Mental Health Services
Children’s Behavioral Health Initiative/Intensive Care Coordination Services
Children’s Behavioral Health Initiative (CBHI) are various services that can be accessed for children and their parents but they must have MassHealth Insurance. We can call the agencies and make these referrals for the families. The service providers are able to meet with clients who are in DYS.
- Intensive Care Coordinator (ICC): The assigned ICC provides comprehensive wrap-around services by referring and coordinating all of the appropriate service and mental health needs for the family. The ICC is required to meet with the family once a week and may increase support if therapeutically necessary. The ICC ensures the implementation and monitoring of a single integrated treatment plan that is developed with child and family centered philosophies. The family is instrumental in developing the necessary tasks and services to achieve the desired goals. The ICC has an on-call component that provides 24 hour telephonic support to the family in the event of a crisis. The service is funded through MassHealth and will authorize continuation for services if there is therapeutic need. The service averages 12-24 months in length. The referral for ICC or CSA is made depending on where the client resides. Many of the agencies have a referral form.
- In-Home Therapy: The function of the In-Home Therapy Team is to provide clinical family therapy in an effort to increase positive communication and improve the overall family functioning. The team will meet with the family weekly with the option of additional sessions if required. We can make these referrals on our own. There are several agencies that offer this service. Just call the agencies to see if there is a waitlist. Some of the agencies have a referral form.
- Family Partner: The ICC can make a referral for the parent or guardian to receive a Family Partner that will provide the parent with support and coaching to navigate the intricacies of caretaking for a child with mental health needs. The Family Partner has experience with raising a child with severe emotional and behavioral needs. The Family Partner will meet with the parent weekly. The referral for the family partner is made through the ICC. There has to be an ICC in place for a family partner.
- Individual Therapist: An individual therapist will develop an individualized treatment plan to address social, emotional, behavioral, and educational functioning. Most clients will engage in individual therapy on a weekly basis. This service does not require MassHealth but some of the agencies will not accept private insurance. Contact the Behavioral Health Member Customer Service to determine what therapists are available for clients with private insurance.
- Therapeutic Mentor: The mentor will provide the child with a structured one-on-one relationship to improve overall functioning in the home, school, and community. The mentor will assist the client with developing vocational skills and identifying positive activities and supports in the community. A therapeutic mentor is not a stand-alone service and must be connected to another service such as ICC, IHT, or individual therapy. If the client is interested in a mentor and does not have any other services then a referral will need to be made for one of these other services. That service provider will then make the referral for a mentor so all you have to do is let the service provider know to make the referral.
- Psychiatrist: Most the individual therapists have a psychiatrist or medication prescriber at their agencies. The therapist will generally make the referral for a medication evaluation. Just let the therapist know to make the referral if this is something the child and parent wants. They generally meet with the psychiatrist once a month.
- Emergency Service Provider/Mobile Crisis: The mobile crisis team is available for clients with MassHealth who are experiencing a psychiatric or mental health emergency. The service is available 24 hours a day 7 days and week and can respond to the home, school, or other places in the community. There is also a walk-in clinic available. A clinician will respond to evaluate the child and determine what level of care is appropriate i.e. inpatient, CBAT, partial hospitalization, or outpatient resources. The mobile crisis team is determined by hometown.
- Community Support Program (CSP): The Community Support Program assists clients of all ages who are considered to be at risk within the community. This is a service that is generally appropriate for our clients that are in the 18+ range and it not appropriate for a CSA referral. The program provides a longer-term case management service that encompasses the client’s entire health profile, in order to reduce the number of hospitalizations and the length of time needed for stabilization. Program interventions include assisting the client in maintaining regular visits with his or her primary care physician, psychiatrist and/or other treatment providers. Typical clients are those who have difficulty staying in outpatient treatment and/or maintaining medication compliance. These clients are often overwhelmed by difficulties getting to treatment and their situations may worsen as a result.
