OMH-29-07-00012-E Child and Family Clinic Plus Program
7/18/07 N.Y. St. Reg. OMH-29-07-00012-E
NEW YORK STATE REGISTER
VOLUME XXIX, ISSUE 29
July 18, 2007
RULE MAKING ACTIVITIES
OFFICE OF MENTAL HEALTH
EMERGENCY RULE MAKING
I.D No. OMH-29-07-00012-E
Filing No. 657
Filing Date. Jun. 29, 2007
Effective Date. Jun. 29, 2007
Child and Family Clinic Plus Program
PURSUANT TO THE PROVISIONS OF THE State Administrative Procedure Act, NOTICE is hereby given of the following action:
Action taken:
Amendment of Part 587 of Title 14 NYCRR.
Statutory authority:
Mental Hygiene Law, section 7.09(b) and 31.04(a)
Finding of necessity for emergency rule:
Preservation of public health, public safety and general welfare.
Specific reasons underlying the finding of necessity:
These amendments provide authority to establish Child and Family Clinic Plus, a program authorized by the 2006–2007 enacted budget. Failure to initiate this program immediately would result in children and their families being without services necessary to their health, safety and general welfare.
Subject:
Child and Family Clinic Plus.
Purpose:
To establish the Child and Family Clinic Plus Program.
Text of emergency rule:
Subdivision (b) of Section 587.4 is amended to add a new definition (1) and existing definitions (1) through (5) are renumbered (2) through (6) to read as follows:
587.4 (b) Program definitions.
(1) Child and Family Clinic Plus provider means a licensed clinic that has been approved by the Office of Mental Health to provide Child and Family Clinic Plus services.
(2) Off-site locations, for purposes of providing outpatient services and reimbursement, [are] means any sites in the community where a recipient may require services.
[(2)] (3) Program capacity shall mean the number of recipients who can be on site at a given time.
[(3)] (4) Program space means discrete space dedicated to the purpose of the outpatient program and includes all space used by recipients enrolled in the program.
[(4)] (5) Provider of service means the entity which is responsible for the operation of a program. Such entity may be an individual, partnership, association or corporation. For purposes of this Part, unless otherwise noted, the term also applies to a psychiatric center or institute operated by the Office of Mental Health.
[(5)] (6) Satellite location of a primary program means a physically separate adjunct site to a certified clinic treatment program, continuing day treatment program, day treatment program serving children or intensive psychiatric rehabilitation treatment program provides either a full or partial array of outpatient services on a regularly and routinely scheduled basis (full or part time).
Subdivision (c) of Section 587.4 is amended to add new definitions (5), (7), (10), (13) and (16), and to renumber existing definitions (5) as (6), (6) as (8), (7) as (9), (8) as (11), (9) as (12), (10) as (14), (11) as (15) and (12) through (29) as (17) through (34) respectively, to read as follows:
587.4 (c) Service definitions.
(1) Activity therapy means therapy designed to assist a recipient in developing the functional skills and social and environmental supports needed to function more successfully in current or intended life environments (i.e., living, learning, working and social). Such therapy should provide an opportunity for a recipient to practice the skills and build or sustain the supports needed to improve functioning.
(2) Assessment is the continuous clinical process of identifying an individual's behavioral strengths and weaknesses, problems and service needs, through the observation and evaluation of the individual's current mental, physical and behavioral condition and history. The assessment shall be the basis for establishing a diagnosis, treatment plan or psychiatric rehabilitation service plan.
(3) Case management services are the process of linking the individual to the service system and monitoring the provision of services with the objective of continuity of care and service. Case management includes the following components:
(i) Linking. The process of referring the individual to all required services and supports as specified in the individual service plan.
(ii) Case-specific advocacy. The process of interceding on behalf of the individual to gain access to needed services and supports.
(iii) Monitoring. The process of observing the individual to assure that needed services and supports are received.
(4) Carved-out services are those specialized services that are not included in the benefit package of a managed care provider, other than a duly authorized managed special care provider, for all current and future managed care enrollees, regardless of aid category. Such services are long term services for individuals with chronic illnesses and include the following:
(v) Comprehensive Medicaid Case Management (CMCM);
(vi) Rehabilitation services provided to a resident of OMH rehabilitation treatment services and family based treatment programs;
(vii) Services provided to children with serious emotional disturbances in designated clinics.
(5) Child and Family Plus Services are Mental Health Screening, Comprehensive Assessment, In-Home Services and Evidence-Based Treatment.
(6) Clinical support services are services provided to collaterals, by at least one therapist, with or without recipients for the purpose of providing resources and consultation for goal oriented problem solving, assessment of treatment strategies and provision of skill development to assisting the recipient in management of his or her illness.
