Agency

A firm, partnership, association, corporation, organization, or trust providing services to children as described in this manual.

Assessment

The process of identifying a child’s strengths, problems and service needs for the purpose of developing the child’s plan.

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Case Record

A unified, comprehensive collection of documentation concerning services provided to a child.  It includes all intake, evaluation, assessment, level of care determination, individual support planning documents as it relates to the child; any and all written notes regarding the child, the family or the care provided; any and all collateral information regarding the child or the family, including third party payer information; and information about crisis interventions.  This is a confidential collection of documents, and shall not be removed in whole or in part from the agency premises.

Central Enrollment

A unified process of determining baseline eligibility for services in accordance with Title 34B and Chapter 790 legislation, which governs the scope of the DHHS-CBHS.  Goals of the Central Enrollment Process:

·     To ensure that every child requesting services from DHHS-CBHS has an intake assessment to determine baseline eligibility for CBHS services.

·     To facilitate referrals to appropriate service providers.

·     To expedite delivery of services to children in need of service(s).

·     To reliably track the service status of children enrolled in the system.

·     To gather data that will inform the Department of resource development needs.

Children’s Enrollment Form (CEF)

The record of basic information needed by DHHS-CBHS to establish a child’s enrollment into the system of care.

Child/Youth

Any person birth through their 20th year.

Child and Family Team

Individuals identified by the child and/or parent or legal guardian to help shape the direction of a plan for a child. The group should include the child, when appropriate, immediate and extended family members, guardians, relevant professionals, and any other community members significant to the child and/or family’s life. Each family team is unique to the person(s) it supports.

Client

A child/youth who uses the services described in these guidelines.

Community Inclusion

Includes the participation of a child in typical community activities that are both age and developmentally appropriate and identified in the Individual Support Plan (ISP).

Community Support

Services and resources provided to a child that promote his or her inclusion in the community.  Community Supports must be identified in the Individual Support Plan (ISP).

Confidentiality

A protection of private information (DHHS-CBHS Confidentiality Draft 6-25-01 and HIPAA regulations).

Crisis

A situation, condition or major event with a high probability of leading to the need for emergency intervention.

Critical Incidents

The reporting, evaluation, and analysis of critical incidents is a DHHS-CBHS Quality Improvement activity, as required by statute (Title 34B MSRA Section 1207).  Informing children of this activity is the responsibility of the licensed contracting provider.  See Appendix B for reporting procedures.

Cultural Competence

The ability to understand, respect and effectively work with children, families and groups of various cultural backgrounds, including age and gender.

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Department

Department of Health and Human Services-Children’s Behavioral Health Services, also referred to as DHHS-CBHS.

Eligibility

The process of meeting known requirements for a given service, before the service can be delivered.

Enterprise Information System (EIS)

The DHHS-CBHS integrated information system to support MaineCare/health planning, management, and quality improvement for its service populations.

Evaluation

A systematic process of data gathering and analysis for the purpose of determining a diagnosis(es).

Family

The people who are involved with the child—both formally and informally, including relatives, non-blood kin, friends, colleagues, neighbors, service providers, foster parents, spiritual leaders, volunteers, teachers, social workers, probation officers, counselors, sponsors and others who care about the child.

Family-Driven Care

Families have a primary decision-making role in the care of their own children as well as the policies and procedures governing care for all children in their community, state, tribe, territory, and nation (Federation of Families for Children’s Mental Health, http://www.ffcmh.org).

Family Involvement

Participation of the family members listed above in all aspects of their child’s services and treatment, and at all levels of care.

Flexible Funding

Flexible funds provide time limited funding to fill identified gaps in services that cannot be addressed through any other funding source. Services are designed to meet the specific, individualized treatment needs of the child and family that are identified on the child's individual support plan. 

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Grievance Procedure

Process by which a child and/or guardian enrolled in the DHHS-CBHS system of care may submit a formal complaint alleging any violation of basic human rights or a complaint related to the denial, decrease, or termination of MaineCare Services. 