The program typically targets the following populations:
- Individuals of any age who have been hospitalized multiple times.
- Individuals dually diagnosed with a major mental illness and substance abuse.
- Pregnant women who are actively abusing substances.
- Individuals newly diagnosed with an Axis 1 psychotic disorder.
- Patients who have been noncompliant with their primary care physician’s plan.
Mental Health Levels of Care
There are various levels of mental health care for adolescents in Massachusetts. The level of care basically means how restrictive a setting is that the adolescent is receiving treatment.
- Inpatient Level of Care: Inpatient level of care is the most restrictive setting at which a client can be hospitalized. It is a locked facility and generally requires a Section 12 for the client to be admitted. It has to be approved through insurance and either a mobile crisis clinician or a clinician at a hospital must provide the authorization.
- Community Based Acute Treatment (CBAT): is provided to children/adolescents who
require a 24-hour-a-day, seven-day-a-week, staff-secure (unlocked) group setting. For
children and adolescents with serious behavioral health disorders, CBAT provides therapeutic intervention and specialized programming in a controlled environment with a high degree of supervision and structure. CBAT services are provided in the context of a comprehensive, multidisciplinary, and individualized treatment plan that is frequently reviewed and updated based on the member’s clinical status and response to treatment. Intensive therapeutic services include, but are not limited to, daily medication monitoring; psychiatric assessment; nursing availability; Specializing (as needed); individual, group and family therapy; case management; family assessment and consultation; discharge planning; and psychological testing as needed. Active family/caregiver involvement through family therapy, a key element of treatment, is expected. Discharge planning should begin at admission, including plans for reintegration into the home, school, and community. If discharge to home/family is not an option, alternative placement must be rapidly identified with regular documentation of active efforts to secure such placement. CBAT may be used as an alternative to, or transition from, inpatient services.
- Partial Hospitalization: The Partial Hospitalization Program (PHP) serves adolescents ages 13 through 18. Patients are referred directly to the program as an alternative to inpatient hospitalization, or as a transition from inpatient programs. The program is completely voluntary, and as such, fosters an environment of trust, caring and support with an eye to permanent, long- term change. The program views problems systematically, and involves both the patient and his or her family in the therapeutic process whenever appropriate. The PHP staff is sensitive and responsive to the individual needs of each patient, and provide a comprehensive spectrum of services.
- Full day of programming, from 9:30 AM to 3:00 PM.
- Comprehensive program of psychotherapy groups, covering topics such as illness education, addiction education, medication education, relapse prevention/weekend planning, de-escalation and anger management, conflict resolution, communication
skills, self-esteem development, coping skills, and family and peer relationships.
- 766-approved tutoring, provided by the program.
- Aftercare case management services and discharge planning to obtain appropriate community services to help patients foster and maintain a healthy mental status after discharge.
- A complete, nutritional hot/cold lunch is served. Light snacks and drinks are available through the day.
Substance Abuse Services
IHR and Residential Programs 617-661-3991 x116
Substance abuse services for adolescents are primarily administered by the Institute for Health and Recovery (IHR). IHR is a statewide service, research, policy, and program development agency. IHR designs its services based on an understanding of the impact of trauma. IHR’s mission is to develop a comprehensive continuum of care for individuals, youth, and families affected by alcohol, tobacco, and other drug use, mental health problems, violence/trauma, and HIV/AIDS.
Youth Central Intake Care Coordination (CICC) staff facilitates access to the range of publicly funded services offered by the Bureau of Substance Abuse Services (BSAS) for Massachusetts youth with substance use issues. Through a process of screening, assessment and referral families can establish and access appropriate care for their adolescents and receive support throughout the process. If the outpatient provider recommends comprehensive residential substance abuse treatment services, Central Intake Care Coordination staff coordinates admission to one of five treatment programs. The average length of stay in the program is 90 days. These residential programs are provided through The Department of Public Health and do not require insurance and do not cost the clients any money. Central Intake Care Coordination staff can offer assistance to families with the BSAS uniform pre-admission paperwork and help explain to youth what to expect in the treatment program. In the event that a bed is not immediately available, Central Intake Care Coordination is a resource and support to families. Through regular telephone check-ins Central Intake Care Coordination staff can offer resources for the brief period of time a youth is waiting for services. If it is appropriate to refer the candidate to an alternative program, CICC staff will offer referrals.
http://hria.force.com/ (do you want to say more about this?)
