abuse and Mental Health Services Administration: U.S. Department of Health and Human Services.  pgs. 4-5.
 

3.1.2. Behavioral Health Assessment

A behavioral health assessment normally involves a more in-depth, comprehensive process and may require specially trained or credentialed staff.  Again, Grisso and Underwood (2004) distinguished behavioral health assessment accordingly.
 
“In contrast, assessment is a more comprehensive and individualized examination of the psychosocial needs and problems identified during the initial screening, including the type and extent of mental health and substance abuse disorders, other issues associated with the disorders, and recommendations for treatment intervention.
 
Assessments typically are more expensive than screening because they require more individualized data collection, often including psychological testing, clinical interviewing, and obtaining past records from other agencies for review by the assessor. Thus, assessment typically requires the expertise of a mental health professional. These facts mean that assessments should be used only for a subset of youth who, through screening or other means, are identified as most likely to be in need of such evaluation”.  [4]


 
[4] Grisso, T. & Underwood, L.A. (2004)  Screening and Assessing Mental Health and Substance Use Disorders Among Youth and in the Juvenile Justice System:  A Resource Guide for Practitioners. US Department of Justice, Office of Justice Programs, office of Juvenile Justice and Delinquency Prevention. pgs. 2-3
 
 
There are multiple options for instruments that may be used as part of a more comprehensive assessment.  These instruments may require administration by clinically trained or credentialed staff and may be included as part of a psychological and/or psychiatric evaluation.   The following are used in youth systems and have varying degrees of research to support their use:
 
Child and Adolescent Functional Assessment Scale (CAFAS; Hodges, 2000): a functional assessment that rates youth on the basis of the adequacy and deficits in functioning within life domains such as home and school and with regard to potential problems areas such as substance use or self-harmful behavior. It was developed to assist in identifying those individuals with “serious emotional disturbances” for the purposes of determining service eligibility.  A screening version of this assessment – the Juvenile Inventory for Functioning – has been created and is currently undergoing validation.
 
Child and Adolescent Needs and Strengths-Comprehensive (CANS-C); Lyons, Griffin, Fazio, & Lyons, 1999): the CANS has several versions.  Although the content of this tool included information about a youth’s mental health problems and risk, it does not measure its characteristics, but rather provided a mechanism to support consistent communication about a youth’s service needs and level of functioning.  It is considered a needs assessment tool that documents functioning in several domains, including substance abuse, mental health, other risk behaviors, and caregiver needs.  It has some reliability evidence.
 
Achenbach System of Empirically Based Assessment (ASEBA; Achenbach & Rescorla, 2001) – formerly known as the Child Behavior Checklist:  a widely studied and used 118-item self-report form focusing on eight behavioral and problem dimensions  that can be grouped into two broader types of pathology:  “externalizing” (outward expression)  and “internalizing” inward feelings and thoughts). It is completed by the youth, parents, or teachers.
 
Behavioral Assessment System for Children (BASC-2; Reynolds & Kamphaus, 2004): a self-report tool that has different versions for the adolescent, parent/guardians, and teacher.  The BASC-2 has different age appropriate versions ranging from childhood to young adulthood.  It provides norm-based information about problem areas including aggression, anxiety, attention problems, conduct problems, and depression.
 
Practical Adolescent Dual Diagnosis Interview (PADDI: Estroff & Hoffman, 2011): a guided interview procedure that identifies suggested diagnoses related to substance abuse and mental disorders.  It can be useful in mental health clinics, private practices, courts and juvenile justice facilities.[5] 
 
 

Risk to Re-Offend Assessment


Behavioral health screening and assessments instruments should not be confused with juvenile justice risk assessment or risk to re-offend assessment instruments.  Juvenile justice risk assessment instruments are designed to provide an indication of the level of criminogenic risk and need presented by a juvenile.   Behavioral health screening and assessment instruments are not designed to predict the risk to re-offend, nor are risk to re-offend assessments able to provide mental health diagnoses.  Both behavioral health assessments and risk to re-offend assessments but can be complimentary and helpful if used as part of an integrated screening and assessment protocol by juvenile probation.[6]    In addition to providing information as to whether any emotional or mental health disorders exist, behavioral health screening and assessment processes can provide insight into issues that might impede the youth’s responsiveness or responsivity to an intervention.   Responsivity is a key concept, along with the principles of Risk and Need, of juvenile justice evidence-based practice.  In order to reduce recidivism, a primary goal of the juvenile justice system, the Risk-Need-Responsivity (R-N-R) principles define who (Risk) should be targeted, what (Need) should be targeted, and how (Responsivity) it should be targeted. [7]

Responsivity describes the ability and motivation of a juvenile to learn and subsequently change behavior.   If a youth is experiencing an emotional or mental disorder, the ability to learn and change behavior may be significantly hindered.  Therefore, it would be necessary to identify and begin to treat the underlying behavioral health issues to improve the ability of the youth to respond to interventions designed to address criminogenic risks and needs.
  