Guardian

Person(s) or agency with ongoing legal responsibility for ensuring the care of the individual. In the case of minor children (under 18), this may include biological or adoptive parents, or an agency appointed by the court.

HIPAA

The acronym for the Health Insurance Portability and Accountability Act of 1996 that requires the federal Department of Health and Human Services to establish national standards for addressing efficiency, effectiveness, security and privacy of health data.

Homeless Youth

A person under 21 years of age who lacks having a fixed, regular, and adequate nighttime residence or having a primary residence.

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Individual Support Plan (ISP)

A comprehensive plan of care for the child that is based on results from a comprehensive strengths and needs assessment across the life domain areas in which specific goals and measurable objectives are developed. It should also be in compliance with DHHS-CBHS licensing requirements and MaineCare rules.

Individual Treatment Plan (ITP)

The plan of care developed by the treatment team in consultation with the family. The ITP uses a strengths-based approach to assess the treatment needs of a child and, when appropriate, his/her family circumstances. The ITP must consider and be appropriate to the developmental level of the child and shall address all the domains of a child’s life. The ITP must specify the following: the service components to be provided; the names and titles of those who will be accountable for provision of the service; the frequency and duration of each service component; the expected duration of treatment; and the expected short and long-range treatment and/or rehabilitative goals or outcomes of the services.  When there is an ITP for identified services, it should be referenced in the ISP.

Informed Consent

Consent obtained in writing from a child’s legal representative, for a specific procedure or service. Elements of a valid informed consent include the following:  the nature and purpose of the procedure(s) or service(s) for which consent is sought, all material risks and consequences of the procedure(s) or service(s), an assessment of the likelihood that the procedure(s) or service(s) will accomplish the desired objective(s), any reasonably feasible alternatives for treatment, with the same supporting information as required regarding the proposed procedure(s) or service(s), and the prognosis if no treatment is provided.

Intake

The collection of data and completion of initial paperwork by a provider agency.

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Kinship Care

Kinship care is the full-time care, nurturing and protection of children by relatives, members of their tribes or clans, godparents, stepparents, or any adult who has a kinship bond with a child.  This definition is designed to be inclusive and respectful of cultural values and ties of affection.  It allows a child to grow to adulthood in a family environment. Kinship care is typically categorized in two ways - informal and formal:

·     Informal kinship care is when the family decides that the child will live with relatives or other kin. In this informal kinship care arrangement, a social worker may be involved in helping family members plan for the child, but a child welfare agency does not assume legal custody of or responsibility for the child.  The parents still have custody of the child. Relatives need not be approved, licensed, or supervised by the state.

·     Formal kinship care involves the parenting of children by kin as a result of a determination by the court and the child protective service agency. The courts rule that the child must be separated from his or her parents because of abuse, neglect, dependency, abandonment or special medical circumstances. The child is placed in the legal custody of the child welfare agency, and the kin provide the full-time care, protection and nurturing that the child needs. Formal kinship care is linked to state and federal child welfare laws. (from Child Welfare League of America) 

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Least restrictive alternative

The least intrusive service or treatment that can effectively and safely address the child’s needs and stated preferences including, but not necessarily limited to, location.

Least restrictive treatment environment

“To a maximum extent appropriate, children with emotional, psychological, and cognitive disabilities will be treated in their families, schools, and communities, along with their typically developing peers. Removal of children with these disabilities from the families, schools, and communities will only occur when the nature or severity of the disability is such that the treatment cannot proceed safely or satisfactorily in their home, school or community. There is a broad range of restrictive environments from the most restrictive (locked inpatient psychiatric unit) to the least restrictive (at home, in the community).  Least restrictive environments vary with the child’s and family’s capacity and the child’s impairment at any given point in time”  (Individuals with Disabilities Act Amendments of 1997, Sect 1412(a)(5)(A) and Section 300.550(b)(1)(2) of Title 34 of the Code of Federal Regulations).

