Children's Mental Health Services

Partial Hospital Program (PHP) is provided by a licensed hospital by licensed and credentialed professionals under the direction of a physician with frequent nursing and medical supervision. Treatment is intensive and is provided in a supervised environment by a multi-disciplinary team of qualified professionals which may include board eligible or certified psychiatrists, clinicians, registered nurses, licensed mental health professionals, and other ancillary staff. This service does not include 24 hour supervision.

There are only three PHP's in the state: Turtle Bay, operated by Northwest Behavioral Health, out of Kalispell; Providence in Missoula; and Billings Clinic.

License Required: Accredited by the Joint Commission on Accreditation of Health Care Organizations and licensed by the state.

Acute care psychiatric hospitals are psychiatric facilities that are devoted to the provision of inpatient psychiatric care for persons under the age of 21. Inpatient hospitalization is the placement of youth in a hospital for observation, evaluation, and/or treatment. Services are medically oriented and include 24-hour supervision; services may be used for short-term treatment and crisis stabilization. A youth might be admitted to an acute hospital if s/he is considered dangerous to self or others.

Four hospitals in Montana employ psychiatrists and admit youth under age 18 to designated psychiatric units: Shodair Hospital (Helena), Billings Clinic (Billings), St. Patrick's Hospital (Missoula), and Pathway's Hospital (Kalispell)

Also known as (AKA): inpatient, psych hospital

License Required: Accredited by the Joint Commission on Accreditation of Health Care Organizations and licensed by the state.

Psychiatric residential treatment is 24-hour non-acute secure facility setting for active interventions directed at addressing and reducing the specific impairments that led to the admission and at providing a degree of stabilization that permits safe return to the home environment and/or community-based services.  A PRTF is a secure residential facility that typically serves 10 or more children and youth and provides 24-hour staff and psychiatrist supervision, and may include individual therapy, group therapy, family therapy, behavior modification, skills development, education, and recreational services. Lengths of stay tend to be longer in residential treatment centers than in hospitals.

Also known as (AKA): residential care, residential treatment

License Required: Accredited by the Joint Commission on Accreditation of Health Care Organizations (JCAHO), Council on Accreditation (COA), or the Commission on Accreditation of Rehabilitation Facilities (CARF) or any other organizations designated by the Secretary of the United States Department of Health and Human Services as authorized to accredit psychiatric hospitals for Medicaid participation.

Therapeutic Group Home (TGH) is a community-based treatment alternative provided in a structured group home environment. TGH is appropriate for youth requiring specific therapeutic treatment services and social supports which require higher intensity of specific therapeutic services and social supports than are available through traditional outpatient services and exceed the capabilities of support systems for the youth.

This level of therapeutic treatment intervention includes a consideration of the:

safety and security needs of the youth;
degree of self-care skills demonstrated by the youth;
likelihood of the youth to benefit from a community integrated program.

Room and board costs (approximately $50/day) in a therapeutic group home are not covered by Montana Medicaid.

Also known as (AKA): group home

License Required: Therapeutic Group Home

Extraordinary needs aide (ENA) services are prior-authorized additional one-to-one, face-to-face, intensive short-term behavior management, and stabilization services provided in the TGH by TGH staff, for youth with serious emotional disturbance (SED). Short-term generally means 90 days or less. ENA services are provided for youth in a TGH who exhibit extreme behaviors that cannot be managed by TGH staffing, including:

1. Harming self or others;
2. Destruction of property; or
3. A pattern of frequent extreme physical outbursts.

Also known as (AKA): group home aide

License Required: Therapeutic Group Home

Targeted Case Management (TCM) services are furnished to assist Medicaid eligible youth with Serious Emotional Disturbance (SED) in gaining access to needed medical, social, educational, and other services. Services are provided by a licensed mental health center with a license endorsement permitting the mental health center to provide case management services.

Case management services include assessment, determination of need, development and periodic revision of a specific care plan, referral and related activities, and monitoring and follow-up activities.

Also known as (AKA): case management

License Required: Mental Health Center and adolescent case management endorsement

Youth Day Treatment services are a set of mental health services provided in a specialized classroom setting (not a regular classroom or school setting) and integrated with educational services provided through full collaboration with a school district. The services are focused on building skills for adaptive school and community functioning and reducing symptoms and behaviors that interfere with a youth's ability to participate in their education at a public school, to minimize need for more restrictive levels of care and to support return to a public school setting as soon as possible. Day Treatment includes:

Individual, Family and Group Therapy
Skill Building and Integration

Also known as (AKA): day treatment, day TX

License Required: Mental Health Center

Home Support Services are in-home therapeutic and family support services for youth living in biological, adoptive or kinship families who require more intensive therapeutic interventions than are available through other outpatient services. Services are focused on the reduction of symptoms and behaviors that interfere with the youth's ability to function in the family and facilitation of the development of skills needed by the youth and family to prevent or minimize the need for more restrictive levels of care. The provider is available by phone or in-person to assist the youth and family during crises.