The Youth Level of Service/Case Management Inventory (YLS/CMI) is the risk assessment instrument adopted for use by Juvenile Probation departments within Commonwealth of Pennsylvania.  A brief summary description of the YLS/CMI is below.

Youth Level of Service/Case Management Inventory (YLS/CMI: Hoge & Andrews, 2006): a well-validated, comprehensive, standardized inventory for assessing risk among youth ages 12-17 involved with the juvenile court.  It includes measures of static and dynamic risks that can assist with post-adjudication case planning.  Created specifically for administration by probation officers, it is probably the most widely used tool by probation offices in the United States.   
 
[5] Vincent, G. (2012).  Juvenile Justice Resource Series. Screening and Assessment in the Juvenile Justice Systems:  Identifying Mental Health Needs and Risk of Offending. Technical Assistance Partnership for Child and Family Mental Health, Substance Abuse and Mental Health Services Administration: U.S. Department of Health and Human Services.  pgs. 5-6. 
[6] Ibid, pgs. 6-7.
[7] Pennsylvania’s Juvenile Justice System Enhancement Strategy: Achieving Our Balanced and Restorative Justice Mission Through Evidence-based Practice (April 2012). pg. 8.

 
3.1.3. Psychological Evaluation
 
Psychological evaluations are written, visual, or verbal tests and assessments administered to measure the cognitive and emotional functioning of children and adults.  Psychological evaluations are used to assess a variety of mental abilities and attributes, including achievement and ability, personality, and neurological functioning.
In the juvenile justice system, psychological evaluations can be used to assist in the development and implementation of an appropriate juvenile court disposition and case plan, including treatment or interventions.  Psychological evaluations are only one aspect of what may be considered in the development and implementation of a juvenile court disposition and case plan.   The level of risk to re-offend and the youth’s responsibility to his/her victim(s) are primary considerations in the process.
All psychological or neuropsychological evaluations should be administered, scored and interpreted by a trained professional.  Professional guidelines require that whomever administers the evaluation advises the youth and parents/guardians of the intended use of the results and with whom the results will be disclosed.   May require an iAn informed consent may need toto be signed to share the results of the evaluation with other professionals.systems.
Tests and Assessments
Tests and assessments are two separate but related components of a psychological evaluation. Psychologists use both types of tools to help them arrive at a diagnosis and a treatment plan.
Testing involves the use of formal tests such as questionnaires or checklists. These are often described as “norm-referenced” tests. That simply means the tests have been standardized so that test-takers are evaluated in a similar way, no matter where they live or who administers the test.  A norm-referenced test of a child's reading abilities, for example, may rank that child's ability compared to other children of similar age or grade level. Norm-referenced tests have been developed and evaluated by researchers and proven to be effective for measuring a particular trait or disorder.
A psychological assessment can include numerous components such as norm-referenced psychological tests, informal tests and surveys, interview information, school or medical records, medical evaluation and observational data. A psychologist determines what information to use based on the specific questions being asked.
(Examples of specialized functions) For example, assessments can be used to determine if a youth has a learning disorder, is competent to stand trial or has a traumatic brain injury.  (can be used for specialized purposes- competency to stand trial)
One common assessment technique, for instance, is a clinical interview. When a psychologist speaks to a youth about his/her concerns and history, they're able to observe how the youth thinks, reasons and interacts with others. Assessments may also include interviewing other people who are close to the client, such as family members or care givers.
Together, testing and assessment allows a psychologist to see the full picture of a youth’s strengths and limitations.
For more information on psychological evaluations see the American Psychological Association website:  http://www.apa.org/helpcenter/assessment.aspx.   
3.1.4. Psychiatric Evaluation[BMB2] 
A psychiatric evaluation is an assessment of a youth for serious emotional and/or behavioral problems performed by a child and adolescent psychiatrist. 
 
A comprehensive psychiatric evaluation usually requires several hours over one or more visits with the youth and his/her parents.  With proper consent, other significant individuals such as the family physician, school officials or other relatives may be contacted for additional information.
   
A comprehensive psychiatric evaluation frequently includes the following:
 
Description of present problems and symptoms
Information about health, illness and treatment (both physical and psychiatric), including current medications
Parent and family health and psychiatric histories
Information about the child's development
Information about school and friends
Information about family relationships
Interview of the child or adolescent
Interview of parents/guardians
If needed, laboratory studies such as blood tests, x-rays, or special assessments (for example, psychological, educational, speech and language evaluation) 
The child and adolescent psychiatrist then develops a formulation. The formulation describes the child's problems and explains them in terms that the parents and child can understand. The formulation combines biological, psychological and social parts of the problem with developmental needs, history and strengths of the child, adolescent and family.
 