Legal Representative

For a child under 18, the legal representative refers to those able to make decisions on behalf of the child and include the child’s biological or adoptive parents, legal guardian, or guardian ad litem.

Legally Emancipated Minor

A child over 16 who has a district court order of emancipation conferring power to make decisions about his/her care.

Level of Care

Type, frequency, and intensity of services.

Level of Care Assessment Tools

DHHS-CBHS approved Level of Care Assessment Tools are:

·     Child and Adolescent Level of Care Utilization System (CALOCUS);

·     Child and Adolescent Functional Assessment Scale (CAFAS); Family Empowerment Scale (FES);

·     Ages & Stages Questionnaires (ASQ);

·     ASQ Social-Emotional Questionnaires (ASQ: SE);

·     Children’s Habilitation Services Assessment Tool (CHAT).

The purposes of the Level of Care Assessment Tools are to:

·     Guide and inform decision making on the appropriate level and intensity of services and supports a child and family may need;

·     Guide service and support planning for children and families;

·     Measure and document child and family progress in identified functional and strength areas;

·     Guide and inform caseload and resource planning activities;

·     Evaluate the effectiveness of services and supports provided to children and families; and

·     Guide statewide program and service system planning and development.

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MaineCare Benefits for Members under 21

Federal regulation requiring state Medicaid plans (MaineCare) to offer early, and periodic screening, diagnostic and treatment services to eligible children under the age of 21 (formerly called “Early & Periodic Screening, Diagnostic, and Treatment”).

Medically Necessary Services

Services provided for the purpose of preventing, diagnosing or treating an illness, injury, condition or disease in a manner that is:

·     Consistent with generally accepted standards of medical practice;

·     Clinically appropriate in terms of type, frequency, extent, site, and duration;

·     Demonstrated through scientific evidence to be effective in improving health outcomes or is generally accepted as representative of “best practices” in the medical profession;

·     Not primarily for the convenience of the child, their family, physician, or other health care practitioner.

Monthly Status Update Form

Information submitted by contracted agencies to DHHS-CBHS monthly capturing referrals for services, and the status of each referral.

Natural Supports

The relatives, friends, neighbors, faith-based organizations, and other community resources that a family goes to for support.

Open Status

The first face-to-face meeting with the child and/or family after service eligibility has been determined and informed consent has been obtained.

Outcomes

Measurable benchmarks in the child’s plan that indicate progress.

Outreach

A service that systematically reaches into the community for identifying children in need of services, alerting children and their families to the availability and location of services, and enabling people to enter and accept the service delivery system.

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Parent

A person who provides a home for and lives with the child who is treated under this service.  The parent may be the biological, adoptive, or foster parent; the legal guardian or designee, or a person who provides kinship care.

Performance Indicators

Measurable statements of outcomes, outputs, or inputs needed to achieve in order to accomplish a performance goal.

Permanency

A child lives or will live with a parent or caregiver; or will return to the parents/caregiver from a hospital admission, a residential treatment facility, or a youth correctional facility such as Long Creek and Mountain View Youth Development Centers; or lives in another planned living arrangement such as long-term foster care.

Policy

A statement of the principles that guide and govern the activities, procedures, and operations of a program or the provision of services.

Prior Authorization

A review of the child’s proposed treatment plan before the child enters treatment.  The purpose of the review is to determine the clinically appropriate level of care.  Prior authorization assesses whether the proposed treatment best meets the needs of the child, is within the standards of practice, and that discharge criteria and planning are initiated at time of admission.  The Regional Offices of DHHS-CBHS or its designated contracted agency conducts prior authorization.

Prioritization

The assignment of a child to a position on the wait list based on the child’s level of need, when compared to others on the same list and/or number of days wait for services.

Procedure

A series of activities designed to implement the goals or policies of a program.

Program

An organized system of services with a mission, philosophy and model of service delivery designed to address the needs of children.

Progress Note

An objectively written note used to document ongoing information about the child and family, changes in their status, and progress made toward goals/objectives in the ISP. 

