Therapeutic Day Treatment
Children and adolescents must demonstrate a clinical necessity for the service arising from a condition due to a mental, behavioral, or emotional illness that results in significant functional impairments in major life activities. A psychiatric diagnosis (DSM-IV, Axis I) is required. This determination of significant disability should be based upon consideration of the social functioning of most children who are the same age.
The disability must have become more disabling over time (within the past 30 days) and must require significant intervention through services that are supportive, intensive, and offered over a period of time in order to provide therapeutic intervention. Individuals must meet at least two of the following on a continuing or intermittent basis (within the past 6 months) and the support for this must be clearly documented in the medical record with child-specific examples:
1. Have difficulty in establishing or maintaining normal interpersonal relationships to such a degree that they are at risk of hospitalization or out-of-home placement (see definition below) because of conflicts with family or community.
2. Exhibit such inappropriate behavior that recent repeated interventions by the mental health, social services, educational system, or judicial system are necessary.
3. Exhibit difficulty in cognitive ability such that they are unable to recognize personal danger or recognize significantly inappropriate social behavior.
In addition to meeting two of the three criteria listed above, children and adolescents must meet one of the following that must be supported by child-specific documentation in the medical record:
1. Have deficits in social skills, peer relations, or dealing with authority; are hyperactive; have poor impulse control; or are experiencing a diagnosed behavioral issue. The deficits or problem behaviors must be documented in the medical record and must be to the level that they significantly impact the child's abilities to participate in activities of daily living compared to most children who are the same age.
2. Would otherwise be placed on homebound instruction because of severe emotional or behavioral problems, or both, that interfere with learning. The medical record must contain documentation from the school that supports this criterion.
3. Require year-round (9-12 months) treatment in order to sustain behavioral or emotional gains. The medical record must document the need for year-round treatment and any periods when service has been decreased and behavioral or emotional gains have been lost.
4. Behavioral and emotional problems are so severe they cannot be handled in self-contained or resource emotionally disturbed (ED) classrooms without this programming during the school day or as a supplement to the school day or school year. The medical record must document the type of classroom programming that is unable to meet the child's needs, and why the needs are not able to be met and how the problem behaviors are exhibited.
5. Children in preschool enrichment and early intervention programs when the child's emotional or behavioral problems, or both, are so severe that he/she cannot function in these programs without therapeutic day treatment services. The medical record must clearly document the severity of the problems and how they impact participation in the preschool or intervention programs.
If a child or adolescent has co-occurring mental health and substance abuse disorders, integrated treatment for both disorders is allowed as long as the treatment for the substance abuse condition is intended to positively impact the mental health condition. The impact of the substance abuse condition on the mental health condition must be documented in the treatment plan and the progress notes
The disability must have become more disabling over time (within the past 30 days) and must require significant intervention through services that are supportive, intensive, and offered over a period of time in order to provide therapeutic intervention. Individuals must meet at least two of the following on a continuing or intermittent basis (within the past 6 months) and the support for this must be clearly documented in the medical record with child-specific examples:
1. Have difficulty in establishing or maintaining normal interpersonal relationships to such a degree that they are at risk of hospitalization or out-of-home placement (see definition below) because of conflicts with family or community.
2. Exhibit such inappropriate behavior that recent repeated interventions by the mental health, social services, educational system, or judicial system are necessary.
3. Exhibit difficulty in cognitive ability such that they are unable to recognize personal danger or recognize significantly inappropriate social behavior.
In addition to meeting two of the three criteria listed above, children and adolescents must meet one of the following that must be supported by child-specific documentation in the medical record:
1. Have deficits in social skills, peer relations, or dealing with authority; are hyperactive; have poor impulse control; or are experiencing a diagnosed behavioral issue. The deficits or problem behaviors must be documented in the medical record and must be to the level that they significantly impact the child's abilities to participate in activities of daily living compared to most children who are the same age.
2. Would otherwise be placed on homebound instruction because of severe emotional or behavioral problems, or both, that interfere with learning. The medical record must contain documentation from the school that supports this criterion.
3. Require year-round (9-12 months) treatment in order to sustain behavioral or emotional gains. The medical record must document the need for year-round treatment and any periods when service has been decreased and behavioral or emotional gains have been lost.
4. Behavioral and emotional problems are so severe they cannot be handled in self-contained or resource emotionally disturbed (ED) classrooms without this programming during the school day or as a supplement to the school day or school year. The medical record must document the type of classroom programming that is unable to meet the child's needs, and why the needs are not able to be met and how the problem behaviors are exhibited.
5. Children in preschool enrichment and early intervention programs when the child's emotional or behavioral problems, or both, are so severe that he/she cannot function in these programs without therapeutic day treatment services. The medical record must clearly document the severity of the problems and how they impact participation in the preschool or intervention programs.
If a child or adolescent has co-occurring mental health and substance abuse disorders, integrated treatment for both disorders is allowed as long as the treatment for the substance abuse condition is intended to positively impact the mental health condition. The impact of the substance abuse condition on the mental health condition must be documented in the treatment plan and the progress notes