A psychological and/or psychiatric evaluation may be required to access behavioral health services
 
For more information on psychiatric evaluations for children and adolescents see the American Academy of Child and Adolescent Psychiatry website at: http://www.aacap.org
 
3.1.5. Life Domain Format for Psychiatric/Psychological Evaluations
Although the disciplines of psychiatry and psychology differ in training and expertise in some ways, in Pennsylvania both psychiatrists and psychologists can serve as “prescribers” of community-based behavioral health services. Both can also prescribe non-JCAHO residential treatment facilities (RTFs), but only psychiatrists prescribe for JCAHO RTFs. The evaluation protocol presented applies to both disciplines for use when behavioral health services are being requested. The protocol can be used, as described here, with slight modification, for both initial and continued care requests. It can also be used to request all levels of care, not just Behavioral Health Rehabilitation Services (BHRS) and RTF services. Since the Life Domain Format helps the evaluator obtain comprehensive information about the child that includes but goes beyond presenting behaviors and symptoms of concern, it can be used whether or not BHRS and RTF are being requested (note the 2007 revision of the Life Domain Format).
 
A useful evaluation cannot be part of an assembly-line process, and instead must be the considered summation of an evaluator’s intense contact with a unique child and family at a critical moment in time. A useful evaluation should build on child and family experiences and include thoughtful, individualized recommendations.
 
The Life Domain Format is provided in the “Guidelines for Child and Adolescent Mental Health Services” published by the Pennsylvania  Department of Public Welfare, Office of Mental Health and Substance Abuse Services, Bureau of Children’s Behavioral Health Services.
 
The goals of the Life Domain Format for Psychiatric/Psychological Evaluations: Initial and Continued Care are:
 
To help implement a strengths-based interview and written report that identify competencies and resources as well as needs, so that each child and adolescent can be understood biologically, psychologically, and socially (e.g., understood within various life domains), resulting in a comprehensive understanding of the child and family.
To identify crisis situations, and ascertain when a child requires a highly restrictive level of care such as inpatient psychiatric hospitalization or RTF.
To obtain core information, so that the interagency team is free to promote an envisioning of positive, future outcomes and to develop a creative treatment plan, rather than engage in a recitation of past failures.
To assist in recommending individualized services and natural supports consistent with CASSP Principles, which support the child’s remaining in the natural family or elsewhere in the community, when possible, or the child’s successful return to the community.
To support the inclusion of parents/caregivers and other treatment team members in a portion of the evaluation process.
To encourage participation by the psychiatrist or psychologist as an active member of the interagency and treatment teams, helping to achieve consensus regarding needs and services, and monitoring progress.
To create a comprehensive document that serves as a baseline for future evaluations, and as a source of reference for a subsequent review of the child’s progress over time. 
The recommended format guides the systematic collection of core information about a child or adolescent with a serious emotional disorder, and assists the evaluator in prescribing medically necessary behavioral health services and in making relevant recommendations.
 
The Life Domain Format makes use of seven primary categories or sections:
 
Identifying Information
Reason for Referral
Relevant Information
Interview
Discussion
Diagnosis
Recommendations 
More detailed description of the domains as well as other Best Practices in Child and Adolescent Mental Health can be at: http://www.dpw.state.pa.us/cs/groups/public/documents/manual/s_001583.pdf
 
 
Add That Psychological/Psychiatric may be needed to access services
What the process ISPT
3.1.65. Medical Necessity
The definition of medical necessity is provided in Pennsylvania regulations (55 Pa. Code §1101.21a), and see DPW "Clarification Regarding the Definition of 'Medical Necessity'" at 37 Pa.B. 1880 (April 27, 2007), and in contracts between the Pennsylvania Department of Public Welfare and the Health Maintenance Organizations.
To meet the Medicaid standard for Medical Necessity, any one of the three standards below can be met: 
The service or benefit will, or is reasonably expected to, prevent the onset of an illness condition, or disability
The service or benefit will, or is reasonably expected to, reduce or ameliorate the physical, mental, or developmental effects of an illness, condition or disability.
The service or benefit will assist the individual to achieve or maintain maximum functional capacity in performing daily activities taking into account both the functional capacity of the individual and those functional capacities that are appropriate for individuals of the same age.The determination can be made either by prior authorization, concurrent review, or post-utilization. For a service to be compensable under the Medicaid program it must be medically necessary.
If private insurance is available it may be necessary to access services through the private insurance plan.
 
