Care coordination is indispensable to the effective operation of a System of Care/Community Collaborative. It is both a service to children and families and a function of a responsive system. As a service, care coordination is carried out in children’s mental health in Connecticut on three levels, which are explained below. As a service, care coordination involves direct client contact by someone who has clinical knowledge but does not function as the clinician on the case. Rather, the Care Coordinator, as an architect of the service plan along with the family, uses clinical and community systems knowledge to broker and advocate for services, and coordinates and monitors the implementation of the plan.
Care coordination services are provided to children and youth who are "Seriously Emotionally Disturbed" (SED) and have complex behavioral health needs and require an intensive coordination of multiple services to meet those needs. Consistent with DCF’s practice standards for Systems of Care/Community Collaboratives, care coordination services shall also be available to other children and youth with complex service needs with priority to those children and youth who are at imminent risk for residential or hospital levels of care or who are returning from these levels of care.
The term "Seriously Emotionally Disturbed" children or adolescents, refers to those children defined in the Connecticut Children's Mental Health Plan and federal agencies NIMH/CASSP as published in the Federal Register on May 20, 1993. It is a broader definition than that used by the adult population to define "mental illness.” SED refers to children or adolescents with a mental, behavioral, or emotional disorder, which has resulted in functional impairment that substantially interferes with or limits the child's role or functioning in family, school, or community activities.
Specifically, Serious Emotional Disturbance is a mental, emotional or behavioral disorder for children who are:
- from age birth to eighteen years (note: children age 16-18 qualify with the understanding that the youth must be willing to participate in the Child Specific Team). Although, services can be received up to age 21 if client is still receiving services from their local educational authority;
- currently or at any time in the past year, had a diagnosable mental, behavioral, or emotional disorder of sufficient duration to meet the diagnostic criteria specified within DSM-IV; and
- resulted in functional impairment which substantially interfered with or limited the child's role or functioning in family, school, or community activities.
Overview: Crisis stabilization is a 24 hour, short term residential program that offers the child and family a “cooling off” period from a particular crisis. This short term intervention is designed to enable crisis stabilization staff an opportunity to make good, appropriate assessments and interventions that may prevent a longer out of home disruption.
There are two crisis stabilization programs in Connecticut. One located in Farmington on the UCONN Medical Center Campus a program of Wheeler Clinic and one in Hamden a program of the Children’s Center.
Target Population: The target population for crisis stabilization includes children and/or youth age 7 – 18 who present with a Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) Axis I diagnosis, or who exhibit complex behavioral health service needs and are at imminent risk of requiring longer term, out of home levels of care.
Admission Criteria: Crisis stabilization will accept all referrals made by Emergency Mobile Psychiatric Service (EMPS) providers that meet the following criteria:
- Age 7-18 and agree to a voluntary admission
- Psychiatric status is not acute and the child and/or youth is able to enter into a written safety contract
- Separation from the family is required in order to stabilize the immediate crisis within a 15 day perod
- A viable discharge resource is in place
The length of service for crisis stabilization service is intended to be a maximum of 15 nights unless authorization is received for an extension from the DCF Area Office Mental Health Program Director or designee.
The crisis stabilization or EMPS provider will complete an assessment on each child and/or youth within 24 hours of admission. The assessment will provide a clinical integration of medical, psychosocial, educational and previous treatment history information and will address the needs of the child and/or youth within the context of his/her family and community.
Clinical services include screening and referral, individual, group and family treatment, consultation, linkage to family substance abuse screening or other services, family sessions and age appropriate therapy. Clinical staff members coordinate their clinical interventions with community providers delivering services to the child and/or family. In addition, contractors have access to a psychiatrist in order to provide consultation, assessment and evaluation services.
Empowerment and family support services include parental guidance, empowerment and support, inclusion in transition/discharge planning and linkage to other community services, such as parent education and instructional modeling. Clinical programming for families should accommodate family work schedules.
Medication management includes consultation and assessment from a psychiatrist or an APRN under the direction of a psychiatrist
Other services include transition to psychiatric, medical care or other appropriate services as necessary upon discharge; case management, including the development of a child specific treatment plan and coordination with local community service providers; and aftercare.