There are two detox facilities for adolescent clients who require short-term services.The detox programs can also make referrals for the residential programs:
The Castle Program: Brockton, MA 508-638-6000
Motivating Youth Recovery: Worcester, MA 508-860-1244
Recovery High Schools
There are currently five Recovery High Schools around the state (Boston, Brockton, Worcester, Beverly, and Springfield).
State Agency Resources
Department of Mental Health
The Department of Mental Health (DMH) is the state agency that provides services for clients with pervasive mental health disorders. DMH has five days from the receipt of the application to make contact with the family. If the client is hospitalized then DMH has five days to render a service authorization determination. For all other clients DMH has 20 days from receiving the application to make a decision of the applicant meets clinical criteria for DMH services, then DMH will determine within 20 days from the clinical determination if the client needs DMH services. All decisions must be made 90 days after the receipt of the completed application. If the family has a CSA, in-home therapist, or other provider they should also be able to assist the family with completing a DMH application. If the client is accepted for DMH services they will be assigned a case manager who is responsible for administering the services. There are several home-based services with the focus on maintaining the client in the home. There are also DMH respite and residential placements. DMH services are all voluntary and depend on family engagement.
Department of Developmental Services
The Department of Development Services (DDS) is the state agency that provides services for clients with significant intellectual deficits. The client must have a full scale IQ less than 70 to qualify for services. This IQ must be documented in an evaluation. DDS provides very few services for children. Potential clients are screened for eligibility after submitting an application. Even if a client is found eligible for services they will only be assigned a case manager if the client is not currently enrolled in school. If the client is enrolled in school they may be found eligible but DDS will determine there is no clinical need because the school is the agency that is responsible for service implementation for clients. Getting a DDS designation is helpful for clients who will require DDS services as an adult. If a client is not enrolled in school they will receive a case manager who will be responsible for the implementation of services.
Massachusetts Rehabilitation Commission
Mass Rehab provides vocational training support and services for clients with disabilities. This is a referral that is appropriate for clients who are 16+. Vocational Rehabilitation Program assists individuals with disabilities to obtain and maintain employment. The Vocational Rehabilitation Program helps individuals with physical, psychiatric and/or learning disabilities face the challenges of the modern workplace. This may include identifying job goals based on individual interests and aptitudes, providing funds for college and vocational training, assessing worksite accommodations, educating an employer about the Americans with Disabilities Act, or assisting an individual returning to work after adjusting to a new disabling condition. Vocational rehabilitation services can often reduce or remove barriers to employment. Priority is given to those individuals who have the most severe disabilities in areas such as communication, mobility, work tolerance and work skills. To be eligible for VR services from a State VR agency, a person must have a physical or mental impairment that is a substantial impediment to employment; be able to benefit from VR services in terms of employment; and require VR services to prepare for, enter, engage in, or retain employment. To help the population of unemployed persons with disabilities join the workforce, State VR agencies must provide comprehensive rehabilitation services that go way beyond those found in routine job training programs. This frequently includes work evaluation and adjustment services; assessment for and provision of assistive technology, such as customized computer interfaces for persons with physical or sensory disabilities; job counseling services, and medical and therapeutic services. The client must be present in person or on the telephone to make the referral. Any individual with a disability can inquire about obtaining services. Friends, relatives, and health care providers can also refer an individual to Mass Rehab. The services are designed to assist individuals with disabilities to make informed choices about work.