3.1.76. Planning Processes/Structures
3.1.76.1. System of Care
A System of Care approach provides an organizational framework and philosophy that result in a spectrum of effective, community-based services and supports for youth with complex behavioral health challenges, multi-system involvement and their families.   These services and supports are organized into a coordinated network, build meaningful partnerships with families and youth, and address their cultural and linguistic needs in order to help them function better at home, in school, in the community and throughout life (Stroul, B., 2011)." Systems of Care have been proven effective for youth with complex behavioral health challenges, multi-system involvement and their families.
 
Youth experience improved outcomes in mental health symptoms and school performance, reduced involvement in child welfare and juvenile justice, and positive family functioning.
And there are cost savings – with real, long term benefit as youth and families become more self-reliant. 
Working at the state, county, and individual levels in Pennsylvania, the PA System of Care Partnership brings youth, families, systems and supports together to find effective and efficient strategies that improve outcomes for youth and their families. In particular, we are focusing on the needs of 8 – 18 year-olds and their families, who have complex behavioral health challenges along with involvement in the juvenile justice and/or child welfare system(s) and who are in, or at risk of out-of-home placement. 
 
Below is a comparison of the PA System of Care and the PA Juvenile Justice System Enhancement Strategy which identifies the features that the two initiatives have in common.
 

 
 
For aAdditional iInformation on PA System of Care, please see: http://www.pasocpartnership.org/about-us#sthash.w8dKMA3R.dpuf
 
3.1.76.22. High Fidelity Wraparound
High Fidelity Wraparound (HFW) is a youth-guided and family-driven planning process that follows a series of steps to help youth and their families realize their hopes and dreams. It is a process that allows more youth to grow up in their homes and communities. It is a planning process that brings people together (natural supports and providers) from various parts of the youth and family’s life. The HFW workforce (HFW Facilitator, and if desired, a HFW Family Support Partner and HFW Youth Support Partner), helps the youth and family achieve the goals that they have identified and prioritized, with assistance from their natural supports and system providers. This is the HFW team. Regardless of the differences in the various implementer counties, High Fidelity Wraparound is driven by the same HFW Principles, and follows the same HFW Phases and basic HFW activities.
 
Family-driven means families have a decision-making role in the care of their own children as well as in the policies and procedures governing care for all children in the community, state, and nation. This includes choosing supports, services; providers; setting goals; designing and implementing programs; monitoring outcomes; and determining the effectiveness of all efforts to promote the mental health of children and youth.
 
Youth-guided means that youth are engaged in the idea that change is possible in his or her life. Youth feel safe, cared for, valued, useful and spiritually grounded. Youth are empowered in their planning process from the beginning and have a voice in what will work for them.
 
For additional information on High Fidelity Wraparound please see: www.systemsofcare.samhsa.gov and pages/the-pa-system-of-care-partnership.
 
3.1.76.32. Family Involvement in Pennsylvania’s Juvenile Justice System
Whenever possible, families are a critical aspect in the care, supervision and treatment of their children involved with the juvenile justice system.  The importance of the role of families is clearly embedded in the foundational principles of Pennsylvania’s juvenile justice system. Families’ goals for their children are consistent with mission set forth in Pennsylvania’s Juvenile Act which requires balance attention to community safety, accountability to victims, and development of competency of youth.  Families want their children to live in safe communities, to be appropriately accountable for their conduct, and to grow and develop into competent individuals.
 
The monograph Family Involvement in Pennsylvania’s Juvenile Justice System was developed by the Mental Health Association in Pennsylvania and the Pennsylvania Council of Chief Juvenile Probation Officers-Balanced and Restorative Justice Implementation Committee’s Family Involvement Workgroup offers the following recommendations for officials at a local level to more effectively involve families in the juvenile justice process:
 
Family members are treated with respect and dignity by juvenile justice system professionals.
Families are considered important to ensuring successful outcomes for youth.
Family members are actively sought out and their views, insights and experiences are valued and utilized.
Information is regularly provided to families from the time of initial contact – arrest, detention, intake, hearings, disposition and placement, and is provided in a variety of means which respect the families’ culture, experience, and needs.
Family members have a single point of contact within the local juvenile justice system that they can rely on to provide open, honest and up-to-date information regarding their child.
Information is made available to family members – such as brochures, resources, or other materials – that describes the mission, goals and expectations of the juvenile justice system.
Families are referred to self-help resources including local and state level family peer advocacy projects.
Professional training courses or other resources available to professional staff include information on family systems, communications skills, and family involvement
Families are included in planning activities associated with the care and treatment of their child, and the plans address the needs of the family to support their child, as identified by the family.
Family members are routinely included in all decisions regarding their child, all planning meetings, and ongoing monitoring. Their input is valued and reflected in the plan, and they come to the table with sufficient knowledge and skills to support their effective involvement.
When a youth is in out-of-home placement, regular communication, visitation and transportation is provided or arranged for family members.
Aftercare planning for a youth in placement includes a ‘family plan’ that is developed in partnership with the family.
Family centered resources and programs, such as Functional Family Therapy, Multi-Systemic Therapy, or Family Group Decision Making are currently available, or plans are underway to make them available in a jurisdiction.[8] 
For additional information on Family Involvement in Pennsylvania’s Juvenile Justice System please see:
http://www.pccd.pa.gov/Juvenile-Justice/Documents/Family%20Involvement%20in%20PA%20JJS.pdf
 