(7) Comprehensive Assessment is an assessment that follows the American Academy of Child and Adolescent Psychiatry practice parameters for comprehensive assessment and includes the regular and methodical use of psychometric tools. This will include collecting the recipient's mental health history, and any current signs and symptoms of mental illness or emotional disturbance, identification of child and family strengths, and the assessment of the data to determine the recipient's mental health status and need for treatment.
[(6)](8) Crisis intervention services are activities and interventions, including medication and verbal therapy, designed to address acute distress and associated behaviors when the individual's condition requires immediate attention.
[(7)] (9) Discharge planning is the process of planning for termination from a program or identifying the resources and supports needed for transition of an individual to another program and making the necessary referrals, including linkages for treatment, rehabilitation and supportive services based on assessment of the recipient's current mental status, strengths, weaknesses, problems, service needs, the demands of the recipient's living, working and social environment, and the client's own goals, needs and desires.
(10) Evidence-Based Treatment is the application of therapeutic and or psychopharmacological approaches that have been scientifically proven to be effective in the treatment of specific emotional disturbances.
[(8)] (11) Family treatment means therapeutic interventions designed to treat the recipient's psychiatric condition (whether the recipient is an adult or a minor) to address family issues that have a direct impact on the symptoms experienced by the recipient, and to promote successful problem solving, communication, and understanding between a recipient and family members as it relates to the recipient's symptoms, treatment, and recovery.
[(9)](12) Health screening service is the gathering of data concerning the recipient's medical history and any current signs and symptoms, and the assessment of the data to determine his or her physical health status and need for referral for noted problems. The data may be provided by the recipient or obtained with his or her participation. The assessment of the data shall be done by a nurse practitioner, physician, physician's assistant, psychiatrist or registered professional nurse. The assessment of physical health status shall be integrated into the patient's treatment plan.
(13) In-Home Services are clinic services of a minimum duration of 30 minutes provided by a qualified mental health professional to a child and/or his or her family, pursuant to his or her treatment plan, within the child's or family's living environment.
[(10)] (14) Medication therapy means prescribing and/or administering medication, reviewing the appropriateness of the recipient's existing medication regimen through review of records and consultation with the recipient and/or family or caregiver, and monitoring the effects of medication on the recipient's mental and physical health.
[(11)] (15) Medication education means providing recipients with information concerning the effects, benefits, risks and possible side effects of a proposed course of medication.
(16) Mental Health Screening is a broad-based approach to identify children and adolescents with emotional disturbances and intervene at the earliest possible opportunity.
[(12)] (17) Pre-admission screening is the initial face-to-face process of contacting, interviewing and evaluating a potential recipient of mental health services to determine the individual's need for services.
[(13)](18) Psychiatric rehabilitation goal setting is the process by which a recipient selects a specific environment in which he or she intends to live, work, learn, and/or socialize. The psychiatric rehabilitation goal identifies a specific environment, specific time frames, and is mutually agreed upon by the recipient and the staff.
[(14)] (19) Psychiatric rehabilitation treatment means therapeutic interventions designed to increase the functioning of a person with psychiatric disabilities so that he or she can succeed in a community environment of living, working, learning and social relationships.
[(15)] (20) Psychiatric rehabilitation functional and resource assessment is the process by which the recipient and practitioner develop an understanding of the skills the recipient can and cannot perform and the social and environmental resources that are available related to achieving the recipient's psychiatric rehabilitation goals.
[(16)] (21) Psychiatric rehabilitation readiness determination means an interview and observation process which evaluates rehabilitation readiness based on a recipient's perceived need, motivation, and awareness of the process involved in making a change in his or her life.
[(17)] (22) Psychiatric rehabilitation service planning is the process of designing and continuously revising an individualized program to assist the patient in obtaining and maintaining a psychiatric rehabilitation goal.
[(18)] (23) Psychiatric rehabilitation skills and resource development is the process of improving a recipient's use of skills and arranging for or adapting social and environmental resources necessary to achieve a psychiatric rehabilitation goal.
[(19)] (24) Psychiatric rehabilitation support services are consultation and technical assistance services provided to collaterals, by at least one therapist, with or without recipients. The purpose of this service is to enhance the capacity of the collateral to serve as a resource in assisting the recipient to achieve or maintain his or her psychiatric rehabilitation goal.
[20)] (25) Referral means a post-assessment planning activity with the objective of referring or directing an individual to a program providing the appropriate services.
[(21)] (26) Rehabilitation readiness development is the process of building a recipient's skills to proceed with the rehabilitation goal setting process. This service might include confidence building activities, self-awareness activities, or trial visits to various environments.
[(22)] (27) Social training is an activity whose purpose is to assist a child in the acquisition or development of age-appropriate social and inter-personal skills.
[(23)] (28) Socialization is an activity whose purpose is to develop, improve or maintain a child's capacity for social or recreational involvement by providing age-appropriate opportunities for development, application and practice of social or recreational skills.