Home Support Services include:

Skill Building and Integration
Crisis Response

And may include:

Individual and Family Therapy

Also known as (AKA): TFC, therapeutic family care, In home services, in home supports, AFSP

License Required: Mental Health Center

Therapeutic Foster Care Services are in-home therapeutic and family support services for youth living in a therapeutic foster home environment, for youth unable to live with their biological or adoptive parents, in kinship care, or in regular foster care. These youth require more intensive therapeutic interventions than are available through other outpatient services. Services focus on skill building and integration for adaptive functioning to minimize need for more restrictive levels of care and to support permanency or return to the legal guardian. The provider is available by phone or in person to assist the youth and family during crises. Medicaid pays the provider agency for the provision of therapeutic services and supports for the youth and foster family. The Child and Family Services Division of Montana Department of Public Health and Human Services contracts with the provider agency for completion of the foster home licensing study, preparation, training, and foster care reimbursement for the foster family. Foster parents participate in treatment team meetings.

Therapeutic Foster Care Services include:

Skill Building and Integration
Crisis Response

And may include:

Individual and Family Therapy

Also known as (AKA): TFC, TFOC

License Required: Mental Health Center and Child Placing Agency

Comprehensive School and Community Treatment is a comprehensive planned course of community mental health outpatient treatment that includes therapeutic interventions and supportive services provided in a public school based environment in office and treatment space provided by the school. Services are focused on improving the youth's functional level by facilitating the development of skills related to exhibiting appropriate behaviors in the school and community settings. These youth typically require support through cueing or modeling of appropriate behavioral and life skills to utilize and apply learned skills in normalized school and community settings.

Comprehensive School and Community Treatment includes:

Individual, Group and Family Therapy
Skill Building and Integration

Also known as (AKA): School based. School based therapy, school based mental health, Altacare, YEP

License Required: Mental Health Center and CSCT endorsement

Outpatient therapy services include individual, family, and group therapy in which psychotherapy and related services by a licensed mental health professional acting within the scope of the professional's license or a mental health center in-training mental health professional defined in ARM 37.87.702(3). Outpatient therapy services represent community-based treatment that incorporates Current Procedural Terminology (CPT) codes. Outpatient therapy services may only be provided by individuals licensed by the state of Montana or a mental health center in-training mental health professional. To be reimbursed for outpatient therapy services, the provider must be enrolled in Montana Medicaid.

Also known as (AKA): psychotherapy

License Required: licensed psychologist services; licensed clinical social worker services; licensed professional counselor services. Note: licensed psychiatrists, mid-levels, psychiatric nurse practitioners and physicians can provider outpatient services. In addition they can provide psychiatric services and medication monitoring.

Medication treatment and monitoring services typically include the prescription of psychoactive medications by a physician (e.g., psychiatrist) that are designed to alleviate symptoms and promote psychological growth. Treatment includes periodic assessment and monitoring of the child's reaction(s) to the drugs(s).

Also known as (AKA): psychiatrist, mid-level, Psychiatric nurse practitioner

License Required: physicians license, mid-level license or, psychiatric nurse practitioner license.

Community Based Psychiatric Rehabilitation and Support (CBPRS) services are adaptive skill building and integration services provided in person for a youth in home, school or community settings in order to help the youth maintain his participation in those settings. CBPRS may only be provided for youth at risk of out of home or residential placement or for youth under six at risk of removal from their current setting. CBPRS is provided under the supervision of a licensed mental health professional and according to the youth's rehabilitation goals. The focus of the services is to improve or restore the youth's functioning in identified areas of impairment to prevent or minimize the need for more restrictive levels of care. Face-to-face consultation with family members, teachers or other key individuals may be included. CBPRS may only be provided if a youth also receives other mental health services. It is not provided at the same time as other mental health services.

Also known as (AKA): therapeutic aide, psych aide

License Required: mental health center

CHILDREN'S MENTAL HEALTH BUREAU NON-MEDICAID SERVICES

Limited funding for supplemental services, including room and board, is available with TANF maintenance of effort money. The purpose of the service must be to support family stabilization/reunification efforts. Eligibility is for families with income under 185% of federal poverty levels. Duration of services is limited to no more than four calendar months in a federal fiscal year.

Respite: Relief services that allow family members who are regular caregivers for a youth with a serious emotional disturbance to be relieved of their caregiver responsibilities for a temporary short-term period. It is not reimbursed by Montana Medicaid except through HCBS waivers.

Who to contact for more information or questions:

Missoula

Trish Christensen, (406) 329-1330

Helena

VACANT, (406) 444-2958