 
 
 
3.1.87 Outpatient Treatment
Outpatient services are provided based on the need of the youth suffering minimal to moderate distress.   Services are delivered in a structured setting such as an office and/or may be school-based.  Activities include: individual, group and family therapy, medication management, and psychiatric evaluations. There are different types of outpatient options- such as specialized (trauma focused, Parent-Child Interaction Therapy, etc.)
 
3.1.8.1. Individual Therapy
 
Individual therapy is a form of therapy in which the youth is treated one-on-one with a therapist. The most popular form of therapy, individual therapy may encompass many different treatment styles including psychoanalysis and cognitive behavioral therapy.
 
3.1.8.2. Group Therapy
 
Group therapy is a type of psychotherapy that involves one or more therapists working with several people at the same time. [BMB3] Group therapy is sometimes used alone, but it is also commonly integrated into a comprehensive treatment plan that also includes individual therapy and medication.
 
3.1.8.3. Family Therapy
 
Family therapy is a type of psychotherapy designed to identify family patterns that contribute to a behavior disorder or mental illness and help family members break those habits. Family therapy involves discussion and problem-solving sessions with the family. Some of these sessions may be as a group, in couples, or one on one. In family therapy, the web of interpersonal relationships is examined and, ideally, communication is strengthened within the family.
 
3.1.8.4 Specialized Therapies[BMB4] 
 
The following specialized therapies are considered evidence-based. Evidence-based programs and interventions use evidence from scientifically-based research studies to design, deliver, and evaluate the services and interventions they provide.  These programs and interventions have been studied using utilizing rigorous research principles to determine their effectiveness.    Other evidence-based programs may be available by checking with the local County Office of Mental Health/Developmental Services.
 
Specialized Therapies include a wide variety of treatments are provided by specially trained or credentialed therapists.  Examples of specialized therapies include Trauma-Focused Cognitive Behavioral Therapy, Dialectical Behavior Therapy (DBT).
 
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is considered a cognitive behavioral treatment for children who have Post-Traumatic Stress Disorder (PTSD).  It was initially developed to address symptoms related to childhood sexual abuse, although it has since been adapted to treat other traumatic experiences of childhood as well. It targets maladaptive and unhealthy thoughts and behaviors that a victim of sexual abuse might experience; for example, TF-CBT may help children modify inaccurate beliefs that lead to unhealthy behaviors, such as beliefs that they are to blame for the abuse. It also identifies unhealthy patterns of behaviors (for example, acting out or isolating) or fear responses to certain stimuli and attempts to modify these by identifying healthier ways of responding to certain stimuli, or in particular situations.
 
[BMB5] Dialectical Behavior Therapy (DBT) is a cognitive-behavioral treatment approach for individuals with both mental health diagnoses and co-occurring diagnoses. The two key characteristics are a behavioral, problem-solving focus blended with acceptance-based strategies, and an emphasis on dialectical processes. "Dialectical" refers to the issues involved in treating patients with multiple disorders and to the type of thought processes and behavioral styles used in the treatment strategies. DBT has five components: (1) capability enhancement (skills training); (2) motivational enhancement (individual behavioral treatment plans); (3) generalization (access to therapist outside clinical setting, homework, and inclusion of family in treatment); (4) structuring of the environment (programmatic emphasis on reinforcement of adaptive behaviors); and (5) capability and motivational enhancement of therapists (therapist team consultation group). DBT emphasizes balancing behavioral change, problem-solving, and emotional regulation with validation, mindfulness, and acceptance of patients. Therapists follow a detailed procedural manual.
 
Contingency Management (CM) is a scientifically-based treatment approach grounded in the principles of behavior management and cognitive-behavioral therapy that provides incentives for abstaining from drug abuse. Techniques involved in this treatment include positive reinforcement for drug abstinence and negative consequences for returning to drug use, with the emphasis on positive reinforcement and the celebration of success.  This celebration of success helps the family and youth remain motivated to change and provide a positive and welcoming treatment environment.   This approach is very similar to Graduated Responses that are used by juvenile probation.
 