[(24)] (29) Supportive skills training is the development of physical, emotional and intellectual skills needed to cope with mental illness and the performance demands of personal care and community living activities. Such training is provided through direct instruction techniques including explanation, modeling, role playing and social re-enforcement interventions.
[(25)] (30) Symptom management, as a service for adults, means the development and provision of appropriate skills and techniques specific to the individual recipient's condition to enable him or her to recognize the onset of psychiatric symptoms and engage in activities designed to prevent, manage, or reduce such symptoms.
[(26)] (31) Symptom management, as a service for children, means a set of skill building interventions, adjunct to verbal therapy.
[(27)] (32) Task and skill training is a nonvocational activity whose purpose is to enhance a child's age-appropriate skills necessary for functioning in home, school and community settings. Task and skill training activities shall include, but not be limited to, personal care, budgeting, shopping, transportation, use of community resources, time management, and study skills.
[(28)] (33) Treatment planning is the process of developing, evaluating and revising an individualized course of treatment based on an assessment of the recipient's diagnosis, behavioral strengths and weaknesses, problems, and service needs.
[(29)] (34) Verbal therapy means providing goal oriented therapy including psychotherapy, behavior therapy, family and group therapy and other face-to-face contacts between staff and recipients designed to address the specific dysfunction of the recipient as identified in his or her treatment plan. As a service in a program serving children with a diagnosis of emotional disturbance, play therapy and expressive art therapy may also be included.
Section 587.9 is amended to add a new paragraph (f), and existing paragraphs (f) through (k) are renumbered (g) through (l), to read as follows:
(f) A clinic treatment program that has been approved to be a Children and Family Clinic Plus provider shall also provide the following services:
(1) Mental Health Screening. Such services shall be provided in a community setting, and shall be provided with the prior written consent of the child's parent or legal guardian.
(2) Comprehensive Assessment. A comprehensive assessment can be performed over the course of not more than three(3) visits per client, and is intended to determine the presence and nature of any emotional disturbance and to develop a treatment plan where appropriate.
(3) In-Home Services.
(4) Evidence-Based Treatment.
This notice is intended
to serve only as a notice of emergency adoption. This agency intends to adopt this emergency rule as a permanent rule and will publish a notice of proposed rule making in the State Register at some future date. The emergency rule will expire September 26, 2007.
Text of emergency rule and any required statements and analyses may be obtained from:
Joyce Donohue, Bureau of Policy, Regulation and Legislation, Office of Mental Health, 44 Holland Ave., 8th Fl., Albany, NY 12229, (518) 474-1331, e-mail: cocbjdd@omh.state.ny.us
Regulatory Impact Statement
1. Statutory Authority: Subdivision (b) of Section 7.09 of the Mental Hygiene Law grants the Commissioner of the Office of Mental Health the authority and responsibility to adopt regulations that are necessary and proper to implement matters under his or her jurisdiction.
Subdivision (a) of Section 31.04 of the Mental Hygiene Law empowers the Commissioner to issue regulations setting standards for licensed programs for the provision of services for persons with mental illness.
Chapter 54 of the Laws of 2006 provides funding appropriations in support of the Child and Family Clinic Plus Program.
2. Legislative Objectives: Articles 7 and 31 of the Mental Hygiene Law reflect the Commissioner's authority to establish regulations regarding mental health programs.
3. Needs and Benefits: Clinic treatment has been the foundation of the public mental health system for over thirty years. Each year, nearly 100,000 children and families are served in clinic treatment. This presents New York with a unique opportunity to demonstrate the impact that a transformation in State policy, financing and regulation, can make. The structure and financing of the clinic treatment program have remained constant and have not kept pace with findings generated by decades of scientific study in the recognition, diagnosis and treatment of childhood mental illness.
Currently, clinic services are very structured, designed to be delivered within an office-based setting, and require children and families to self-identify. To effectively address the mental health needs of children and their families in a timely manner, services need to be readily available and provided in a larger variety of settings, like the home. In order to achieve this shift in service provision, OMH recognizes the need for changes to be made to current clinic service structure and funding to improve access to effective and flexible services. Building on the knowledge that early and effective intervention increases the likelihood of positive outcomes; the OMH also recognizes the need to systematically identify childhood mental illness early through screening activities and to improve services by incorporating evidenced-based practices. Additionally, the President's New Freedom Commission's goal to address disparities in mental health services must be considered. These disparities are readily seen through the lenses of culture, race, age and gender. The opportunity to reduce these disparities in the children's mental health system is within our grasp. When taken together, these actions are expected to result in the transformation of the children's mental health system into one that more effectively addresses the needs of the children and families of New York State.
