Oregon Health Authority
Health Systems Division: Behavioral Health Services - Chapter 309
Division 19
OUTPATIENT BEHAVIORAL HEALTH SERVICES
309-019-0167
Intensive In-Home Behavioral Health Treatment (IIBHT) for Children
(1) The Intensive In-Home Behavioral Health Treatment (IIBHT) for Children is a program that offers a combination of services and supports delivered in a community-based setting to a child, infant through 20 years of age and their family.
(2) IIBHT Providers shall have program staff that includes LMP, QMHP, QMHA, Peer Support Specialists available and sufficient to meet the individual needs of the child and their family.
(3) IIBHT Services shall include a minimum of the following types of services:
(a) Child Psychiatric Services provided by:
(A) A Board Eligible or Certified Child and Adolescent Psychiatrist or;
(B) A Psychiatric Mental Health Nurse Practitioner (PMHNP) under the weekly consultation of a Board Eligible or Certified Child and Adolescent Psychiatrist.
(b) Skills training;
(c) Individual therapy;
(d) Family therapy;
(e) In-home Proactive Support and Crisis Response available 24 hours each day;
(f) Case Management; and
(g) Peer Delivered Services, specifically Family Support Specialists and Youth Support Specialists.
(4) IIBHT Services shall include the provision and documentation of the following:
(a) No fewer than four hours of in-person planned program services shall be offered each week, as identified within the Assessment and Service Plan;
(b) IIBHT services shall be available to a child in their home, school, or other community environment, determined by the child and family and at times that are convenient to the child and family as agreed upon in the signed Service Plan;
(c) Children and their families may not be required to participate in other services or supports, including Wraparound, in order to receive IIBHT;
(d) Children are considered for IIBHT services without regard to race, ethnicity, gender, gender identity, gender presentation, sexual orientation, religion, creed, national origin, age, intellectual and/or developmental disability, IQ score, or physical disability;
(e) Children are eligible to receive IIBHT services in congregate care settings including Behavioral Rehabilitation Services or Developmental Disability group homes; and
(f) The IIBHT provider shall administer an Authority approved outcome measures tool:
(A) For each child enrolled in IIBHT services within 14 calendar days of entry;
(B) Within 14 calendar days prior to discharge from IIBHT services; and
(C) Results from the Authority approved outcome measurement tool shall be entered into the Authority-approved data system within the seven days of completion of the tool.
(5) The IIBHT Entry and Engagement process shall include the provision and documentation of the following:
(a) The IIBHT program shall create and utilize a written entry procedure to ensure a child is offered an intake within three calendar days of authorization, or timeliest manner feasible consistent with the child and family presenting circumstances;
(b) Written informed consent for services shall be obtained from the child, guardian, or other legal representative, as applicable and in the languages requested by each person, prior to the start of services. If such consent is not obtained, the reason shall be documented and further attempts to obtain informed consent shall be made as appropriate;
(c) A written description of the program team meeting expectations including team meetings every 30 days and an IIBHT Transition Meeting at the end of services; and
(d) At the time of entry, the IIBHT program shall offer the child and family written program orientation information. The written information shall be in the languages requested by the child and, when applicable, by the family.
(6) The IIBHT assessments shall be completed at the time of entry, prior to development of the service plan and the beginning of IIBHT services; and include the provision and documentation of the following:
(a) Sufficient information and documentation to justify the presence of a qualifying DSM 5 diagnosis that is the medically necessary reason for services;
(b) An assessment of risk of injury to self or others which includes a safety plan and lethal means counseling with the child and family;
(c) Screening for the presence of co-occurring disorders and chronic medical conditions; and
(d) Screening for the presence of symptoms related to physical or psychological trauma.
(e) When the assessment process determines the presence of co-occurring substance use and mental health disorders or any significant risk to health and safety:
(f) Additional assessments shall be used to determine the need for additional services and supports and the level of risk to the child or to others; and
(g) All providers shall document referral for further assessment, planning, and intervention from an appropriate professional, either with the same provider or with a collaborative community provider.
(h) In addition to periodic updates to the assessment based on changes in the clinical circumstances, any child continuing to receive mental health services for one or more continuous years shall receive an annual assessment by an LMP.
(7) Planning and Coordination of IIBHT services shall be facilitated in the following manner:
(a) Each type of planned service shall be collaboratively delivered or coordinated by the IIBHT Provider;
(b) A QMHP shall lead the service planning process which includes:
(A) Informing the child and the family of the proposed services and supports;
(B) Obtain written informed consent for all proposed services and supports, and;
(C) Give the individual and guardian a written copy of the Service Plan in the most developmentally and culturally appropriate languages.
(c) The service plan shall reflect the assessment and includes:
(A) Be completed within five calendar days of the initial and annual assessments, and prior to the rendering of any behavioral health services or supports;
(B) Be culturally and linguistically responsive;
(C) A LMP shall approve the Service Plan at least annually for everyone receiving mental health services for one or more continuous years. The LMP may designate annual clinical oversight by documenting the designation to a specific licensed health care professional, per service record;
(D) The IIBHT Service Plan at a minimum shall include treatment objectives that are agreed to by the child and family through signed, informed consent; and
(E) Documentation that a minimum of four hours of weekly direct service was recommended and documented within the Service Plan as agreed by the child and family.