 
 
 
 
 
 
 
 
3.1.98. Community-Bbased Services
Community-Bbased Services is term used to describe behavioral health services such as Behavioral Health Rehabilitative Services (BHRS), but also includes services such as Multi-Systemic Therapy (MST), Functional Family Therapy (FFT), or other services.  The distinction , of course, is that the service in provided in the home, community or any other environment other than an office. of youth.[BMB6] 
 
 
 
3.1.98.1 Add Family-Based Mental Health Services
 
A team delivered service rendered in the home and community that is designed to integrate mental health treatment, family support services and casework so that families may continue to care for their children and adolescents with a serious mental illness or emotional disturbance at home.  The service reduces the need for psychiatric hospitalization and out-of-home placement by providing a service, which enables families to maintain their role as the primary care giver for their children and adolescents.  Services are available 24 hours a day, 7 days a week.  Families have a least one face-to-face contact per week for up to 32 weeks.
 
[BMB7] [BMB8] 
 
3.1.98.2. Behavioral Health Rehabilitative Services (BHRS)
 
Behavioral Health Rehabilitation Service (BHRS) are behavioral health services prescribed for children/youth with serious emotional/behavioral disorders, whose needs cannot be effectively addressed by more traditional, office-based mental health treatment. These services may be provided when the problems or difficulties of the child/youth with managing emotions/behaviors occur in the home, school or community. The services are intended to build on the child’s/youth’s strengths and teach skills relevant to the youth’s behavioral health needs and goals.
 
Services may be delivered by the following mental health professionals, including a Behavioral Specialist Consultant, a Mobile Therapist, and Therapeutic Staff Specialist:
 
 
A Behavioral Specialist Consultant (BSC) designs and directs the implementation of a behavior modification intervention plan.  The BSC identifies the behavioral goals and intervention techniques to be used by the child/youth, family, and other individuals identified in the behavior plan who work with the child/youth such as school staff or community resources such as daycare or Boys and Girls club. The BSC works with the family and other treatment team members, but does not typically provide direct services to the child/youth.  BSC may be the only BHR service or, when medically necessary, may consult to an MT and/or TSS worker. A BSC must be a mental health clinician. The BH-MCO may have additional qualifications such as a certain number of years’ experience. 
 
Mobile Therapy (MT) provides intensive therapeutic services such as assessment of strengths and therapeutic needs to a child/youth and family in settings other than the provider agency or office.  Settings can include the child’s/youth’s home, school, church, or a community center. Depending on the needs of the child/youth, MT services may be the only BHR service or, when medically necessary, may work in conjunction with a BSC and/or a TSS worker.  A mobile therapist must be a licensed mental health professional or an individual with a Master’s degree in a mental health field.  The BH-MCO may have additional qualifications such as a certain number of years’ experience. 
 
The Therapeutic Staff Support (TSS) worker provides one-to-one interventions based on a behavior/treatment plan typically created by an MT or BSC to a child/youth in a home, school or community setting based on a behavior/treatment plan typically created by a MT or BSC.  TSS is not a stand-alone service.
 
 
 
Behavioral Health Rehabilitation Services (BHRS) are services for youth who need individual therapeutic assistance. A skilled staff person works with the child for a specified number of hours per week in his/her home, school, and/or community.
 
Services are targeted to improve functioning in the community, school or home environments. The youth must be at-risk of out-of-home placement and the family must agree to the service. Interventions should build upon strengths and be flexible. Level of support Behavioral Specialist Consultant (BSC), Mobile therapy (MT), Therapeutic Staff Support (TSS), behavioral interventions, skill building, one to one support and after-school activities are possible services. [BMB9] BHRS is used widely used to reduce many types of mental health behaviors and symptoms.
 
BSCs, MTs, and TSSs work together to provide the following services:
 
Formulation and implementation of behavioral treatment plans
Collaboration with and transfer of skills to parents, school staff, and other caregivers
Specialized treatments targeting symptoms of various childhood mental health disorders such as Attention Deficit Hyper-Activity Disorder, Oppositional Defiant Disorder, and Anxiety Disorders
Specialized Autism treatment 
3.1.98.3. Multisystemic Therapy (MST)[BMB10] 
 
Multisystemic Therapy (MST), along with Functional Family Therapy (FFT) are two of the more widely known Evidence-Based Programs and are classified as “Blue Print Programs”[9].  MST and FFT are funded under Pennsylvania’s Medical Assistance Program.  
 
 
Multisystemic Therapy (MST) is an evidence-based program developed to treat delinquent youth by intervening in the various systems in which the youth is embedded (i.e., family, school, peer, community) to change factors that contribute to or maintain problem behaviors. MST is a practical and goal-oriented treatment that draws from social-ecological and family systems theories of behavior.
 