By this rulemaking, and as funded and authorized by the 2006–07 enacted State Budget, OMH is seeking to transform local mental health clinics from a passive program waiting for clients to present, to an active program that will intervene earlier in a child's developmental trajectory. Through Child and Family Clinic-Plus, the children's mental health system will adopt a public health approach to the early recognition and treatment of health concerns. With this new approach, children will be screened for emotional disturbance in their natural environment each year. Children in need of treatment will have access to a comprehensive assessment that utilizes the practice parameters from the American Academy of Child and Adolescent Psychiatry as well as evidence- based tools and scales. Children and families requiring treatment will find that Clinic-Plus brings improved access, in-home services, and treatments that have been shown through science to work. The initiative calls for the expansion of clinic services, creating greater access for children and their families receiving clinic treatment and in-home treatment services.
Each Child and Family Clinic-Plus provider will collaborate with its respective County or the City of New York to conduct systematic early recognition activities for the identified priority populations; demonstrate skill in engaging families in treatment; offer a range of evidence-based treatments that are individually determined and family focused; and will provide a constellation of support services in the home and community that lead to skill mastery for the child and family. Each Clinic-Plus will be licensed by the OMH as an outpatient clinic and will receive Medicaid and State Aid enhancements.
The primary components of Child and Family Clinic-Plus include:
Broad-based screening in natural environments
Comprehensive assessment
Expanded clinic capacity
In-home services
Evidence Based Treatment
Numerous research studies document the lack of adequate identification and treatment for children with serious emotional disturbance. In what was perhaps the largest epidemiological study of its kind, Kessler et al shows that the age of onset for serious mental illness in adulthood occurs in early adolescence, yet identification and treatment are often delayed for years. The age of onset is much earlier than once thought and has profound implications for children's mental health. There is a long and rich scientific history substantiating the fact that there is a developmental progression to behavioral/emotional problems among young children. Emotional or behavioral problems unrecognized in childhood can cascade into full blown psychiatric disorders with serious debilitating consequences in adolescence or adulthood. Furthermore, there is a strong gradient of risk, such that problems left unrecognized and untreated can become far more severe and intractable illnesses in adulthood. In fact, the continuity of young children's behavioral or emotional disorders into later problems in adolescence or adulthood is among the strongest and most unequivocal of scientific findings.
Decades of research, support the following:
(1) mental health problems can be recognized as early as preschool;
(2) risk factors for development of mental health problems can be identified in childhood and many are modifiable;
(3) failure to identify and to intervene can have life-long and often devastating effects;
(4) scientifically-validated tools for early recognition exist; and
(5) a range of effective intervention service programs exist and they have a strong scientific base.
4. Costs:
(a) Costs to private regulated parties: There will be no mandated unreimbursed costs to the regulated parties.
(b) Costs to state and local government: The annual state cost for the program is estimated to be $21,500,000.00. There is no local Medicaid share or other costs for this program.
(c) The cost projection was calculated as follows:
Screening for approximately 235,000 children
$ 1,881,000
New clinic admissions for approximately 23,500*
11,679,000
In-home services (17,500)
7,940,000
Total
$ 21,500,000
* Includes comprehensive assessments and clinic expansion
5. Local Government Mandates: These regulatory amendments will not involve or result in any additional imposition of duties or responsibilities upon county, city, town, village, school or fire districts.
6. Paperwork: This rule should not substantially increase the paperwork requirements of affected providers.
7. Duplication: These regulatory amendments to not duplicate existing State or federal requirements.
8. Alternatives:
A. Alternatives to providing authorization for Child and Family Clinic Plus.
The only alternative would be inaction. As this program, Child and Family Clinic Plus, has been established and funded in statute, this alternative was considered as contrary to the intent of the legislation.
9. Federal Standards: The regulatory amendments do not exceed any minimum standards of the federal government for the same or similar subject areas.
10. Compliance Schedule: The authority to establish and fund the Child and Family Clinic Plus program is effective on the filing date of this rulemaking.
Regulatory Flexibility Analysis
A Regulatory Flexibility Analysis for Small Businesses and Local Governments is not being submitted with this notice because the amended rule will not impose a significant negative economic impact on small businesses, or local governments. The clinic expansion associated with Child and Family Clinic Plus contains no local government share of Medicaid. The establishment of the Child and Family Clinic Plus Program is required by the enacted 2006–2007 state budget.
Rural Area Flexibility Analysis
A Rural Area Flexibility Analysis is not being submitted with this notice because the amended rules will have no negative impact on services and programs serving residents of rural counties. Child and Family Clinic Plus is an expansion of existing clinic services creating increased access for children and families statewide. Children and families in the 44 counties designated as rural counties by the New York State Legislature, as well as non-rural counties will benefit from the establishment of this new statewide program.
Job Impact Statement
This rulemaking establishes a new program: Child and Family Clinic Plus which will involve new employment opportunities for staff providing these services. It will not have any negative impact on jobs and employment activities.
