Name of the Procedure:

Therapeutic Behavioral Services (TBS), also referred to as Therapeutic Behavioral Aide Services per diem, HCPCS Code H2020.

Summary

Therapeutic Behavioral Services (TBS) involves individualized, one-on-one therapeutic interventions designed to modify behavior and support emotional well-being. Provided on a per diem basis, these services are tailored to meet the unique needs of individuals, often youths, experiencing severe emotional or behavioral challenges.

Purpose

Therapeutic Behavioral Services aim to address serious emotional and behavioral issues that impede daily functioning. The goals include reducing problematic behaviors, improving coping strategies, supporting emotional regulation, and enhancing social skills to enable better integration at home, school, and community settings.

Indications

• Severe emotional disturbances
• Behavioral issues such as aggression, defiance, or excessive emotional outbursts
• Diagnoses such as ADHD, PTSD, Oppositional Defiant Disorder, or Autism Spectrum Disorder
• Situations where traditional outpatient therapies have been insufficient

Preparation

• Pre-assessment by a licensed mental health professional
• Behavior assessment to identify specific target areas
• Coordination with family members or caregivers to understand context and history
• No specific physical preparation like fasting or medication adjustments is typically required

Procedure Description

1. Assessment Phase: Initial evaluation to understand the client's needs and behavior patterns.
2. Planning Phase: Development of a tailored intervention plan, including specific goals and strategies.
3. Implementation Phase:
   • One-on-one sessions with a behavioral aide or therapist.
   • Use of behavioral techniques such as positive reinforcement, modeling, and role-playing.
   • Crisis intervention strategies if necessary.
4. Review Phase: Ongoing monitoring and adjustment of the plan based on progress and feedback.

Tools and equipment may include assessment tools, behavioral tracking charts, and therapeutic materials. Anesthesia or sedation is not applicable to this procedure.

Duration

The duration varies, typically involving daily sessions which could last a few hours to a full day, depending on the individual's needs.

Setting

Therapeutic Behavioral Services can be provided in various settings, including:

• Client’s home
• School
• Outpatient clinic
• Community centers

Personnel

• Licensed behavioral therapists
• Behavioral aides or counselors
• Collaboration with other healthcare providers such as psychiatrists or psychologists if needed

Risks and Complications

• Emotional distress during challenging interventions
• Temporary increase in problematic behavior as new strategies are implemented
• Requires consistent family involvement and support for effectiveness

Benefits

• Significant reduction in problematic behaviors
• Improved emotional regulation and coping strategies
• Enhanced social and communication skills
• Long-term positive impact on educational performance and interpersonal relationships

Recovery

• Ongoing support and follow-up sessions may be needed to reinforce positive behaviors.
• Regular follow-up appointments to monitor progress.
• Continuous family education and involvement are essential.

Alternatives

• Traditional outpatient therapy (counseling or psychotherapy)
• Pharmacotherapy, with consideration of benefits and potential side effects
• School-based interventions and support
• Residential treatment programs for severe cases

Patient Experience

Patients might initially feel resistant or uncomfortable; however, consistent and empathetic approach by the therapist can help build trust and engagement. Pain is not a typical concern, but emotional discomfort may arise as difficult issues are addressed. Comfort measures include creating a supportive and understanding environment, encouraging open communication, and involving loved ones in the process.