In MST, a single therapist delivers services to 4 – 6 families. For the purposes of supervision, consultation, training, and monitoring, clinical staff are organized into teams of 2 – 4 therapists led by an MST Supervisor. The therapist meets with the youth or family at least weekly throughout most of the treatment and often multiple times per week, depending on need. Services occur in the family’s home or community at times that are convenient for the family. Staff members are expected to work on weekends and evenings, for the convenience of their clients, and therapists and/or their supervisors are on-call for families 24/7. On average, a youth receives MST for 3 to 5 months, and typically no longer than 6 months.[10] 
 
For additional information on MST please see: http://episcenter.psu.edu/ebp/multisystemic
 
3.1.98.4. Functional Family Therapy (FFT)
 
Evidence-Based Programs use evidence from scientifically-based research studies to design, deliver, and evaluate the services and interventions they provide.  Evidence-Based Programs have been studied using utilizing rigorous research principles to determine their effectiveness.    Functional Family Therapy (FFT), along with Multisystemic Therapy (MST), are two of the more widely known Evidence-Based Programs and are classified as “Blue Print Programs”[11].  MST and FFT are funded under Pennsylvania’s Medical Assistance Program.   Other Evidence-Based Programs may be available by checking with the local County Office of Mental Health/Developmental Services.
 
 
Functional Family Therapy (FFT) is a short-term, behaviorally oriented family therapy program that targets youth ages 10-18 with severe behavior problems and chronic delinquency, as well as youth at risk for delinquency. Trained FFT therapists address a youth’s referral behavior by providing intensive family therapy to change patterns of family interaction that are contributing to the problem behavior and by helping family members develop specific skills (e.g., communication, problem solving, conflict resolution and effective parenting skills). After change has been achieved within the family, the FFT therapist helps the family generalize changes to other situations and settings, such as peers, school, and community, and identifies supports that can help to maintain the progress made. Treatment is structured around five phases of treatment, each with specific assessment and intervention components that are tailored to the unique characteristics of each family. Sessions occur at least once per week and more often if needed, typically for 3-4 months, and can be delivered in both community-based and office-based settings. Research shows that FFT reduces the likelihood of out-of-home placement, reduces youth substance use and criminal recidivism, and improves family functioning and youth behavior. FFT is an evidence-based treatment program and is recognized as a Blueprints for Healthy Youth Development Model Program.[12]
 
For additional information on FFT please see: http://episcenter.psu.edu/ebp/familytherapy
 
 
3.1.109. Intensive Case Management[BMB11] , Resource Coordination & Blended Case Management
 
Intensive Case Management (ICM) and Resource Coordination (RC) are primary, direct services (as opposed to administrative case management, which consists mainly of referral and linkage function) to targeted adults with serious and persistent mental illness and to children with a serious mental illness or emotional disorder.  ICM and RC services are designed to insure access to community agencies, services and people to provide support, and assistance required for a stable, safe and healthy community life.   ICM is targeted to individuals with serious mental illness with a need for intensive assistance.  Resource Coordination is targeted for persons who have mental illness with a need for assistance.   Blended Case Management blends aspects of Intensive Case Management and Resource Coordination dependent upon the needs of the individual. Case Management Services provides support for individuals who are experiencing a serious mental illness that puts them at risk for hospitalization.  Services may include:
 
Obtaining the most appropriate resources through monitoring and problem solving
Making assessments and referrals
Directing individuals to community resources
Connecting individuals with other natural supports that build on personal strengths
 
 
3.1.11. Mental Health Crisis Services[BMB12] 
Immediate, crisis-oriented services designed to ameliorate or resolve precipitating stress.  Services are provided to adults or children and adolescents and their families who exhibit an acute problem of disturbed thought, behavior, mood or social relationships.  The services provide rapid response to crisis situations, which threaten the well-being of the individual or others.  Mental Health Crisis Intervention (MHCI) services include the intervention, assessment, counseling, screening and disposition services which are considered appropriate to the provision of Mental Health Crisis Intervention. 
Responsibility for the provision of these services either directly, or through contract, is assigned to the county MH/MR Administrator.
Twenty-four hour, 7 day a week emergency services must be available.  In all counties, establishing a telephone hot line with hospital emergency room back up fulfills this requirement,  Some counties provide additional crisis services such as walk-in crisis service, mobile crisis service, medical-mobile crisis services and residential crisis services.
 component……..
 
See Megan’s ppt. for different levels of CM- no blended definition is provided-need
 
Add High fidelity Wrap
 
 
3.1.120. Partial Hospitalization
 
Partial Hospitalization Services are provided daily to individuals suffering moderate emotional or mental disorders.  The individual resides in the community and spends the day at a treatment location.  Some programs are community based; a few are school based. Services may include group therapy, individual therapy and medication management and provides daily psychiatric services and can vary in length from acute to longer term.  Most programs have weekly family therapy.  The service is used to prevent inpatient psychiatric care or as a transition from inpatient. A primary goal is to Primary goal- stabilize mental healthMH  behaviors with psychotropic medication.
 