(d) A Crisis and Safety Plan shall be created within five calendar days of the completion of the assessment and shall, at a minimum include the provision and documentation of the following:
(A) Be developed and approved by the child and family in consultation with the IIBHT team;
(B) Document the child and family’s definition of crisis;
(C) Include at least one strategy to prevent a crisis situation and at least one strategy to use during a crisis situation;
(D) Include a list of triggers, warning signs, and recommended de-escalation strategies and supports identified by the child and family in consultation with the IIBHT team;
(E) Document strategies for risk prevention for existing or anticipated safety concerns. This shall include strategies developed through lethal means counseling to help individuals at risk for suicide and their families to reduce access to lethal means, including but not limited to firearms and medications;
(F) Include strength-based strategies for addressing the child and family’s needs when in crisis;
(G) Document natural and formal supports approved by the child and family for crisis response;
(H) Be updated at the request of the child or family, or when clinical circumstances change, including following any placement change, psychiatric crisis, overdose, suicide attempt, police involvement, or other situations identified by the child or family;
(I) Document safety requirements from other child-serving or legal systems;
(J) Be culturally and linguistically responsive;
(K) Include contact information for resources that the child and family may use before or during a crisis event;
(L) Be provided to the child and family in a format and languages chosen by the child and family; and
(M) Made available to all the IIBHT team members working with the family.
(e) Transfer planning shall begin at entry and include at a minimum the services and support needed for a successful transfer from IIBHT.
(8) The IIBHT Service Plan Review Meeting structure shall meet the following requirements:
(a) IIBHT teams shall include, at minimum:
(A) The child and family;
(B) Natural supports as approved by the child and family;
(C) The child’s assigned QMHP; and
(D) Other members of the child’s treatment team as chosen by the child and family.
(b) An IIBHT team shall meet either in home, in office, by two-way audio-visual conference or by telephone as requested by the child and family, for no less than one time every 30 calendar days. At each meeting, the team shall document the review of each of the following:
(A) Each objective in the Service Plan, specifically addressing:
(i) Progress since last review;
(ii) Identification of the services and supports that sustain progress;
(iii) Adjustment of the services and supports as determined by the review; and
(iv) Updates to Psychiatric Services and recommendations since the last review.
(B) The Crisis and Safety Plan shall include:
(i) Incidents occurring since the most recent review;
(ii) Adjustments to the Crisis and Safety Plan as determined by the review; and
(iii) Additional interventions to meet the needs of the child and family.
(C) Adjustments to the transfer planning, including the services and supports needed for the successful transfer from IIBHT services.
(c) If the child is a participant in Wraparound or Intensive Care Coordination, the IIBHT Service Plan Review meeting may be included in the regular scheduled Wraparound meeting. The IIBHT provider shall ensure all documentation requirements are met for this rule.
(9) The IIBHT Proactive Support and Crisis Response shall include the provision and documentation of the following:
(a) Provide on-going support by responding to crises 24-hours each day, in person and by phone, as defined and requested by the child and family;
(A) A QMHA may respond to a crisis in person or by phone;
(B) A QMHP shall be available 24 hours each day to provide support by phone or face to face crisis response.
(b) All crisis interventions must be clearly documented in the child’s Service Notes and include:
(A) A description of the incident;
(B) A description of the interventions used;
(C) A summary of the debrief with the child and family; and
(D) Recommendations for the Crisis and Safety Plan and the Service Plan update, and a timeframe for the next team meeting.
(10) IIBHT Transfer Summary shall include the provision and documentation of the following:
(a) Include a final IIBHT team meeting to plan the transfer of services. This shall occur in home, in office, by two-way audio-visual conference or by telephone with the child and Ffamily present and IIBHT team members and next providers when possible. An IIBHT program shall not successfully discharge a child without holding this meeting;
(b) Complete a provisional Transfer Summary prior to the final IIBHT meeting. The provisional Transfer Summary shall include:
(A) The date and reason for the transfer;
(B) Referrals to follow up services and other behavioral health providers;
(C) Outreach efforts, when applicable as defined in OAR 309-019 as it pertains to IIBHT;
(D) A summary statement that describes the effectiveness of services in assisting the child and family to achieve intended outcomes identified in the Service Plan and Crisis and Safety Plan;
(E) Proactive strategies and action steps, including prevention, safety and suicide prevention planning to promote personal wellness and resilience;
(F) Identification and development of post IIBHT community-based resources and supports to assist both the child and family, including both formal and informal supports and;
(G) Written instructions on how and when to access IIBHT services in the future, as needed.
(c) A copy of the provisional Transfer Summary, with detailed referrals and scheduled appointments, shall be provided to the child and family during the final IIBHT team meeting;
(d) A final IIBHT team meeting shall include, at a minimum:
(A) A review of the Service Plan;
(B) Progress made on the objectives in the Service Plan;
(C) Incomplete objectives;
(D) A review and update of the Crisis and Safety Plan;
(E) A review and finalization of the Transfer Summary and;
(F) Recommendations of objectives to be addressed in ongoing treatment.
(e) An IIBHT provider shall send the final Transfer Summary to the child and family and the new provider within 3 calendar days of transfer and;
(f) If a child transfers from IIBHT to a residential treatment program, an IIBHT provider shall ensure the residential treatment program receives all relevant clinical materials, including the assessment, service plans, crisis and safety plans, and transfer summary within 3 calendar days of transfer.
Statutory/Other Authority: ORS 413.042, ORS 430.640 & ORS 430.705
Statutes/Other Implemented: ORS 430.010, ORS 430.205 & ORS 430.708
History:
BHS 25-2021, amend filed 12/21/2021, effective 12/21/2021
BHS 22-2021, amend filed 12/10/2021, effective 12/17/2021
BHS 13-2021, temporary amend filed 06/21/2021, effective 06/21/2021 through 12/17/2021
BHS 10-2020, adopt filed 07/23/2020, effective 07/23/2020