Department of Transitional Assistance
The Department of Transitional Assistance DTA is the agency that administers food stamps (Supplemental Nutrition Assistance Program/SNAP), cash assistance, and emergency shelters placement for low income families and individuals.
SNAP benefits are provided by the federal government and administered by DTA. Residents of the Commonwealth who participate in SNAP are families with children, elders and disabled. Many are the working poor with limited income or those who are temporarily unemployed. At the check-out counter, the Electronic Benefit Transfer (EBT) card, which works like a debit card, is used by many more residents to assist them in making ends meet. A client can apply for SNAP benefits online, in-person, or by mail. Here is the website for more information on applying and the online application:
Transitional Aid to Families with Dependent Children (TAFDC) cash assistance
Transitional Aid to Families with Dependent Children (TAFDC) is a state and federally funded program which provides cash assistance to families with children and pregnant women in the last 120 days of pregnancy, with little or no assets or income. It is operated under the federal Temporary Assistance for Needy Families (TANF) block grant and is described in the Commonwealth’s TANF State Plan. Participants receive child care and transportation support associated with job assistance and can access a number of supportive referrals to substance abuse and mental health services, and domestic violence specialists.
As part of TAFDC, participants may be required to perform a work-related activity in order to receive benefits. DTA provides job assistance to TAFDC participants including job training, job search, and placements into jobs. Other key services include Access to Basic Education, English for Employment, Graduate Equivalency Diploma (GED) assistance, work readiness and skills training. It is especially important for clients to gain employment during their time on TAFDC as recipients are limited to 24 months of assistance in any continuous 60-month period. DTA offers many job assistance programs to provide clients with access to employment and training.
To be eligible for TAFDC, a recipient must meet certain requirements including:
• Have at least one dependent child under 18 or 19 (including teen parents) -OR- be a pregnant women with no children (the child is expected to be born within 120 d days of the application)
• Meet income and asset limits
• Be a U.S. citizen or a legal immigrant
• Live in Massachusetts
To apply for public assistance go to the Transitional Assistance Office that covers your city or town (location lookup). There you will meet with a Transitional Assistance Worker who will start the process. For more help applying for public assistance, call the Application Information Unit at 1-800-249-2007.
MassHealth is the medicaid insurance for low income children and families. Most of our clients already have MassHealth. Sometimes our clients do not have insurance or their MassHealth has lapsed. I will generally assist the families with applying for MassHealth if they don’t have insurance or with contacting MassHealth if it was recently turned off. If it has lapsed it is generally because some paperwork was not filled out. This is generally easily resolved by contact MassHealth with the parent.
MassHealth Enrollment Center: 1-888-665-9993
MassHealth Customer Service Center: 1-800-841-2900
211 and Family Resource Centers
There are a few general places that families can go to find resources/assistance. They include calling 211 or visiting the website. There are also now family resource centers around the state that families can walk in for assistance and referrals to services. While the FRCs have a contract with DCF, families do not need to be DCF involved nor do they have to go to the FRC closest to them.
The Massachusetts Alliance for Teen Pregnancy advocates for responsible public policies, build capacity and resources available for young parents and their families and strives to education young people and the organizations serving them to understand and control their own sexual health. They are a valuable resource for young families.
Child Trauma Training Center 1-855-LINK-KID
Domestic Violence Resources
There are several agencies that provide support, counseling, and housing for victims of domestic violence. Most of the domestic violence resources are free. These resources are available for our clients who are either witnesses to domestic violence or victims. It is also a helpful resource for parents of our clients.
Casa Myrna/Safelink [(877) 785-2020] is the hub for all most domestic violence resources in the state of Massachusetts. The hotline number is available 24 hours a day 7 days a week. The hotline counselors can assist with a client who is having an emergency, needs referrals for services, or is in an unsafe living situation. Casa Myrna is the agency that provides shelter placement for adults and families who are in an unsafe living situation. This is a very helpful resource for domestic violence.