 
 
3.1.131. Community Residential Rehabilitation (CRR)
 
CRR host homes are less restrictive than Residential Treatment Facilities (RTFs). CRRs are treatment homes with trained and supported caregivers. Host homes are single family residences.  The program relies upon community schools for educational services. This program offers at least one hour a week of therapy (this varies among providers).
 
 
 
 
 
3.1.142. Residential Treatment Facility (RTF)
 
Residential Treatment Facility (RTF) services are provided on a 24 hour/seven day a week in a non-hospital psychiatric care setting.  Comprehensive treatment is provided with educational services on-site or in collaboration with Local Education Authority (LEA).  RTFs typically provides a minimum of one hour of individual and group therapy per week.  Where ever possible, families are involved in the treatment process.
 
One of the primary goals of the RTF is to prepare the individual for return to the home and/or community.  Discharge planning, involving the family and including the identification of, and access to, community supports is an integral part of the process.
 
Family component and planning for discharge to home/community.
 
 
 
3.1.163. Inpatient Psychiatric Care
 
Inpatient psychiatric care provides 24-hour hospital care in a community psychiatric inpatient facility or a unit within a larger medical facility.  Care is short-term and stabilizes the youth’s acute mental health crisis.  The facility will provide diagnostic and evaluative information upon discharge and recommend follow-up treatment and supports. 

[1] Grisso, T. (2005).  Why we need mental health screening and assessment in juvenile justice programs.  In T. Grisso, G. Vincent, D. Seagraves (eds.), Mental health screening and assessment in juvenile justice (pp.3-21). New York: Guilford Press.
[2] Grisso, T. & Underwood, L.A. (2004)  Screening and Assessing Mental Health and Substance Use Disorders Among Youth and in the Juvenile Justice System:  A Resource Guide for Practitioners. US Department of Justice, Office of Justice Programs, office of Juvenile Justice and Delinquency Prevention, pg. 2. 
 
[3] Vincent, G. (2012).  Juvenile Justice Resource Series. Screening and Assessment in the Juvenile Justice Systems:  Identifying Mental Health Needs and Risk of Offending. Technical Assistance Partnership for Child and Family Mental Health, Substance Abuse and Mental Health Services Administration: U.S. Department of Health and Human Services.  pgs. 4-5. 
[4] Grisso, T. & Underwood, L.A. (2004)  Screening and Assessing Mental Health and Substance Use Disorders Among Youth and in the Juvenile Justice System:  A Resource Guide for Practitioners. US Department of Justice, Office of Justice Programs, office of Juvenile Justice and Delinquency Prevention. pgs. 2-3
[5] Vincent, G. (2012).  Juvenile Justice Resource Series. Screening and Assessment in the Juvenile Justice Systems:  Identifying Mental Health Needs and Risk of Offending. Technical Assistance Partnership for Child and Family Mental Health, Substance Abuse and Mental Health Services Administration: U.S. Department of Health and Human Services.  pgs. 5-6. 
[6] Ibid, pgs. 6-7.
[7] Pennsylvania’s Juvenile Justice System Enhancement Strategy: Achieving Our Balanced and Restorative Justice Mission Through Evidence-based Practice (April 2012). pg. 8.
[8] Family Involvement in Pennsylvania’s Juvenile Justice System, Prepared for Models for Change-Pennsylvania, Mental Health Association in Pennsylvania, Pennsylvania Council of Chief Juvenile Probation Officers-Balanced and Restorative Justice Implementation Committee’s Family Involvement Workgroup, John D. and Catherine T. MacArthur Foundation, 2009, p. 16.
[9] See: http://blueprintsprograms.com/
[10] Excerpted from Penn State EPISCenter website at: http://www.episcenter.psu.edu/sites/default/files/resources/EBP%20Guide%20-%20Section%20Seven%20MST%209-2012.pdf
[11] See: http://blueprintsprograms.com/
[12] Excerpted from Penn State EPISCenter website at: http://episcenter.psu.edu/sites/default/files/ebp/FFT%20FAQs%204-2013.pdf
 
 [BMB1]Use Megan’s defintions and citations
 [BMB2]same as Psychological section
 [BMB3]remove
 [BMB4]Scott will send dialectical piece
 [BMB5]Remove and ad “contact your local county office for what is available.”
 [BMB6]Home or community /any place other than the office
 [BMB7]Add community, school, etc.
 [BMB8]Add a t a minimum of weekly contact
 [BMB9]Use document Bernadette provided.
 [BMB10]Add intro re: EBP and more widely known and two that are funded under MA.  MST & FFT designed for at-risk/delinquent populations and are Blueprint Program. Check with local office.
 [BMB11]Outdated
 [BMB12]This should be its  own service section !   Walk-in, mobile and phone  Contact your county for what is available.