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Quality Management

Processes designed to assure and/or improve the quality and delivery of services within an organization.

Referral

Presentation of an identified child to an agency for a specific service.

Release of Information

Authorization from a legally responsible parent/guardian to obtain or disclose information.

Sliding fee

The legislative directive (PL 2003, c.673) requiring families who receive certain state grant-funded services through DHHS-CBHS to pay fees according to a sliding fee scale.  The fee requirement is imposed on all service providers under contract with DHHS-CBHS that receive grant funds for the following services: 

·     targeted case management

·     outpatient

·     home-based mental health services

·     respite care 

The sliding fee scale is based on the federal, non-farm income, official poverty line data and is re-determined annually.  These fees do not apply to children eligible to receive these services under the MaineCare Program.  The rule was effective September 1, 2004.  

System of Care

A comprehensive array of services and supports for children, birth through 20, with behavioral and/or developmental health needs.

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Targeted Case Management Services

Children’s targeted case managers utilize the Wraparound Process to develop and coordinate individual support plans and monitor services to be provided to a child and his/her family or guardian in consultation with the family, a multidisciplinary team of professionals from schools, child, welfare, mental health, and other agencies, and other support people chosen by the parents. Children’s targeted case managers conduct intake; coordinate comprehensive assessments of the child’s strengths and needs; produce an individualized support plan (ISP) to address those needs; coordinate, advocate for and develop services identified in the plan; monitor the child’s progress, and evaluate the appropriateness and effectiveness of services.

Transition Planning

Assessment, planning, referral, and interagency collaboration in the process of coordination of services for an adolescent beginning at 16 years of age in preparation for accessing services through the adult service system to help prepare for adult life. Education, employment, housing, health and other significant areas identified by the young person and his/her family are all part of the planning process.

Trauma Informed System of Care

A system of care involving a basic understanding of trauma dynamics, including those caused by childhood sexual and/or physical abuse. This awareness is used to accommodate and address the vulnerabilities of trauma survivors. All components of the system of care, from policy to treatment, are considered and evaluated while understanding the challenges that trauma presents for those seeking mental health services.  

Treatment

The broad range of planned and continuing services (including, but not limited to counseling, medical, psychiatric, psychological, and social service care) that may be extended to children of a program to influence their behavior toward identified goals and objectives.

Utilization Review (UR)

The process of ensuring that the clinical care provided to a child is consistent with best practice standards and is medically necessary, as defined in 24-A MRSA §4301-A, sub-§6, and is cost-effective.  Utilization review is an ongoing process in order to ensure the child’s treatment meets his or her changing developmental needs. Utilization Review as described in MBM, Chapter I also governs this Section.

V-9 Extended Care or Status

A written agreement for continued care that allows a child who is 18 through 20 years of age to continue to be under the care and custody of the Department of Health and Human Services.  Normally, a child who reaches the age of 18 is automatically dismissed from custody and achieves full adult rights and responsibilities.  The child may negotiate a written agreement with DHHS, Child Welfare Services for the following reasons:

·     To obtain a high school diploma or general equivalency diploma, or obtain post-secondary educational or specialized post-secondary education certification;

·     To participate in an employment skills support service;

·     To access mental health or other counseling support;

·     To meet specialized placement needs;

·     Is pregnant and needs parenting support; or

·     Has medical and special health conditions or needs.

No child in care may be accepted for continuing services after his or her 18th birthday unless an “Application and Agreement of Responsibility for Continued Care” (V-9) has been signed by both the child and the child’s caseworker prior to the child’s 18th birthday.  Most children having this status must participate in full-time secondary or post-secondary education approved by the DHHS caseworker and that caseworker’s supervisor.

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Wait List

An unduplicated collection of names of children who have requested a service and for whom the service is not currently being provided.

Wraparound Process

A family and community centered, strengths-based, highly individualized planning process aimed at helping children meet their needs both within and outside of the formal human services systems, while they remain in their homes and communities, whenever possible.

            Muskie School of Public Service